2nd Year MBBS student At GMERS Medical College,Junagadh. Upload Date:- 24/07/2018

2. 1. Choice and Dose according to seizure type and
need of patient.
2. Initiate treatment early,
Single Drug (Low Dose) -> Increase Dose gradually
till maximum tolerated dose -> Substitution ->
Combination (of different mechanisms)
3. No Initiation if no Tonic Clonic Seizure.
4. Simplest Therapy.

3. 5. Gradual drug withdrawal (at least 3 years after last
seizure)
- Childhood epilepsy
- Absence of family history
- Primary generalized Tonic Clonic Epilepsy
- Recent onset at start of treatment
- Absence of cerebral disorder and normal
interseizure EEG.
6. Dose Regulation -Therapeutic Range
-Individual Variation
-Compliance

4. 7. If Women on therapy concieves ;
- Don’t stop -> As risk of Status Epilepticus
- Substitute Valproate
- Prophylactically:- Folic Acid + Vitamin K (Last Month)
8. No treatment for individual seizure episodes.
* Prone Position * Gag * Head Turned * Patency of
airway Ensured *
2nd and 3rd trimester

5. No. Types of seizure First Choice Drugs
Second Choice
Drugs
Alternative
Drugs
1
Generalized Tonic
Clonic and Simple
partial seizures
Carbamezepine
Phenytoin
Valproate
Phenobarbitone
Lamotrigine
Gabapentin
Topiramate
Primidone
2
Complex Partial
Seizure
Carbamezepine
Valproate
Phenytoin
Gabapentin
Lamotrigine
Levetriacetam
Clobazam
Zonisamide
Topiramate
3
Absence seizures Valproate Ethosuximide
Lamotrigine
Clobazam
Clonazepam
4
Myoclonic seizure Valproate Lamotrigine
Topiramate
Levetriacetam
Clonazepam
5
Atonic Valproate Clonazepam
Clobazam
Lamotrigine
6
Febrile Seizures Diazepam
(Rectal)
- -
7
Status Epilepticus Lorazepam (I.V.)
Diazepam (I.V.)
Fosphenytoin
(I.V.)
Phenobarbitone
(I.V. & I.M.)
General
Anaesthetics

6. (Generalized Tonic Clonic Seizure)
Also called Grand-Mal Seizure.
Involves entire body.
Carbamezepine & Phenytoin is used.
(Focal Impaired Awareness Seizure)
Difficult to control
Relapses are common on withdrawl of drugs
Carbamezepine-DOC
One of the generalized seizures
Ethosuximide=Valproate
But valproate is preferred because it also prevent GTCS

7. Muscle Jerk Seizures Sudden Loss of Muscle Strength
Valproate is Preferred drug.
Lamotrigine can be used alternatively.
Children under 5 years may develop during fever
Rectal DIAZEPAM 0.5 mg/kg
Rectal solution in tubes 5 mg in 2.5 ml
The drug is repeated after 12 hourly for 4 doses.
If fever is prolonged, wait for 24-48 hrs!
Occur in children of age 1 year.
Corticosteroids + Valproate/Clonazepam
(Symptomatic Relief + Adjuvant)

8. - Seizure Activity >30 mins
- 2 or more Seizures occur
without recovery of conciousness
•What Is Status
Epilepticus??
-:MANAGEMENT :-
4 mg
(0.1 mg/kg in
children)
Intravenously at
the infusion rate
of 2 mg/min
Repeat after 10
minutes if required!!
•Effective in 75-90% cases
•Action lasting 6-12 hours (More effective than DIAZEPAM)

9. 10 mg (0.2-
0.3 mg/kg)
Intravenous
infusion at the
rate of 2
mg/min
Repeat after
10 minutes
if required!!
•Effect starts fading after 20 minutes.
•Can damage to injected vein.

10. 100-150 mg/min
Intravenous Infusion
Maximum up to 1000 mg
(15-20 mg/kg)
•Needs continuous ECG monitoring.
•Used if seizures recur or fail to respond 20
minutes after onset.

11. (IF FOSPHENYTOIN NOT AVAILABLE)
• 25-50 mg/min
• Local Vascular Complications
5.PHENOBARBITONE SODIUM
(Used Alternative to FOSPHENYTOIN)
50-100 mg/min Intravenous
Infusion
Maximum up to
10 mg/kg

12. A+B+C+Euglycaemia
-Are those, who fail to respond lorazepam and
fosphenytoin within 40 minutes of seizure onset.
-May be treated with Intravenously by
MIDAZOLAM/PROPOFIL/THIPENTONE
ANAESTHESIA
-: Refractory Cases :-
-: General Measures :-