Table 1.
The new International League Against Epilepsy 2017 operational classification of seizure types (basic version) (Fisher et al., 2017a)
| FOCAL ONSET | GENERALIZED ONSET | UNKNOWN ONSET | |
|---|---|---|---|
| Aware | Impaired awareness | Impaired awareness | |
| • Motor onset | • Motor | • Non-Motor | |
| Tonic-clonic other motor | Tonic-clonic other motor | ||
| • Non-motor onset | • Motor | • Non-motor | |
| Focal to bilateral tonic-clonic | Unclassified | ||
Table 2.
Recommendation for the choice of AEDs in monotherapy and add-on treatment in adults with epilepsy according to seizure type
| Type of seizure | Monotherapy/Alternative monotherapy I – Line Drugs | Add-on therapy II – Line Drugs | Add-on therapy III – Line Drugs |
|---|---|---|---|
| Focal (Focal onset) | CBZ, GBP, LEV, LTG, OXC, VPA* | CBZ, GBP, LCM, LEV, LTG, PGB, OXC, TPM, VPA* | BRI, ESL, PB, PHT, PER, RFN, TGB, VGB, ZNS |
| Primary generalized tonicclonic (Generalized onset motor tonic-clonic) | LEV, LTG, VPA**, To consider: CBZ, OXC | CLB, LEV, LTG, TPM, VPA**, ZNS | |
| Myoclonic (Generalized onset motor myoclonic)*** | VPA** To consider: LEV, LTG | LEV, LTG, TPM, VPA** | CLB, CLN, ZNS, piracetam (In Dravet Syndrome to consider: CBD and STR) |
| Generalized atonic/tonic (Generalized onset motor atonic/tonic)*** | VPA** | LTG To consider: TPM | RFN (In Lennox-Gastaut Syndrome to consider: CBD) |
| Absence (Generalized onset non-motor)*** | ESM, VPA** To consider: LTG | ESM, LTG, TPM, VPA** | CLB, CLN, LEV, ZNS |
2** PA treatment must not be used in girls and women, unless alternative treatments are not adequate.
3*** CBZ, OXC, GBP, PHT, PGB, VGB, TGB should not be used.
Seizure type according to new classification in parenthesis (Fisher et al., 2017b).
Not all compounds are reimbursed – updates are available on the website of the Ministry of Health and National Health Service.
AEDs in individual columns are shown in alphabetical order: BRI – brivaracetam, CBD – cannabidiol, CLB – clobazam, CLN – clonazepam, CBZ – carbamazepine, ESM – ethosuximide, ESL – eslicarbazepine, GBP – gabapentin, LCM – lacosamide, LTG – lamotrigine, LEV – levetiracetam, OXC – oxcarbazepine, PB – phenobarbital, PER – perampanel, PGB – pregabalin, PHT – phenytoin, RFN – rufinamide, TGB – tiagabine, TPM – topiramate, STR – stiripentol, VGB – vigabatrin, VPA – valproate, ZNS – zonisamide