Treatment of epilepsyWhen 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 seizureb. Benign epileptic syndromesc. 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 EEG4. Positive family history of epilepsy5. Seizures associated with severe head injury6. Myoclonic seizures7. 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) (Clonazepam) Mixed Seizures Valproic acid (VPA) Anti epileptic drugs: General principles in the treatment of epilepsy1. Monotherapy is the rule; 2. Start with single drug start with low does and increase dose gradually3. 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.