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.
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
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
Stop driving for a
period of the next 12 months (minimum)
Avoids swimming or
but exercise regularly to avoid breathing difficulty.
Use showers and not
precipitating factors (e.g. bright light, alcohol), which are suspected to have
induced previous seizure/s.
relaxation techniques like yoga
sufficiently at consistent schedule
well balanced and nutritious meals
caffeine, alcohol and artificial sweetener
in Young Women
of Adverse Reactions
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.
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.
we can see that drug therapy is all but an individual thing.
of AED therapy
- An appropriate drug
is started with a low dose and if seizure continue and no side effects occur,
the does can be increased gradually until seizures are controlled or if there is
an overdosed effect. If an adverse effect occur, the dose is reduced to previous
tolerable dose and increased with smaller increment.
introduction of AED during the first month of the therapy helps to minimize
the side effects which frequency will tend to decrease over the first few
months as a person's body gain the ability to endure the larger doses of
initiation side effects are especially troublesome with carbamazepine,
ethosuximide, felbamate, lamotrigine, primidone, tigabine, topiramate and
- If seizures continue despite maximally
tolerated doses, the indication to introduce any add-on drug (of the next
first-choice) requires reevaluation of the following factors: 1.
Diagnosis 2. Classification of seizure type and/or epilepsy
syndrome 3. Presence of an active lesion 4. Adequate dosage
(varies widely in individual) and/or duration of the therapy 5. Compliance of the person with the
medication schedule (taking AED at specify time is important to maintain the
drug in blood at the efficacious level.
- After that,
the add-on drug must have its dose
gradually increases as described previously. The initial drug/s can be gradually
removed if satisfactory control of the seizures is achieved with the add-on drug.
Withdrawal of the first drug should be done gradually over 1-3 weeks to
avoid triggering any seizure attacks. This is particularly true for
phenobarbital and phenytoin.
process to achieve monotherapy [use of one single drug in treatment] should
be continued until 2 or 3 of the drug of the first choice have failed.
after this, should polytherapy or a combination of 2 or more AED
concurrently be considered. Drugs of the same mechanism of action should not
be use in a single therapy. [ Combination therapy enhances toxicity and drug
interactions may occur between AED. Check
- Usually, therapy with a single anticonvulsant is preferred and is
effective in 70% of patients.
are not adequtely controlled with 2 drugs but there has been some
improvements, a third AED will be added from the newer drugs available.
symptoms are not adequately controlled on the two drugs and there is no
improvement, the second drug should be withdrew gradually and subsitute with
an alternative AED from the newer drugs available.
surgery should be considered in people with failed monotherapy with drug of
first choice and an initial attempt with polytherapy.
therapy, assessing and monitoring for drug/s efficacy, identification of
serious side effects and drug toxicity, and evaluation of cause of an
unexpected loss of seizure control require:
- 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.
record of the AED used including the dosage
of adverse side effects from blood and/or urine tests.
- Regular blood level monitoring
by a simple blood test. These medications include phenytoin, phenobarbitone
and sometimes carbamazepine and sodium valproate.