Describe the Pathology, Presentation, Investigation and Management of EpilepsyEdit
Pharmacotherapy is individualised according to patient needs. Therapy can be assigned according to seizure type, or by epilepsy syndrome diagnosed.
Other factors include concurrent medication regimes, comorbities, and patient lifestyle and preference.
|Seizure Type||First line therapy||Second line notes|
|Generalised Tonic-Clonic Seizures||Sodium Valproate|
|Myoclonic Seizures||Sodium Valproate|
|Tonic or Atonic Seizures||Sodium Valproate|
|Epilepsy Syndrome||First line Therapy|
|Benign Epilepsy Syndromes||
Childhood Absence Epilepsy
|Dravet Syndrome a.k.a. Severe Myoclonic Epilepsy of Infancy||Refer to Specialist|
|Epilepsy with Generalised Tonic-Clonic Seizure Only||
|Idiopathic Generalised Epilepsy||Sodium Valproate|
|Infantile Spasms||Refer to Specialist|
|Juvenile Myoclonic Epilepsy||Sodium Valproate|
Refer to Specialist
|Other, Rare syndromes||Refer to Specialist|
Special Considerations for PharmacotherapyEdit
Sodium Valproate - Teratogenicity.
Lamotrigine - May exacerbate myoclonic seizures (although it is still a second-line treatment option in syndromes such as juvenile myoclonic epilepsy)
Carbamazepine/Oxcarbazepine - Risk of exacerbating absence or myoclonic seizures.
Pregnancy - offer 5mg of folic acid to all women before pregnancy
Emergency AED therapy for convulsive status epilepticus (published in 2004) Edit
|Premonitory stage (pre-hospital)||Diazepam 10−20 mg given rectally, repeated once 15 minutes later if status continues to threaten, or midazolam 10 mg given buccally.
If seizures continue, treat as below.
|Early status||Lorazepam (intravenous) 0.1 mg/kg (usually a 4 mg bolus, repeated once after 10−20 minutes; rate not critical).
Give usual AED medication if already on treatment.
For sustained control or if seizures continue, treat as below.
|Established status||Phenytoin infusion at a dose of 15–18 mg/kg at a rate of 50 mg/minute or fosphenytoin infusion at a dose of 15−20 mg phenytoin equivalents (PE)/kg at a rate of 50–100 mg PE/minute and/or phenobarbital bolus of 10–15 mg/kg at a rate of 100 mg/minute.|
|Refractory status a||General anaesthesia, with one of:
2–10 mg/kg/hour) titrated to effect