Focal Epilepsy AED Selection — RACP Adult Medicine MCQ

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ModerateNeurologyFocal Epilepsy AED SelectionRACP Adult Medicine

A 45-year-old man with new-onset focal epilepsy (temporal lobe — complex partial seizures with secondary generalisation) from a cavernoma requires an AED. He has no comorbidities. He takes no other medications. What is the most appropriate first-line AED?

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Correct answer: E — Lamotrigine

For focal epilepsy, lamotrigine and levetiracetam are recommended first-line by NICE and ILAE. Lamotrigine has the best tolerability profile and is effective for both focal and generalised seizures. Carbamazepine is effective for focal epilepsy but has more drug interactions (enzyme inducer). SANAD II trial: lamotrigine was superior to levetiracetam for time to 12-month remission in focal epilepsy. Start low and titrate slowly (risk of SJS with rapid titration).

Reference: eTG Neurology – 2024 – Focal Epilepsy; SANAD II Trial; ILAE 2024