If EEG is totally normal, it is not clear the basis for diagnosing epilepsy. There must be a firm diagnosis since medication once started will need to be continued for at least three years.
It is also necessary to determine the sub-type of epilepsy since there are several types such as simple partial seizures, complex partial seizures, partial seizures with secondary generalisation, generalised seizures, generalised Tonic-Clonic seizures etc.
Generally drug treatment is started when recurrent seizures have taken place. Whether one should start drug therapy after a single attack is controversial, particularly if all tests are normal. There is a 31 to 71% chance that a second attack will take place within 12 month. This also means that there is a 29 to 69% chance that another attack will not take place in a year's time.
The first-line treatement of primary generalised tonic-clonic epilepsy is sodium valproate (sold under the trade name of Valcontin 200 and Valcontin 500).
The first line therapy for simple partial, complex partial and secondarily generalised seizures is carbamazepine (sold under the trade name of Carbacontin, Mazetol, Tegrital etc.) or phenytoin (sold under the trade name of Epsolin) or sodium valproate (trade name Valcontin).
If the sub-type of epilepsy cannot be accurately determined, it is best to give sodium valproate (Valcontin) since it is the first line treatment of nearly all types of epilepsy such as primary generalised, partial, absence and atypical, myoclonic, atonic.
Oxcarbazepine (Oxteol) is indicated only for Partial Seizures with/without secondarily generalised tonic-clonic seizures.