How should I approach the management of a patient with newly diagnosed epilepsy who is concerned about medication side effects?

Approach to managing a patient with newly diagnosed epilepsy concerned about medication side effects:

• Develop an individualised treatment plan: Engage the patient (and family/carers if appropriate) in shared decision-making considering their sex, age, seizure type, epilepsy syndrome, comorbidities, other medications, and personal circumstances such as employment, pregnancy plans, and lifestyle preferences ¹.
• Discuss risks and benefits: Clearly explain the importance of antiseizure medications in reducing seizure risk and epilepsy-related mortality, balanced against potential side effects ¹.
• Start with monotherapy: Use a single antiseizure medication initially to minimise side effects and simplify adherence ¹.
• Address side effects proactively: Inform the patient about common side effects and coping strategies, and schedule regular reviews to assess adverse effects and adherence ¹,².
• Tailor medication choice: Consider medications with favourable side effect profiles for the patient’s seizure type and personal factors; for example, avoid valproate in women of childbearing potential unless no alternatives exist, due to teratogenic risks ¹.
• Provide ongoing support and information: Offer education about epilepsy, medication side effects, and the importance of adherence to reduce risks such as sudden unexpected death in epilepsy (SUDEP) ².
• Monitor and adjust treatment: Review seizure control and side effects regularly, and if side effects are intolerable, consider switching to another monotherapy or add-on therapy with careful titration ¹.