| Fundamentals |
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Epilepsy In Clinical Pratice
-Dr S.V.Khadilkar |
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| Table IV |
| Doses of first-line anticonvulsants |
| Drug |
Initial daily dose |
Increments
(mg) |
Usual dosage regimen |
Maintenance
dose/day |
| Valproic acid |
400 mg |
200-500 |
BID |
30-50 mg/kg |
| Carbamazepine |
200 mg |
100-200 |
BID/TID |
5-8 mg/kg |
| Phenytoin |
200 mg NOCTE |
25-100 |
BID/NOCTE |
3-5 mg/kg |
| Phenobarbitone |
30-60 mg NOCTE |
30-60 |
BID/NOCTE |
5-8 mg/kg |
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Some patients may not come under effective control - the intractable epilepsy. In such individuals, one should retrace all the diagnostic steps and exclude alternative diagnosis, check the seizure type, use appropriate medicines in appropriate doses and ensure compliance.
In truly intractable epilepsies, there is a role of newer antiepileptic agents.
It is important to bear in mind that the newer antiepileptic agents like lamotrigine, gabapentin and clobazam are mainly additive and are used in conjunction with the principal antiepileptic agents described earlier.
In modern times, a large majority of patients with epilepsy can be well controlled and successfully treated, giving them a chance to lead normal productive lives - that is, providing them with the hope of a new life.
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| Table V |
| Toxic effects of major anticonvulsants |
| Carbamazepine |
Rash, blood dyscrasia, diplopia, ataxia, sedation, dizziness, nausea, hyponatremia |
| Phenobarbitone |
Rash, blood dyscrasia, sedation, behavioral disturbances, intellectual blunting, hyperactivity |
| Phenytoin |
Rash, blood dyscrasia, unsteadiness, dizziness, hirsutism, gum hypertrophy, coarsening of features, ataxia |
| Valproic acid |
Rash, blood dyscrasia, hepatic dysfunction, acute pancreatitis, acute thrombocytopenia, unsteadiness, behavioral changes, tremor, hair loss, weight gain, gastritis
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| Table VI |
| Interaction of anticonvulsants |
| • Changes in plasma concentration when a new drug is added |
| Primary Drug |
| |
CBZ |
VPA |
PHT |
PB |
| CBZ |
- |
 |
/ |
- |
| VPA |
(CBZ-E) |
- |
/ |
|
| PHT |
|
|
- |
|
| PB |
|
|
/ |
- |
| • Changes in plasma concentration when an anticonvulsant is withdrawn. |
| Remaining Drug |
| |
CBZ |
VPA |
PHT |
PB |
| CBZ |
- |
|
/ |
- |
| VPA |
(CBZ-E) |
- |
/ |
|
| PHT |
|
|
- |
|
| PB |
|
|
/ |
- |
CBZ = Carbamezepine; CBZ-E = Carbamezepine epoxide;
VPA = Valproate; PHT = Phenytoin;
PB = Phenobarbitone;
= Decrease/ increase |
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