Treatment of Epilepsy
A)General Treatment
1. moderation of the patient's physical activities specially swimming , driving or working near machines or at heights for fear of drowning or injury during a fit
2. precipitating factors are avioded as photic stimulation(e.g. watching T.V. in thedark) or hyperventilation(e.g. running along distance)
3. Alcohol intake is forbidden
4. ketogenic diet,inducing acidosis,used to be given.Acidosis raises threshold of stimulation of brain cells,while alkalosis lowers it
B)Specific Treatment
1. treatment of the cause in symptomatic epilepsy
2. Anti-epileptic drugs
Anti-epileptic drugs
for at least 2 to 3 years
1)barbitarates:
• Luminal(phenobarbitone)
Dose
• 100-600 mg daily
Best indicated
• broad spectrum anticonvulsant
• NOT for petit mal seizure
2)Hydontion:
• Epanutin
Dose
• 200-600 mg daily
Best indicated
• simple partial motor seizure
• Grand mal seizure
3)Carbamazepine
• tegretol
Dose
• 400-800 mg daily
Best indicated
• Simple partial motor seizure
• Complex partial motor seizure
• Grand mal seizure
• NOT for petit mal seizure
4)Clonazepam
Rivotril
Dose
• 2-6 mg daily
Best indicated
• myoclonic seizure
• Grand mal seizure
5)Valproate:
Depakin
Dose
600-1500 mg daily
Best indicated
• Simple partial motor seizure
• Complex partial motor seizure
• Grand mal seizure
• Myoclonic seizure
6)Succinimide
• Zarontin
Dose
• 500-1000 mg daily
Best indicated
• Petit mal seizure
7) New antiepileptics
1. Gabapentin(Neurontin)
2. Vigabation(Sbril)
3. Topiramate(Topamax)
4. Lamotrigine(Lamictal)
5. Tiagabine(Gabitril)
1)Gabapentin(Neurontin)
Dose
• 1200-2400 mg daily
Best indicated
• Refractory partial and generalized seizure
2)Vigabation(Sbril)
Dose
• 2000-3000 mg daily
Best indicated
• Refractory partial and generalized seizure
3)Topiramate(Topamax)
Dose
• 400-800 mg daily
Best indicated
• Refractory partial and generalized seizure
4)Lamotrigine(Lamictal)
Dose
• 200-600 mg daily
Best indicated
• Refractory partial and generalized seizure
5)Tiagabine(Gabitril)
Dose
• 30-60 mg daily
Best indicated
• Refractory complex partial seizure
Side effects of antiepileptics
• drowsiness,Ataxia,skin rash and blood dyscrasias; therefore blood pictures should be done
• Depakin rarely cause hepatic insufficiency;thus frequent liver function tests are needed early in the treatment
• Epanutin also produce gum hyperplasia and hirsutism
• antiepileptics have teratogenic effect thus an epileptic woman should postpone pregnancy untill she is fit-free and off medication;however,if achild ia wanted,or she is already pregnant,she should continue her medication,as the fits are dangerous to her and to her foetus
Guidlines for drugs used
1)Always start with one drug to avoid iteracton between antiepileptics
2)If the patient doesn't respond to one drug another drug may be added. the new antiepileptic drugs are mainly used as add-on treatment in case of refractory epilepsy not responding to classical treatment
3)Antiepileptics are discontinued only when the patient has been free from fits foe at least 2 years and his E.E.G. is normal
The end
