4. EPILEPSY
• Tendency to have seizures.
• Symptom of a brain disease tan disease
itself.
• Single seizure is not epilepsy.
• In a group of disorders,it is the only or
main symptom,in others,its just one of the
manifestations.
8. GUIDELINES FOR
ANTICONVULSANT THERAPY
• Start with one 1st line drug.
• Start with low dose;gradually increase to
effective control of seizures or side effects.If 1 st
drug fails,start 2nd line drug whilst gradually
withdrawing 1st.
• Try 3 agents singly before using combinations.
• Do not use more than 3 drugs in combination.
• If above fails.consider occult structural or
metabolic cause.
9. CHOICEOF AED
Epilepsy
Type
1st LINE
2nd LINE
3rdLINE
Partial&/2n Carbamaze Lamotrigine
dry GTCS pine
Topiramate
Valproate
Phenytoin
Gabapentin
Clobazam
Primidone
Phenobarb
Vigabatrin
Myoclonic
Phenobarbi
tone
Valproate
Clonazepa
m
14. ANTICONVULSANT DRUG
BLOOD LEVELS
• Can be a useful guide in case of some
drugs.
• In valproate,no relationship b/w level &
anticonvulsant efficacy.
• Particularly useful in phenytoin &
carbamazepine.
15. WITHDRAWL OF AED’S
• Can be considered after complete control
of seizures for 2-4 years.
• Should be undertaken slowly, reducing the
drug dose gradually over 6-12 months.
16. OUTCOME AFTER
20 YEARS
• 50% seizure free, without drugs for last 5
years.
• 20% seizure free for last 5 years but
continue to take medication.
• 30% seizures continue in spite of anti
epileptic therapy.
