Treatment
Medication
Epilepsy is eminently treatable with medication, and the aim of treatment is to totally suppress seizures with the lowest possible dose of a single Anti-Epileptic Drug (AED). It is worth being aware that control of seizures is affected by failure to comply with prescribed treatment, and a surprisingly large number of patients do not accurately follow prescribed treatment.
In general, the outlook is better than many people realise, with 80% being well controlled with no, or few, seizures. Complete suppression of seizures can be achieved in about 70% of people developing epilepsy.
The type of AED prescribed will depend upon the following factors: -
- Type of epilepsy,
- Age,
- Drugs taken for other conditions,
- Possible AED side-effects,
- Desire to become pregnant.
Monitoring of blood levels may be appropriate with the use of some AED’s, and in some situations, such as the suspected toxic effects of the medication, or suspected non- compliance.
The following table lists the current recommended anti-epileptic drugs for different seizure types.
The person should always be started on a single drug, and if the epilepsy is more difficult to control, more drugs will be added.
| Seizure Type | First-line Drugs | Second-line Drugs | Other Drugs that may be considered | Drugs to be avoided (may worsen seizures) |
|---|---|---|---|---|
Generalised tonic-clonic |
Carbamazepine Lamotrigine Sodium Valproate Topirmate | Clobazam Levetiracetam Oxcarbazepine | Acetazolamide Clonazepam Phenobarbital Phenytoin Primidone |
Tiagabine Vigabatrin |
Absence |
Ethosuximide Lamotrigine Sodium Valproate | Clobazam Clonazepam Topiramate | Carbamazepine Gabapentin Oxcarbazepine Tiagabine Vigabatrin |
|
Myoclonic |
Sodium Valproate (Topiramate) | Clobazam Clonazepam Lamotrigine Levetiracetam Piracetam Topiramate | Carbamazepine Gabapentin Oxcarbazepine Tiagabine Vigabatrin |
|
Tonic |
Lamotrigine Sodium Valproate | Clobazam Clonazepam Levetiracetam Topiramate | Acetazolamide Phenobarbital Phenytoin Primidone |
Carbamazepine Oxcarbazepine |
Atonic |
Lamotrigine Sodium Valproate | Clobazam Clonazepam Levetiracetam Topiramate | Acetazolamide Phenobarbital Primidone |
Carbamazepine Oxcarbazepine Phenytoin |
Focal with/without secondary generalisation |
Carbamazepine Lamotrigine Oxcarbazepine Sodium Valproate Topirmate | Clobazam Gabapentin Levetiracetam Phenytoin Tiagabine | Acetazolamide Clonazepam Phenobarbital Primidone |
Diazepam Use
Rectal diazepam may be used in the home management of prolonged or repetitive seizures. The clinical effect from rectal diazepam occurs rapidly, within a few minutes. It should be used with caution as it can cause, although rarely, respiratory depression (slower breathing or even brief cessation of breathing) especially in children. It is usually not necessary for children with mild or well-controlled forms of epilepsy. More recently however, buccal midazolam (the medication is placed against the sides of the gums and cheek) is being used instead of rectal diazepam. Buccal midazolam is easier to administer, with similar effectiveness and a better safety margin.
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Amended November 2009
