Childhood Epilepsy

Email Comment bookmark
Font : A-A+

Treatment of epilepsy
When to initiate treatment?
The need to treat epilepsy is ominous except in certain situations where the approach might be slightly conservative. These include:
a. First seizure
b. Benign epileptic syndromes
c. Seizure not timely classifiable as epilepsy.

The risk factors where AED treatment may be considered after first seizures include.
1. Symptomatic seizures due to underlying etiology (atrophy, inflammatory granuloma, infarct, migration defect).
2. Partial seizures with greater relapse risk than generalized tonic clonic events.
3. Abnormal epileptiform discharges on the EEG
4. Positive family history of epilepsy
5. Seizures associated with severe head injury
6. Myoclonic seizures
7. Absence seizures.

Siezure type and anti epileptic drugs of choice

Partial seizures Carbamazepine (CBZ)
Phenytoin (PHT)
Phenobarbitone (PB)
Newer AED
Clobazam (CLBZ)
Lamotrigine (LTG)
Vigabatrin (VGB)
Generalised Tonic Clonic Seizures Sodium Valproate (VPA)
Phenytoin (PHT)
Carbamazepine (CBZ)
Petit Mal Ethosunimide (ET)
Valproic acid (VPA)
Myoclonic seizures Valproic acid (VPA)
Benzodiazepines (BZD)
Mixed Seizures Valproic acid (VPA)
Anti epileptic drugs:

General principles in the treatment of epilepsy

1. Monotherapy is the rule;
2. Start with single drug start with low does and increase dose gradually
3. Caution patient about possible risk of seizure in early phase due to non attainment
of blood levels and steady state.
4. Stress compliance with AED.
5. In case of seizure recurrence, increase dose to maximum pharmacological dose or maximum tolerated dose level.
6. In case of non-response switch to alternate AED.
7. It must be realised that changing the drug is effective in controlling the seizures in only 20% of patient who did not respond to the initial drug.
8. In case of non response, check compliance by history, drug levels, drug interactions, intercurrent precipitating events, reevaluate diagnosis, exclude progressive neurological disease. If a single drug does not control seizures in the highest tolerated dose, change to another while gradually opening off the first drug.

Post a Comment

Comments should be on the topic and should not be abusive. The editorial team reserves the right to review and moderate the comments posted on the site.
Notify me when reply is posted
I agree to the terms and conditions

CME Lessons

Medindia Newsletters

Subscribe to our Free Newsletters!

Terms & Conditions and Privacy Policy.

Find a Doctor