(FDA approved in bold)

• Complex partial seizures (adjunctive in adults and children 4 and older)
  
• Primary generalized tonic-clonic seizures (adjunctive for patients 6 and older)
  
• Myoclonic seizures including juvenile myoclonic epilepsy (adjunctive for patients 12 and older)
  
• Status epilepticus
  
• Neuropathic pain or headache
  
• Mania

• Binds to synaptic vesicle protein isoform SV2A in the brain, a unique mechanism of action compared with other AEDs. SV2A is involved in synaptic vesicle exocytosis
  
• Does not appear to affect GABA transmission, sodium channel or calcium channel function
  
• Effective in rat kindling models

• Seizures – effective within 48 hours at starting dose, and should reduce seizures by 2 weeks

• Seizures – goal is the remission of seizures. Continue as long as effective and well-tolerated. Consider tapering and slowly stopping after 2 years without seizures, depending on the type of epilepsy
  
• Headache/Pain – goal is a 50% or greater decrease in frequency or severity

• Increase to highest tolerated dose
  
• Epilepsy: consider changing to another agent, adding a second agent or referral for epilepsy surgery evaluation

• Epilepsy: Commonly used in combination with other AEDs

• No regular blood tests are recommended