From the Guidelines
Treatment for partial seizures should primarily involve antiepileptic drugs (AEDs), with carbamazepine being a preferred option for patients with partial onset seizures, as indicated by the most recent and highest quality study 1. The treatment approach typically begins with a single AED at a low dose, gradually increasing until seizures are controlled or side effects become problematic.
- First-line medications include carbamazepine (Tegretol, 50-200 mg/day), with approximately 85% of patients achieving complete remission and 10% achieving partial control 1.
- Other AEDs such as oxcarbazepine, lamotrigine, and phenytoin may also be considered as alternative or adjunctive treatments.
- For drug-resistant cases, surgical options like temporal lobectomy or lesionectomy may be explored if a focal seizure origin can be identified.
- Neurostimulation therapies such as vagus nerve stimulation (VNS), responsive neurostimulation (RNS), or deep brain stimulation offer alternatives when surgery isn't viable.
- Patients should maintain regular sleep patterns, avoid alcohol, manage stress, and take medications consistently, as recommended by the World Health Organization guidelines for the management of epilepsy 1.
- Treatment success is measured by seizure reduction or elimination while minimizing side effects, with the goal of achieving good seizure control and improving the patient's quality of life.
From the FDA Drug Label
Oxcarbazepine tablets are indicated for use as monotherapy or adjunctive therapy in the treatment of partial-onset seizures in adults and as monotherapy in the treatment of partial-onset seizures in pediatric patients aged 4 years and above, and as adjunctive therapy in pediatric patients aged 2 years and above with partial-onset seizures. The effectiveness of topiramate as initial monotherapy in adults and children 10 years of age and older with partial onset or primary generalized seizures was established in a multicenter, randomized, double-blind, parallel-group trial The effectiveness of topiramate as an adjunctive treatment for adults with partial onset seizures was established in six multicenter, randomized, double-blind, placebo controlled trials The effectiveness of topiramate as an adjunctive treatment for pediatric patients ages 2 to 16 years with partial onset seizures was established in a multicenter, randomized, double-blind, placebo-controlled trial
The treatment options for partial seizures include:
- Monotherapy with oxcarbazepine in adults and pediatric patients aged 4 years and above 2
- Adjunctive therapy with oxcarbazepine in pediatric patients aged 2 years and above 2
- Monotherapy with topiramate in adults and children 10 years of age and older with partial onset seizures 3
- Adjunctive therapy with topiramate in adults with partial onset seizures 3
- Adjunctive therapy with topiramate in pediatric patients ages 2 to 16 years with partial onset seizures 3
From the Research
Treatment Options for Partial Seizures
The treatment options for partial seizures include various antiepileptic drugs (AEDs), both old and new generation, as well as non-pharmacological treatments such as the ketogenic diet, vagus nerve stimulation, and surgical therapy 4, 5, 6, 7.
- Old Generation AEDs: Carbamazepine, phenytoin, and valproic acid are commonly used for the treatment of partial seizures, but they have significant shortcomings such as variable pharmacokinetics, narrow therapeutic index, and propensity to cause adverse effects and drug interactions 4.
- New Generation AEDs: New AEDs such as lamotrigine, topiramate, zonisamide, and felbamate have been introduced, offering advantages in terms of less variable kinetics and lower interaction potential 4.
- Lamotrigine: Effective against partial seizures and generalized seizure types, and can be used as monotherapy in some cases 5, 6.
- Topiramate: Effective against partial seizures and generalized seizure types, and can be used as monotherapy in some cases 5, 6.
- Oxcarbazepine: Mainly used for patients with partial epilepsy, and can be used as monotherapy in some cases 4, 6.
- Gabapentin: Mainly used for patients with partial epilepsy, and can be used as monotherapy in some cases 4, 6.
- Vigabatrin: Effective against partial seizures, but its use is limited due to the risk of visual field constriction 4, 7.
- Tiagabine, Felbamate, Levetiracetam, and Zonisamide: Have been shown to be effective in adults with partial seizures, but there is limited data on their use in children 7.
- Non-Pharmacological Treatments: The ketogenic diet, vagus nerve stimulation, and surgical therapy may be considered as adjunctive treatments for refractory partial seizures, although more research is needed to determine their effectiveness 7, 8.
Special Considerations
The choice of treatment should be based on a careful comparison of the risk-benefit ratio for the different treatment options, and the outcome of such evaluation may be different in patients with new onset compared with chronic epilepsy 5. Additionally, certain AEDs may be more suitable for specific patient populations, such as children or women of childbearing potential 5, 6.