Antiepileptic drug therapy is recommended for patients with clear-cut epilepsy when the efficacy of the drug is assessed to outweigh the potential risks of the drug. It is after considering the patient’s seizure type, seizure frequency, age, gender, presence of concomitant disease, and adverse effects of the medication that the decision to proceed with antiepileptic drug therapy is made. Generally, after the first tonic clonic seizure, the decision to start considering medication should be postponed until the second seizure occurs. Except for patients whose EEG suggests the presence of epileptic discharges between seizures, or where the cause of the seizure persists, such as MRI-confirmed cortical dysplasia, or where the assessment that another seizure would be physically and psychologically harmful to the patient outweighs the risk of drug therapy, such patients may be considered for drug therapy after the first seizure. In other patients, standardized drug therapy should be recommended to be started after the second or more episodes (but patients in whom the interval between episodes is long, e.g., greater than one year, may be appropriately considered for observation). Drug therapy is also generally not advocated for benign pediatric epilepsy with a tendency to self-resolve, especially in Rolandic epilepsy, where only patients with severe degree, frequent seizures and seizures during the daytime require drug therapy; children under one year of age with seizures caused by fever also do not require long-term drug prophylaxis. Some patients with clear triggers, such as seizures caused by alcohol or drugs in adults, or seizures caused by stress, fatigue, or photosensitivity, can be observed without medication if seizures are rare and can be avoided in the future.