The choice of first antiepileptic drug (AED) is probably the most important decision in the treatment of epilepsy. This slide set describes that although many newer, second-generation AEDs cause fewer drug interactions and are better tolerated than older agents, they have not been proven to be more effective, nor have they reduced the prevalence of drug-resistant epilepsy. Lack of superior efficacy and treatment costs associated with newer AEDs may cause older AEDs to be first line choice in epilepsy treatment.