The rate of absorption of many anticonvulsants will vary with different manufacturers, and there may be some variation in their metabolism as well. Thus the blood level may vary. In a sensitive individual, small changes in blood level may either allow seizures or cause toxicity. Therefore, we strongly urge that children take the brand-name drug rather than the cheaper generic form, at least until the generic drugs become more standardized and consistent. We strongly urge also that you always stick to the form made by the same manufacturer. The only way that this can be done is to use the brand name drug.

The choice of an antiepileptic drug must be individualized, taking into account the seizure type and concerns about possible side effects in a particular child. The pharmacology of these medications is important because it tells us how long we should expect to wait to see the impact of our therapy and how frequently the drug should be administered.

All medications have potential side effects, and parents should be familiar with the ones most commonly associated with the drug their child is taking. Monitoring the impact of therapy is crucial—whether seizures have been completely controlled and whether there are any unwanted side effects. It is always the response of the child that is important, not what the blood level is. Understandably, one-drug monotherapy is preferable to multi-drug polytherapy, and a concerted attempt at seizure control with a single drug should be made before another drug is added. Most seizures can be controlled in children using this careful approach, leading to the question of how long therapy should be continued.

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