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Treatments   

 

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Drug therapy, Surgery, Alternative methods

 

In the treatment of epilepsy, early control of the condition is important as it allows a quicker return to normal lives including playing most sports and prevents any physical harm with recurrent seizures. In addition, early control is associated with successful discontinuation of AED (anti-epileptic drug)/anticonvulsant.

However, treatment is not recommended until the diagnosis is certain because once started, regular long-term medications must be taken which can be taxing (because of the high cost of treatment) and inconvenient (side effects from medications).

There is no harm in delaying treatment provided precautions are taken after the first single unprovoked seizure which relapse rate varies from 30-70%. These precautions include:  

 

 

 

Drugs Therapy

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Principles

Drugs of Choice

Choice in Young Women

Types of Adverse Reactions

Special Concerns

Drug Withdrawal

Recurrent Risk Factors

 

Seizure disorders are most often controlled/prevented with medications, which use requires professional consultation for optimum and efficacious outcome. Although they do not cure, they can decrease the number, severity and/or the duration of the seizures and ideally, lead to a seizure-free outcome. Optimal AED therapy may completely control seizures in 60-95% of patients. Seizures still occur while taking  AED.

Optimization of drug therapy is dependent on:

·        Choice of appropriate AED – based upon accurate classification of seizures, common side effects and potential toxicity and their risks in each individual. Considering these factors, trials of several medications may be necessary before the most effective drug is found.

·        Patient’s factors – age, response to AED used, other concurrent medical conditions, medical/medications history etc.

Hence, we can see that drug therapy is all but an individual thing. 

 

Principles of AED therapy

  1. A record of the seizure with the date and time of occurrence, duration and type to identify any change in seizure frequency, seizure type and the length of seizure free interval. 
  2. A record of the AED used including the dosage
  3. Monitoring of adverse side effects from blood and/or urine tests.
  4. Regular blood level monitoring by a simple blood test. These medications include phenytoin, phenobarbitone and sometimes carbamazepine and sodium valproate.

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