In most countries, there is now a choice of nearly 20 anticonvulsants for treating patients with epilepsy. Thus, physicians need to be well informed on how to choose between treatments, particularly in view of the recent shift from poly- to monotherapy. Unfortunately, there is little in the way of hard evidence on the subject of optimal treatment selection. According to speakers at the 21st International Epilepsy Congress [Sydney, Australia; September 1995], choices are currently based on familiarity with agents and keeping costs down. In this report, data and opinions reported at the conference are brought together to provide an up-to-date perspective on the best therapeutic options in epilepsy.