EPILEPSY
Epilepsy is a disorder of the central nervous system (CNS) which is
characterized by spontaneous recurrent seizures or the tendency to have
seizures.
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DISORDERS OF THE CENTRAL NERVOUS SYSTEM
Epileptic seizures may be classified as follows:
· Generalized seizures
· Grand mal (tonic-clonic) seizures
· Petit mal (absence) seizures
· Other types (atonic, myoclonic)
· Partial or focal seizures
· Simple partial (consciousness not impaired)
· Complex partial (consciousness impaired) eg temporal lobe seizures
· Partial seizures with secondary generalization
· Status epilepticus
CAUSES
· See section on Seizures
SYMPTOMS
· See section on Seizures
SIGNS
· See section on Seizures
INVESTIGATIONS
· See section on Seizures
TREATMENT
Treatment objectives
· See section on Seizures
Non-pharmacological treatment
· See section on Seizures
Pharmacological treatment
(Evidence rating: A)
Anticonvulsant drug therapy:
Traditionally, a single seizure has been regarded as an indication for
investigation and assessment, but not for drug treatment unless a second
attack follows closely or based on the circumstances of the seizure.
Drug treatment should certainly be considered after two seizures and
the type of drug depends on the type of seizure. The underlying abnormality
must also be corrected if possible.
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DISORDERS OF THE CENTRAL NERVOUS SYSTEM
Table 10-1 : Drug Treatment of Seizures
Type of Seizure Drug Dose
Adult Child
Generalized seizure
Phenytoin (daily) 300-500 mg 3-5 mg/kg
Phenobarbital (daily) 60-180 mg 5-8 mg/kg
Primidone (2 times daily) 250-1000 mg 2 0-30 mg/kg
Carbamazepine (2 times daily) 400-1200 mg 10-20 mg/kg
Sodium valproate (2-3 times daily) 600-2000 mg 20-30 mg/kg
Generalized absence (petit-mal) seizure
Sodium valproate (2-3 times daily) 600-2000 mg 20-30 mg/kg
Ethosuximide (daily) 500-1500 mg 250-500 mg
Partial seizure
Carbamazepine (12 hourly) 400-1200 mg 20-30 mg/kg
Sodium valproate (2-3 times daily) 600-2000 mg
NB: where available slow release preparations are preferred20-30 mg/kg
Note
DON'TS FOR EPILEPTIC PATIENTS
· Driving of a vehicle if not certified to be seizure free
· Swimming alone
· Working at heights
· Excessive alcohol ingestion
· Machine operation
· Cooking by open fire alone
