1. Choice of anti-epileptic drugs depends on seizure type and patient needs, starting with low doses of a single drug and gradually increasing. Combination therapy may be used if seizures are not controlled. 2. Treatment should begin early and be the simplest regimen. Drugs should be gradually withdrawn after at least 3 years of seizure freedom. 3. Carbamazepine and phenytoin are first-line treatments for generalized tonic-clonic seizures, while valproate is preferred for absence seizures and myoclonic seizures.

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 :-