PHARMACOLOGICAL

MANAGEMENT OF
EPILEPSY

EPILEPSY VERSUS SEIZURE

A seizure is symptom caused by abnormal
electrical discharges in the brain
Epilepsy is a disorder characterized by
recurring seizures
A seizure is a symptom of epilepsy

EPILEPSY-CLASSIFICATION
Focal seizures
account for 80% of
adult epilepsies

Generalized
seizures

Unclassified
seizures

INCIDENCE OF EPILEPSY BY AGE

CAUSES OF EPILEPSY

POST-TRAUMATIC EPILEPSY
Epilepsy arising as a result of head trauma
Head trauma may be subtle or severe
Extent & location of injury may increase likelihood of
developing seizures
2 types of seizures -early/acute & delayed onset

Early treatment with anti-epileptic drugs (AEDs) may

not affect the development of seizures later on

MORTALITY
Risk of death higher in people with epilepsy
Mortality rate associated with seizures lasting > 30
minutes may be as high as 19%
Vast majority of deaths occur in people with seizure in the
context of an acute brain insult, hypoxia, trauma, etc.
Sudden Death in Epilepsy (SUDEP)

A Spectrum of Severity

Uncomplicated epilepsy

Seizures refractory to
treatment

Increase risk of SUDEP

Case 01
A 24 year old male with idiopathic
generalized epilepsy, who has been
defaulted treatment for 2 months, admitted
with recurrent GTC seizures without
regaining consciousness in between.

IV Benzodiazepines
Lorazepam
4-8mg
Maximum effect in 2 min
Lasting for 4-6hour

Diazepam
5-30mg
Act early(10-20sec)
Lasting only for 2 hour

Midazolam
2.5-10mg
Act in < 1min
Can be used as infusion

Complications
Over sedation
Hypotension
Respiratory
depression
Tolerance

IV Phenytoin
Dose
20mg/kg
<50mg/min

Compatibility
Incompatible with dextrose

Adverse effects
Cardiac arrhythmias
Purple glove syndrome

Case 2
A, 30 year male with post-traumatic
epilepsy presented with unsteady gait for
one week and double vision for 3 days. He
was on phenytoin and phenobarbitone
since the time of RTA and his medication
changed to carbamazepine 200mg tds
recently.

Carbamazepine
Dose
800 1200mg daily

Side effects
Ataxia/diplopia
Skin rash

Other uses
Trigeminal neuralgia
Bipolar disorder
Neuropathic pain

Phenytoin
Dose
150 400mg daily

Side effects
Gum hypertrophy
Dose related toxicity

Other uses
?Anti-arrhythmic

Phenobarbitone
Dose
30 120 mg daily

Side effects
Depression
Withdrawal seizures

Other uses
Preoperative sedation

Case 3
A, 26 year old newly married female with
Juvenile Myoclonic epilepsy who has been
on Sodium valproate is being evaluated in
the routine clinic.

Sodium valproate
Dose
600mg - 3g

Side effects
Hepatotoxicity
Hair loss

Other uses
Mania
Migraine

Levetiracetam
Dose
1000mg 3g

Side effects
Sedation
Behavioral disturbances

Other uses
Myoclonus

 A, 64 year old male with post stroke

epilepsy has developed painful loss of
vision of the right eye. His medications
include
Topiramate,
Lamotrigine
and
Oxcarbazepine.

Topiramate
Dose
50 400mg daily

Side effects
Weight loss
Impaired cognition

Other uses
Migraine
Diabetic neuropathy

Oxcarbazepine
Dose
600-1200mg daily

Side effects
Skin rash
vertigo

Other uses
Neuropathic pain
Bipolar disorder

Lamotrigine
Dose
100 300mg daily

Side effects
Skin rash
Nausea

Other uses
Bipolar disorder
Trigeminal neuralgia

SUMMARY
Definition of seizure
Definition of epilepsy
Causes and burden of epilepsy
Management of status epilepticus
Pharmacology of antiepileptics