Focal epilepsy: personalized selection of anticonvulsant therapy according to the patient’s clinical profile

Focal epilepsy is a clinically heterogeneous disease that requires an individualized approach to the selection of anticonvulsant therapy. The clinical manifestations of focal seizures depend on the localization of the epileptogenic zone and may include motor, sensory, autonomic, cognitive or behavioral symptoms, seizures with impaired consciousness, as well as focal seizures with a transition to bilateral tonic-clonic seizures. The article reviews modern approaches to the classification of focal epilepsy, the principles of personalized selection of anticonvulsant drugs, and the place of levetiracetam, lamotrigine, and lacosamide in the treatment of focal seizures according to the patient’s clinical profile. Particular attention is paid to the recommendations of the National Institute for Health and Care Excellence (NICE), according to which levetiracetam and lamotrigine are considered as 1st-line monotherapy drugs for partial seizures, while lacosamide can be used as a subsequent monotherapy option or as a component of adjunctive therapy. The evidence on the effectiveness of levetiracetam for partial seizures in adults and children is summarized, in particular in drug-resistant epilepsy, tumor-associated epilepsy and post-stroke seizures. It is shown that the choice of anticonvulsant drug should take into account not only the type of seizures, but also the etiology, patient age, comorbidity, cognitive and psychoemotional status, concomitant therapy and the risk of drug interactions.