What is your preferred antiepileptic medication for a patient with treatment refractory epilepsy who also has alcohol use disorder?

If the patient has alcohol use disorder, it is best to avoid any medications that could cause elevated liver enzymes, because that could be misconstrued as alcohol-related liver issues. This would eliminate the first-generation anti-seizure medications such as phenytoin, phenobarbital, and valproate.

If there is no current hepatic dysfunction, any of the newer ASMs would be acceptable. A modified-release once-a-day formulation might be better since adherence could be an issue.