Certain epilepsy types occur more commonly or exclusively in children and adolescents. Proper diagnosis of the specific seizure type and the etiology of the seizure is the cornerstone for appropriate management of these patients. When treatment is determined to be necessary, antiepileptic drug (AED) selection should focus on the agent(s) that will provide the best risk:benefit ratio. A number of new AEDs are now available for use in patients who are refractory to or intolerant of classic medications. These recent additions to the therapeutic armamentarium are also receiving consideration as first-line therapy in some indications. As with the classic AEDs, optimizing efficacy and safety of the new compounds requires adherence to recommended dosing regimens and careful monitoring for adverse effects.