Management

First and most important question…..

treat or don’t treat?

→confirmed epilepsy?

→trigger or provoking factors ?

→bothersome?

→Patients view on treatment?

Treatment

Anti-Epilepsy Drug

Therapy

Surgery

Alternative Therapies

Up to 70 - 80% chance of seizure freedom

Available for refractory patients only: resective or stimulation

Most commonly used (esp paeds) ketogenic diet

Commonly used AED’s

Carbamazepine Sodium Valproate

Leveitracetam

Lamotrigine

Phenytoin Topiramate

Zonisamide

Common Rescue Medications

Midazolam / Diazepam / Clobazam

Major drug related issues

Type of epilepsyAgeSex

Co-morbid problemsCompliance

Understanding of treatment Guidance (NICE, SIGN)

Drug interactions

Aims of treatment

→Long term

→Single drug

→Lowest effective dose

→Established treatments first

→Minimise adverse effects

Vigabatrin and visual field loss

Foetal Valproate Syndrome

Women of childbearing age should not be started on

sodium valproate without specialist neurological

advice

Epilepsy surgery

Resective Stimulation

Resective

Young agePartial onset / 2nd generalised seizures

Resistance to AEDIdentifiable site of origin

Minimal risk to memory and speechConcordance of all factors

Stimulation

Ketogenic diet

→high-fat, low-carbohydrate “long-chain triglyceride diet”

→3 / 4 g of fat for every 1 g of carbohydrate and protein

→mechanisms unknown but Ketones are thought to be the more likely mechanism with higher ketone levels often leading to improved seizure control

→Research in adults limited

→In paeds 50% have up to 50% seizure reduction

Ultimate Treatment Aim

For patients to be seizure free on appropriate medication, with little or no side-effects form their AED

→70% of patients will become seizure free optimal therapy→80% controlled on single drug→10 – 15% controlled on polytherapy