7. Disease
        Neurology
            Epilepsy
Epilepsy - Treatment

Epilepsy
- Treatment

Treatment of active seizure

General principles

Starting treatment

Treatment after the first seizure (without any previous history) is controversial.

Treatment is recommended after 2nd seizure or after the 1st juvenile myoclonic seizure (due to increased risk of recurrence).

Maintenance therapy

Once the seizure is fully controlled by therapy that does not cause unacceptable adverse effects, continue with that therapy until the patient has been seizure-free for at least 3 years.

Occasional measurement of drug concentration will help preventing non-compliance.

Others

Pt must not operate heavy machinery, swim, drive, climb ladder, or engage in activities where momentary lapse of consciousness would be detrimental.

Delayed adverse effects

Other drug interaction/implication

Treatment of generalised seizures

Tonic-clonic

Sometimes may be difficult to determine if the seizure is a generalised seizure or a partial seizure with secondary generalisation.

 

 

Absence seizure

If infrequent and no other seizure occur, drug therapy may not be necessary.

If needed, ethosuximide OR sodium valproate are equally effective.

Treatment is continued until the EEG ceases to show 3 per second spike wave activity and no seizure has occurred for 2 years.

 

Myoclonic seizures

 

Partial (focal) seizures

Surgical treatment for temporal lobe epilepsy secondary to hippocampal sclerosis

   -> Partial temporal lobectomy

 

Special seizure syndromes

Febrile seizures

Rectal diazepam may be used for seizures lasting more than 5 minutes

Otherwise drug treatment is rarely necessary.

Neonatal seizures

Identify and treat other causes (e.g. meningitis)

If a cause cannot be found, use:

 

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