For newly diagnosed epilepsy in children, treatment should be initiated once the diagnosis is confirmed, considering individual factors such as seizure type and epilepsy syndrome NICE NG217.
Start treatment with an antiseizure medication immediately after diagnosis, especially if there are signs of neurological deficit, unequivocal epileptic activity on EEG, or structural brain abnormalities identified on imaging NICE NG217.
Use a single antiseizure medication (monotherapy) whenever possible NICE NG217.
For generalised tonic-clonic seizures, first-line monotherapy options include lamotrigine, levetiracetam, or sodium valproate, following safety advice for valproate NICE NG217.
For absence seizures, ethosuximide is recommended as the first-line treatment NICE NG217.
If initial monotherapy is unsuccessful, consider switching to another first-line agent or trying add-on treatments, with careful titration and regular review NICE NG217.
Medication choices should be tailored to the child's individual circumstances, including age, sex, comorbidities, and treatment preferences NICE NG217.