It is best for care epilepsy patients

1. Epilepsy & Seizure
Shair Muhammad Hazara
PhD Public Healh (fellow), MSPH, MSBE, BSN

3. Famous people with epilepsy
Hugo
Weaving
Danny
Glover
Tony
Greig
Kerry
Armstrong
Neil Young
Wally Lewis
Bud Abbott Napoleon
Bonaparte
Socrates Margaux
Hemingwa
y

35. Seizures - Management
I Management of acute attack:
Calm down
Head down lateral position
Prevent hurt
If does'nt stop convulsing in 3-5 min,
Inj Diazepam 0.3 mg/kg slow iv bolus
Maybe repeated after 20 min
Effect lasts 0.5-3 hrs
SE- hypotension, respiratory depression, secretions
or
Rectal diazepam 0.5 mg/kg dose/ nasal midzolam 0.2
mg/kg/dose

36. Seizures: Status epilepticus:
Prolonged seizure for >20 min or repeated
seizures without regaining consciousness
Persistent seizure activity  hypoxia,
hypoglycemia, hyperthermia, cerebral
edema & vasomotor instability
Life threatening
Risk of permanent brain damage  Medical
emergency

37. Mx of Status epilepticus
ICU, monitoring
IV dextrose drip
Oxygen
IV Inj Diazepam 0.3 mg/kg or Lorazepam 0.1 mg/kg (longer
action) or Midzolam (lesser respiratory depression)
Inj phenytoin 15-20 mg/kg iv at a rate of <1mk/kg/min
Inj Phenobarbitone 20 mg/kg iv at a rate of 1
mg/kg/min or IV Valproate 20 mg/kg as infusion in 50 ml NS
over 30 min
Ventilatory support + diazepam/midzolam infusion
`` Thiopental infusion

38. LONG TERM MANAGEMENT OF EPILEPSY:
I General advice:
• As normal a life style as possible
• No swimming/cycling on road/driving
• Inform teacher
• First aid
• Seizure dairy
• Regularity

39. LONG TERM MANAGEMENT OF EPILEPSY:
Drugs:
When to start? If 2 or more seizures within a 12
month period
Monotherapy:
Start at lower limit & build up gradually till
toxicity/control
If no effect at maximum dose, taper off while
introducing 2nd drug
4 first line drugs - Carbamazepine, phenytoin,
valproate and phenobarbitone
No drug completely safe
70% can be controlled

40. First line AEDs
Carbamazepine:
Ind: Partial, tonic clonic
Dose: 10-30 mg/kg/d in 2-3 doses13-18 hrs,
Adv: Relatively safe, improves cognitive fn.
SE: Diplopia,drowsiness, giddiness
initially.Hepatitis, skin rash, BM depression,
drug interactions, dystonia, can aggravate
minor motor seizures

41. First line AEDs
Sodium valproate:
Ind: Broad spectrum
Dose: 20-30 mg/kg/d (upto 80) in 2-3 doses
Half Life; 7-10 hrs
SE: Nausea, vomiting, wt gain, hair loss, hepatic
failure, tremors, platelets, s ammonia, s
carnitine, no correlation between drug levels &
toxicity, levels of other AEDs

42. First line AEDs
Phenobarbitone
Ind: Tonic-clonic, partial, febrile
Dose: 3-6 mg/kg/d as single doses
level:10-15 g/ml20-80 hrs
Adv: Cheap, once daily dose
SE: Drowsiness, hyperkinesia, cognitive
impairment ??, rash, rickets

43. First line AEDs
Diphenylhydantoin:
Ind: Tonic-clonic, atonic, partia
Dose: l4-8 mg/kg/d in 2 doses
level: 10-20 g/ml
Half Life: Upto 20 hrs
SE: Hirsutism, gum hyperplasia, rickets, ataxia,
lymphoma like syndrome, Sle like illness,
megaloblastic anemia, rash, low margin of
safety

44. Ethosuximide:
Ind: Absence seizures
Dose: 20-25 mg/kg/d in 2 doses
Half Life: 4-30 hrs
SE: Photophobia, WBC, nephrosis, blood
dyscrasia
ACTH:
Ind: West syndrome
Dose: 20-40 u/d for 4-6 wks
SE: hypercortisolism
First line AEDs

45. Nitrazepam
Ind: Myoclonus, atypical absence
Dose: 0.5 mg/kg/d in 2 doses
SE: Sleepiness, salivation,hypotonia, ataxia,
tolerance
Clonazepam
Dose: 0.05-0.25 mg/kg/d in 3 doses
Drug level monitoring
EEGs
When to stop ? 2-3 yrs seizure free
First line AEDs

46. Newer AEDs
Clobazam
Ind: Partial, generalised & myoclonus (add on drug)
Dose: 0.5 mg/kg/d single dose
SE: Drowsiness, tolerance,  secretions
Gabapentin
Ind: Secondarily generalised, complex partial
SE: liver enzymes, impaired swallowing & aspiration,
somnolence, fatigue, dizziness, wt gain
Lamotrigine
Ind: Generalised, absence, JME, LG syndrome
SE: Synergy with valproate, skin rash, SJ syndrome

47. Newer AEDs/ Other modalities
Topiramate:
Ind: Partial, generalised, drop attacks, LG syndrome
SE: ?cognitive impairment
Vigabatrine:
Ind: Partial, infantile spasms
Dose: 40-80 mg/kg/d
SE: Drowsiness, agitation, confusion
Oxcarbazepine:
Derivative of carbamazepine
Ketogenic diet
Surgery