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sedation, ataxia, behavioral changes, and visual field constriction. Generally, dosing is started at 50 mg/kg/d given once daily or divided in two doses. It is increased to a goal of 75 to 150 mg/kg/d if some response is seen with the initial dose. Patients who do not respond or who worsen with treatment are considered resistant to the drug [10,14,26,53]. Zonisamide (Zonegran) is an effective adjunctive therapy for partial seizures in patients over 16 years of age. It has also been used effectively in generalized tonic-clonic, myoclonic and atonic seizures, infantile spasms, and Lennox-Gastaut syndrome. Some recent evidence shows that it may be useful as monotherapy in multiple seizure types including absence seizures [60–62]. Side effects are more common early in treatment and include nausea, vomiting, anorexia, fatigue, ataxia, and rash. Dosing begins at 2 to 4 mg/kg/d divided two to three times daily. It is titrated to maintenance dosing between 4 and 8 mg/kg/d [10,58]. Oxcarbazepine (Trileptal) is indicated in partial seizures as an adjunctive therapy. Side effects may include nausea, ataxia, diplopia, somnolence, rash, and hypersensitivity reactions. Twenty-five percent of children allergic to carbamazepine are also sensitive to oxcarbazepine. It is better tolerated than phenytoin and may have mood stabilizing benefits. Use of this medication may increase serum levels of phenobarbital and phenytoin. Dosing is started at 5 mg/kg/d and increased to 45 mg/kg/d divided in two doses [6,10,56]. Levetiracetam (Keppra) is a useful adjunct in the treatment of partial seizures in children between the ages of 6 and 12 years. Side effects include behavioral problems, somnolence, vomiting, anorexia, rhinitis, pharyngitis, otitis media, and gastroenteritis. Leukopenia has been reported in adults but has not been observed in children. The usual maintenance dose is between 10 and 60 mg/kg/d [10,56,58,63]. Tiagabine (Gabitril) is an adjunctive medication useful for refractory partial seizures. Side effects include headache, mood disturbances, inability to concentrate, fatigue, and dizziness. They are accentuated with multidrug therapy. Maintenance doses range from 0.5 to 1 mg/kg/d titrated from a starting dose of 0.1 mg/kg/d [10,14,26,53,58]. Topiramate (Topamax) is an adjunctive therapy in partial or generalized tonic-clonic seizures, refractory complex partial seizures, LennoxGastaut syndrome, and infantile spasms. Its side effects include anorexia, weight loss, renal stones, headache, fatigue, diplopia, and metabolic acidosis. Sleep disturbances, behavioral and cognitive effects, confusion, and speech problems can also occur. A few recent studies have documented hypohydrosis and intermittent hyperthermia occurring as a result of topiramate administration. The effects were reversible and resolved shortly after the medication was discontinued [37,64]. Topiramate may be beneficial in patients with migraine headaches [37]. Dosing begins at 1 mg/kg/d and is titrated to a maintenance dose of 3 to 9 mg/kg/d divided twice daily [10,14,26,53,58].