This protocol applies to adults aged 16 years and older with epilepsy with myoclonic-atonic seizures — characterised by a myoclonic seizure immediately followed by an atonic seizure — whose first-line antiepileptic drug monotherapy has not achieved the goal of seizure freedom.
Adults 16 years and older presenting with myoclonic-atonic seizures, in whom a full trial of initial antiepileptic monotherapy has been completed without reaching the treatment target.
The first line of treatment — monotherapy with an initial antiepileptic drug (such as carbamazepine, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, topiramate, or valproic acid) — did not achieve reduction or elimination of seizures. Failure to reach seizure freedom triggers escalation to this next-line protocol.
Reduction or elimination of seizures, with the primary aim of achieving complete seizure freedom.
The structured protocol involves a trial of monotherapy using a different indicated antiepileptic drug — one not used during the first line. The full selection framework, including which agents are indicated, the sequencing logic, and the criteria for escalation, are detailed in the complete protocol.