Generalized onset seizures:

Monotherapy with lamotrigine or levetiracetam, or valproic acid (sodium valproate), should be offered as first-line treatment for generalized onset seizures in men/boys and women/girls who are not of childbearing potential.
In women and girls of childbearing potential with generalized onset seizures, lamotrigine or levetiracetam should be offered as first-line monotherapy.
If the first monotherapy is not successful for generalized onset seizures, an alternative first-line monotherapy should be tried.
Valproic acid (sodium valproate) is not recommended in women and girls of childbearing potential owing to the high risk of birth defects and neurodevelopmental disorders in children exposed to valproic acid (sodium valproate) in the womb.
If lamotrigine, levetiracetam and valproic acid (sodium valproate) are not available for generalized onset seizures, monotherapy with either phenytoin or phenobarbital can be considered.
Strength of recommendation: STRONG
Certainty of evidence: HIGH

Focal onset seizures:

Monotherapy with lamotrigine or levetiracetam should be offered as first-line treatment for focal onset seizures in children and adults with epilepsy.
If neither lamotrigine nor levetiracetam are available, then carbamazepine should be used as an alternate first-line treatment for focal onset seizures in children and adults with epilepsy.
If the first monotherapy is not successful for focal onset seizures, an alternative first-line monotherapy should be tried.
Lacosamide should be offered as a second-line monotherapy for focal onset seizures if none of the first-line medicines are effective.
If antiseizure medicine monotherapy is unsuccessful in people with generalized onset seizures or focal onset seizures, prompt referral should be made to a specialist for consideration of other treatment options.
Strength of recommendation: STRONG
Certainty of evidence: HIGH

2012 updated

Recommendation(s) 

Monotherapy with any of the standard antiepileptic drugs (carbamazepine, phenobarbital, phenytoin, and valproic acid) should be offered to children and adults with convulsive epilepsy. Given the acquisition costs, phenobarbital should be offered as a first option if availability can be assured. If available, carbamazepine should be offered to children and adults with partial onset seizures.
Strength of recommendation: STRONG
Quality of evidence: LOW