Initial Treatment of Epilepsy

Once a patient is diagnosed as having epilepsy, there are many aspects of care that must be addressed within a relatively short period of time. These quality indicators provide guidance for primary care or general neurology providers that pertain to the early period of time following the diagnosis of new-onset epilepsy.

Because this is a stressful time for the patient and their family, and given the importance of conveying a great deal of information to them about epilepsy and its treatment, we have provided a number of useful links at the bottom of this page to help you in your role as educator. The links also connect you to pages on this site that discuss seizure types, strategies for selecting initial drug therapy, and detailed descriptions of seizure medicines.

QI 1. IF the patient meets the criteria for epilepsy diagnosis (generally two unprovoked seizures) THEN AED treatment should be discussed with the patient and caregivers and offered.  Primary
QI 2. IF the patient is diagnosed with a seizure disorder/epilepsy and started on therapy THEN the patient should be treated with monotherapy. Primary
QI 3. IF a person newly diagnosed with epilepsy is taking medications for other disorders, THEN the physician should minimize the risk of interactions between the newly prescribed AED and concomitant medications. Primary
QI 4. IF a patient is thought to have a diagnosis of epilepsy THEN the diagnosis should include a best estimation of seizure types. Secondary
QI 5. IF a patient is a woman of childbearing potential THEN referral to a neurologist or an epilepsy specialist is indicated. Secondary

QI 6. During the visit at which a patient is diagnosed with a seizure disorder/epilepsy, the patient should receive information on:

  • Driving restrictions, safety and injury prevention
  • Diagnosis and treatment options including the importance of taking AEDs as directed
  • Triggers and other lifestyle factors that may affect seizure control (e.g. sleep deprivation, alcohol/ drug use)
  • Contraception and family planning 
QI 7. IF a newly diagnosed person with epilepsy is over the age of 60 and is not currently on any AED therapy, THEN use of enzyme inducing AEDs (phenobarbital, phenytoin, carbamazepine) should not be started unless at least two other AEDs have been unsuccessful in stopping seizures or have intolerable adverse effects. Secondary

QI = Quality Indicator
Primary = Items that were rated as both valid and necessary indicators are primary quality indicators.
Secondary = Items that were rated as valid but not necessary are secondary quality indicators.

For more information:

Authored By: 
Mary Jo V. Pugh PhD RN
Steven C. Schachter MD
Authored Date: