Abstract
Epilepsy is a chronic condition that affects the quality of life of both patients and their family members. Numerous factors influence the treatment of epilepsy, the most important of which is the selection of an effective antiseizure medication (ASM). Currently, a wide range of antiseizure medications are available, including older-generation drugs that have been in use for more than 100 years, as well as newer-generation drugs that have only been introduced within the past few years. In Vietnam, numerous antiseizure medications are also in use, including older-generation drugs such as phenobarbital, phenytoin, carbamazepine, and valproate, as well as newer-generation drugs such as topiramate, gabapentin, pregabalin, oxcarbazepine, levetiracetam, lamotrigine, and perampanel. Older-generation drugs continue to be used and remain effective in the majority of cases. Newer-generation drugs have begun to be used more widely owing to certain advantages in terms of side effects and drug interactions, as well as efficacy that has been demonstrated across numerous studies. How to select the correct antiseizure medication for each individual patient is a question frequently posed by neurologists when treating patients with epilepsy. Optimal selection of an antiseizure medication for a patient with epilepsy depends largely on the type of seizure, the epilepsy syndrome, the underlying etiology of epilepsy, the patient's age, the patient's sex, comorbid conditions, drug availability, the patient's financial circumstances, and other factors. When selecting a medication, all of these factors must be carefully weighed for each individual patient. Medication selection must also take into account the possibility of combination therapy. Combination therapy should generally be limited to a maximum of two drugs, except in difficult cases, where combining more than two drugs may be necessary and should be carried out at specialized epilepsy centers. When selecting drugs to combine, rational polytherapy must be taken into consideration. Rational polytherapy is achieved when the combined medications enhance efficacy, produce fewer side effects, and have little or no drug interaction with one another.
