Epilepsy is a common and disabling disorder with a protracted course. Medical therapy is the keystone for the treatment of epilepsy. Most patients with more than one well-documented non-provoked seizures require prophylactic antiepileptic treatment. Those with underlying structural abnormalities or other risk factors should probably be treated after a single seizure. The goal of treatment should be the maintenance of normal life, avoidance of seizure-related brain or physical injuries including sudden unexpected death of epileptic patients. Nearly two-thirds of patients are well controlled on a single antiepileptic drug. If the first or second monotherapy improves control of seizure but does not produce seizure freedom, an antiepileptic drug with a different or multiple mechanisms can be added. Strategies for the choice of initial antiepileptic drug or combining drugs should involve the assessment of individual patient-related factors, including seizure types and epilepsy syndrome and pharmacology of antiepileptic drugs. The impact of adverse effects of antiepileptic drugs should not be underestimated. The introduction of many new antiepileptic drugs has provided a wider choice for patients and doctors.