### Epilepsy with Generalised Tonic Clonic Seizures Treatment guideline

**Developed by**: National Institute for Clinical Excellence (NICE)

**Description**:
This guideline the treatment recommendation by NICE in the United Kingdom for epilepsy with generalised tonic-clonic seizures. This is section 5.1 of the comprehensive epilepsy guideline


## Clinical Recommendations

### Monotherapy

#### Sodium Valproate
- **First-line for:** Boys and men, girls under 10 (unlikely to need long-term treatment), women unable to have children.

#### Lamotrigine or Levetiracetam
- **First-line for:** Women and girls able to have children.
- **Second-line if sodium valproate is unsuccessful.**
- Note: Off-label use in children under specified ages as of April 2022.

#### Restrictions
- **Do not offer sodium valproate to women and girls able to have children** unless other treatments fail, risks discussed, and a pregnancy prevention program is in place.

### Add-On Treatment

#### First-Line Add-Ons
- **Options:** Clobazam, lamotrigine, levetiracetam, perampanel, sodium valproate (except for women/girls able to have children), topiramate.

#### Second-Line Add-Ons
- **Options:** Brivaracetam, lacosamide, phenobarbital, primidone, zonisamide.
- Note: Off-label use in children under specified ages as of April 2022.

#### Restrictions
- **Do not offer sodium valproate as an add-on to women and girls able to have children** unless other treatments fail, risks discussed, and a pregnancy prevention program is in place.