Drug Therapy

Living with epilepsy is never easy. Parents with Epileptic children need not give up medication as it is the only chance their loved ones to have a life almost normal to other kids. Stigmatization and diminished self-worth are few of the issues affecting Epilepsy victims and so, much love and care is paramount to ensure they too have a life, and a less complicated one too.
More than one seisure should have occured, and other causes for the convulsions excluded before regular treatment with anti Epileptic drugs (AEDs) is  begun.
The aim is to try and prevent furher seizures,either completely or to reduce their frequency and severity as much as possible with least possible side effects.

The medication should be given daily for many years, sometimes lifelong, sometimes  less. After a sesure free period with medication for atleast two years in idiopathic, and atleast three years in symptomatic epilepsy, the dosagemight be reduced gradually over many months, and if no relapse has occurred, dicontinued.

In cases where the epilepsy was very severe before treatment was started, or where there is a known brain lesion, it is better to continue the treatment for much longer, as the chance of relapse is then much greater.

Sudden Miscontinuation Effects.
A sudden discontinuation may lead to a dangerous status epilepticus. The treatment should be started with one drug only.Ideally, the choice of the drug depends on the type  of epilepsy and the seisure type.

In practice, however, it also depends on the availability and affordability of the drug.





As it is often difficult to know in the beginning which type of epilepsy there is, treatment is usually started according to the presenting seizure type. The most common are the generalised tonic clonic seizures(GTCS).

The main four AEDs are;

1. Phenobarbitone
2. Phenytoin
3. Carbamazepine
4. Valproate

If we are able to differenciate between primary and secondary tonic clonic seizures, then phenobarbitone is the drug of choice for the primary GTCS and phenytoin for the secondary GTCS, but all fournare effective and can be tried separately if necessary.

Guide To AEDs Administration

Inorder to start anticonvulsant drugs treatment in previously untreated patients, there are guiding principals one should observe:

• carefully establish diagnosis.
• start drug treatmment with one drug.
• start treatment with small dose.
• gradually increase dosage until complete seizure control.
• the aim of tratment is to achieve the lowest maintenance dose which results in complete seisure control
• a gradual introduction of an anticonvulsant can produce theraputic effects just as fast as a rapid initiation with large doses,but with fewer side effects.
• rapid increases of large doses may not improve seizure controll and may increase the risk of side effects.
• severe `intoxication` side effects appearing at the beginning of the treatment can indicated too rapid or too large dosage increases.
• if the initial drug treatment is not well tolerated, e.g. if side effects occur of if the maximum tolerated dose does not produce seizure controll,substitute the initial drug with another first line anticonvulsant.
• a second anticonvulsant  should be  added gradually at first, then slowly withdrawn.
• Incase of acute withdrawaal symptoms, e.g. reccurence of seizures, use DIAZEPAM as a control drug.
• Regular compliance is the key to successful seizure control, and counselling the patient is the most critical factor in compliance.

Side effects of AEDs

Phenobarbitone
Drowsiness especially during the first week of treatment, slowly disappearing, and only recurring when the dosage becomes high.
In some children ther might be a reduction in scholastic performance or changes in the behaviour, such as hyperactivity and sometimes aggressiveness.

Phenytoin

• drowsiness
• Gum hypertrophy
• Hirsutism
• ataxia
• Nystagmus

Besides these reversable cerebellar signs at  high dosage, it has  been suggested recently that a permanent cerebellar syndrom may also result from chronic therapy. If toxicity has appeared, the dosage should be ommitted for one day and then restarted on a lower level.
If at all possible, a change-over to another anticonvulsant could be made to prevent further misharps.

                                                   

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