Anticonvulsant therapy. Approaches to some common clinical problems.

The anticonvulsants generally preferred for initial therapy of most seizure disorders are phenytoin for adults and phenobarbital for children. If seizures continue despite a high serum level of drug or the patient has symptoms of toxicity, another anticonvulsant may be added. A patient who is taking three or four drugs but still having seizures may benefit from adjustments in dosage, or if an epileptogenic focus is present, from surgical excision. Anticonvulsant therapy is usually continued indefinitely because of the continued risk of seizures. Newer drugs are becoming available, but none is free from side effects. Increasing attention is being given to the effect of anticonvulsants on the fetus.