Drug of choice for focal seizure is:

 # Drug of choice for focal seizure is:

A. Phenytoin

B. Gabapentin

C. Lorazepam

D. Levetiracetam

The correct answer is D. Levetiracetam.

Levetiracetam is the drug of choice for focal (partial) onset seizures.

Current clinical practice and guidelines (including ILAE and NICE) prefer Levetiracetam (or Lamotrigine) as a first-line monotherapy due to its broad-spectrum efficacy, rapid onset, linear pharmacokinetics, minimal drug interactions, and superior safety profile compared to older agents.

Breakdown of the options:

• Levetiracetam: First-line drug of choice for newly diagnosed focal seizures (both with and without focal-to-bilateral tonic-clonic evolution).

• Phenytoin: Classic first-line agent for focal seizures, but largely replaced by newer anticonvulsants due to zero-order kinetics, severe drug-drug interactions, and adverse effects (e.g., gingival enlargement, nystagmus, ataxia).

• Gabapentin: Used primarily as adjunctive (add-on) therapy for focal seizures, or for neuropathic pain.

• Lorazepam: First-line drug of choice for acute emergency management of status epilepticus, not long-term monotherapy.