1. MANAGEMENT Chua Szu May Wong Chui King

2. MANAGEMENT 1. Immediate 2. Long term 3. Patient education

3. First Aid Management Keep calm and reassure other people who may be nearby. Don't hold the person down or try to stop his movements. Time the seizure with your watch. Clear the area around the person of anything hard or sharp. Loosen ties or anything around the neck that may make breathing difficult. Put something flat and soft, like a folded jacket, under the head. Turn him or her gently onto one side. This will help keep the airway clear. Do not try to force the mouth open with any hard implement or with fingers. Don't attempt artificial respiration except in the unlikely event that a person does not start breathing again after the seizure has stopped. Stay with the person until the seizure ends naturally. Be reassuring as consciousness returns. Administer Diazepam if available

4. Principles 1. Treat with 1 drug, by 1 doctor only 2. Slowly build up doses over 2 -3 months until seizures are controlled or toxic effects manifest or maximum drug dosage reached. 3. If an Antiepileptic Drug has failed because of adverse effects or continued seizures, a second drug should be started 4. Antiepileptic treatment strategy should be individualised according to the seizure type, epilepsy syndrome, co-medication and co-morbidity, the individual’s lifestyle, and the preferences of the individual and their family and/or carer.

5. Mono or Combined Therapy? It is recommended that combination therapy (adjunctive or ‘add-on’ therapy) should only be considered when attempts at monotherapy with AEDs have not resulted in seizure freedom. If trials of combination therapy do not bring about worthwhile benefits, treatment should revert to the regimen (monotherapy or combination therapy) that has proved most acceptable to the individual, in terms of: A. providing the best balance between effectiveness in reducing seizure frequency and B. tolerability of side effects

8. Long Term Adherence: educating individuals and their families and/or carers in the understanding of their condition and the rationale of treatment reducing the stigma associated with the condition using simple medication regimens positive relationships between healthcare professionals, the individual with epilepsy and their family and/or carers.

9. Indication for blood monitoring of AED Indications: detection of non-adherence to the prescribed medication suspected toxicity adjustment of phenytoin dose management of pharmacokinetic interactions 5. specific clinical conditions, for example, status epilepticus, organ 6. failure and pregnancy.