Goal of epilepsy treatment
is to achieve optimal quality of life for patients. Principle that
pharmacological treatment of epilepsy:
1. AED (anti-epileptic drug) was started when the diagnosis of epilepsy is confirmed, there are at least two times a seizure in a year, the patient and family understand the purposes of treatment and possible side effects.
1. AED (anti-epileptic drug) was started when the diagnosis of epilepsy is confirmed, there are at least two times a seizure in a year, the patient and family understand the purposes of treatment and possible side effects.
2. Therapy begins with monotherapy
3. Drug administration started on a low dose and increased gradually until effective dose is reached or the possible side effects; plasma drug levels determined if the resurrection is not controlled with an effective dose.
4. When the maximum dose of AED use can not control the generation, added a second AED. When both have reached levels of AED therapy, the first AED tapered slowly.
5. The addition of a third AED only after proven resurrection can not be overcome by the use of maximal doses of both AEDs first. Patients with a single seizure recommended to begin therapy when the probability of recurrence is high, namely when: found a clear epileptic focus on EEG, there is a history of epilepsy siblings, history of head trauma with loss of consciousness, status epilepticus is the first resurrection.
Principle mechanism of action of anti-epileptic drugs:
a. Increase the inhibitory neurotransmitter (GABA)
b. Lowering excitation: kponduksi modification through ion: Na +, Ca2 +, K +, and Cl-or activity of neurotransmitters.
Discontinuance of AED
In children gradually AED discontinuation may be considered after 2 years of free attacks. General Terms stopping AEDs are as follows:
a. AED discontinuation can be discussed with the patient or his family after a minimum of 2 years seizure free
b. Should be done gradually, in general, 25% of the original dose, every month within 3-6 months
c. When used more than one AED, the AED discontinuation beginning of one, which is not the main drug (a drug that was first given)
Anti-epileptic drug
A. First-generation drugs
Phenytoin
Phenytoin is one of the drugs commonly used for anti-convulsive therapy. Phenitoin often considered as the first choice drug for the treatment of partial seizures, tonic clonic seizures (grand mal) and status epilepticus. Phenitoin work by suppressing electrical activity in brain nerve cells. This drug is used for the first time can be taken orally or intravenously. Oral form of the drug has therapeutic benefits for both single dose per day. Phenitoin usage rate should be monitored with liver function tests and complete blood count. Recommended therapeutic dose is 10-20 mg / L. Side effects from the use of phenitoin are Anemia, Excessive hair growth, Lethargy, Gum Hyperplasia, neuropathy if used for long periods
Carbamazepin
This drug is commonly prescribed for the treatment of partial seizures and tonic clonic grand mal seizures). This drug works by a mechanism that is less understandable. In oral form, carbamazepin can drink 2 to 3 times. Level of use of carbamazepine should be monitored. Recommended therapeutic dose was 8-12mg / L. liver function tests and complete blood count should be performed routinely. Side effects of carbamazepine can cause drowsiness, nausea, anemia, neutropenia.
Phenorbital
This medication is used to treat both types of seizures are generalized seizures and convulsions parsial.obat is also used in the protocol after use phenitoin status epilepticus in infants who suffer from epilepsy. This drug can be used in the form of oral or intravenous. Level of use of these drugs should be monitored. Recommended therapeutic dose is 15-40 mg / L. complete blood count should be performed routinely. Side effects of phenorbital is drowsiness, cognitive impairment and cause irritability.
Valproate
This medication is used to treat partial seizures, tonic clonic seizures (grand mal), absence seizures (petit mal) seizures and mioclonic. It is also recognized can prevent migraine headaches. Mechanism of action of this drug is associated with brain substance called GABA (gamma aminobutyric acid). This drug can be used in oral form and should be taken 2 to 3 times a day to get adequate doses. Level of use of these drugs should be monitored, such as the liver function tests and blood tests. The side effects of this drug is liver damage (hepatotoxicity) nausea, weight gain, alopecia, and tremor.
Ethosuximide
This medication is used to treat absence seizures (petit mal). These drugs work by suppressing the activity of brain cells that berhubungna with loss of consciousness. This drug is administered orally, can take the form of tablets or syrup. Level of use of these drugs should be monitored to ensure the therapeutic dose used was 40-100 mcg / mL. complete blood count, urinalysis, and liver function tests should be performed regularly to monitor possible side effects are not expected. Side effects that can be caused ethosuximide, namely:
• Gastrointestinal (nausea, vomiting, abdominal pain, diarrhea, weight loss)
• genitourinary (vaginal bleeding and hematuria)
• Hematology (emphasis on bone marrow)
• Integument (excessive hair growth, skin rash, systemic lupus erythematosus)
• Neurological (headache, dizzy, insomnia, aggressiveness, confusion, difficulty concentrating)
Primidone
This drug is a barbiturate-containing phenorbital. This medication is used to treat generalized tonic-clonic seizures (grand mal) and partial seizures. This drug is used in adults and children older than 8 years. Effective dose to the body is 5-12 mcg / mL. This drug is available in tablets of 250 mg to be taken 3 to 4 times a day. The dose may be increased but not to exceed 500 mg taken four times a day.
Side effects of primidone are: Blurred vision, Confused, Nausea and vomiting, Impotence, Vertigo, Loss of weight. Patients who are allergic to phenorbital epilepsy should not use primidone. This medication appears in breast milk and related neonatal bleeding and coagulation disorder due to deficiency of vitamin K.
B. Second-generation drugs
Topiramate
This medication is used with other anti-seizure drugs in the treatment of partial seizures and generalized tonic-clonic seizures in adults and children aged 2 to 16 years. It is also recognized as a preventive migraine headaches. This medication is available in the form of people who can be taken twice a day (Gordon, 2008).
In March 2011, the U.S. Food and Drug Administration announced that information indicates that topiramate increases the risk of such abnormalities in infants, sample: palatoschisis labioschisis, and when this drug is used during the first trimester of pregnancy. The side effects of this drug are drowsiness, nausea, dizzy, impaired coordination and balance, aphasia, loss of weight, and kidney stones. In children may cause distraction and may become aggressive. Acute glaucoma and visual abnormalities is that Sirius and complications have been reported in some cases.
Gabapentin
This drug is indicated as adjunctive therapy in partial seizures with or without secondarily generalized seizures. This drug is available in oral form and is taken three times a day. There is no laboratory examinations such as blood and liver function tests are needed. Side effects of gabapentin are confused, dizzy and balance disorder.
Lamotrigine
This drug is indicated as adjunctive therapy in partial seizures and for single-dose therapy in adult epilepsy patients with partial seizures. This drug is available in oral form and is taken twice a day. There is no laboratory examination is required. Side effects of lamortrigine are headache, nausea, dizzy and skin rash.
Lacosamide
Lacosamide is used as an additional medication in the treatment of partial seizures in patients aged more than 17 years. This drug is available in oral and injectable form and is usually taken twice a day. Side effects of lacosamide are Vertigo, Diplopia, Somnolence, Confused, Headache, Nausea and vomiting
Tiagabine
This medication is used as an adjunctive therapy in partial seizures. Mechanism of action of these drugs may be associated with the effect of GABA in the brain substance. It is available in oral bentu and should be given at doses that have been divided by 2 to 4 times a day. There is no laboratory examination is required. The side effects are dizzy and somnolence.
Levetiracetam
This medication is used as an additional medication in the treatment of partial seizures in patients with epilepsy aged children 4 years and older and adults. This medication is available in tablet and oral liquid are used in children who can not swallow tablets, taken twice a day. The side effects of levetiracetam is confused, balance disorders and personality changes usually disappear after the first month of therapy.
Oxcarbazine
This drug is indicated for single-dose therapy and adjunctive therapy in adult epilepsy patients with partial seizures and as adjunctive therapy in children aged 4 years and older with partial seizures. Side effects of oxcarbazine are Abdominal pain, nausea, vomiting, dizzy, Diplopia, Drowsiness, confusion, Hyponatremia, Impaired gait.
Zonisamide
This medication is used as an adjunctive therapy in adult patients with partial epilepsy seizures. This medication is used twice a day. The side effects of this drug are dizzy, balance disorders, weight loss, and confusion.
Pregabalin
This medication is used as an adjunctive therapy in partial seizures in adult with epilepsy. This drug can be used 2 to 3 times a day. The side effects of this drug are Blurred vision, Difficulty concentrating, dizzy, Dry mouth, Difficulty in swallowing and Somnolence
Phenytoin
Phenytoin is one of the drugs commonly used for anti-convulsive therapy. Phenitoin often considered as the first choice drug for the treatment of partial seizures, tonic clonic seizures (grand mal) and status epilepticus. Phenitoin work by suppressing electrical activity in brain nerve cells. This drug is used for the first time can be taken orally or intravenously. Oral form of the drug has therapeutic benefits for both single dose per day. Phenitoin usage rate should be monitored with liver function tests and complete blood count. Recommended therapeutic dose is 10-20 mg / L. Side effects from the use of phenitoin are Anemia, Excessive hair growth, Lethargy, Gum Hyperplasia, neuropathy if used for long periods
Carbamazepin
This drug is commonly prescribed for the treatment of partial seizures and tonic clonic grand mal seizures). This drug works by a mechanism that is less understandable. In oral form, carbamazepin can drink 2 to 3 times. Level of use of carbamazepine should be monitored. Recommended therapeutic dose was 8-12mg / L. liver function tests and complete blood count should be performed routinely. Side effects of carbamazepine can cause drowsiness, nausea, anemia, neutropenia.
Phenorbital
This medication is used to treat both types of seizures are generalized seizures and convulsions parsial.obat is also used in the protocol after use phenitoin status epilepticus in infants who suffer from epilepsy. This drug can be used in the form of oral or intravenous. Level of use of these drugs should be monitored. Recommended therapeutic dose is 15-40 mg / L. complete blood count should be performed routinely. Side effects of phenorbital is drowsiness, cognitive impairment and cause irritability.
Valproate
This medication is used to treat partial seizures, tonic clonic seizures (grand mal), absence seizures (petit mal) seizures and mioclonic. It is also recognized can prevent migraine headaches. Mechanism of action of this drug is associated with brain substance called GABA (gamma aminobutyric acid). This drug can be used in oral form and should be taken 2 to 3 times a day to get adequate doses. Level of use of these drugs should be monitored, such as the liver function tests and blood tests. The side effects of this drug is liver damage (hepatotoxicity) nausea, weight gain, alopecia, and tremor.
Ethosuximide
This medication is used to treat absence seizures (petit mal). These drugs work by suppressing the activity of brain cells that berhubungna with loss of consciousness. This drug is administered orally, can take the form of tablets or syrup. Level of use of these drugs should be monitored to ensure the therapeutic dose used was 40-100 mcg / mL. complete blood count, urinalysis, and liver function tests should be performed regularly to monitor possible side effects are not expected. Side effects that can be caused ethosuximide, namely:
• Gastrointestinal (nausea, vomiting, abdominal pain, diarrhea, weight loss)
• genitourinary (vaginal bleeding and hematuria)
• Hematology (emphasis on bone marrow)
• Integument (excessive hair growth, skin rash, systemic lupus erythematosus)
• Neurological (headache, dizzy, insomnia, aggressiveness, confusion, difficulty concentrating)
Primidone
This drug is a barbiturate-containing phenorbital. This medication is used to treat generalized tonic-clonic seizures (grand mal) and partial seizures. This drug is used in adults and children older than 8 years. Effective dose to the body is 5-12 mcg / mL. This drug is available in tablets of 250 mg to be taken 3 to 4 times a day. The dose may be increased but not to exceed 500 mg taken four times a day.
Side effects of primidone are: Blurred vision, Confused, Nausea and vomiting, Impotence, Vertigo, Loss of weight. Patients who are allergic to phenorbital epilepsy should not use primidone. This medication appears in breast milk and related neonatal bleeding and coagulation disorder due to deficiency of vitamin K.
B. Second-generation drugs
Topiramate
This medication is used with other anti-seizure drugs in the treatment of partial seizures and generalized tonic-clonic seizures in adults and children aged 2 to 16 years. It is also recognized as a preventive migraine headaches. This medication is available in the form of people who can be taken twice a day (Gordon, 2008).
In March 2011, the U.S. Food and Drug Administration announced that information indicates that topiramate increases the risk of such abnormalities in infants, sample: palatoschisis labioschisis, and when this drug is used during the first trimester of pregnancy. The side effects of this drug are drowsiness, nausea, dizzy, impaired coordination and balance, aphasia, loss of weight, and kidney stones. In children may cause distraction and may become aggressive. Acute glaucoma and visual abnormalities is that Sirius and complications have been reported in some cases.
Gabapentin
This drug is indicated as adjunctive therapy in partial seizures with or without secondarily generalized seizures. This drug is available in oral form and is taken three times a day. There is no laboratory examinations such as blood and liver function tests are needed. Side effects of gabapentin are confused, dizzy and balance disorder.
Lamotrigine
This drug is indicated as adjunctive therapy in partial seizures and for single-dose therapy in adult epilepsy patients with partial seizures. This drug is available in oral form and is taken twice a day. There is no laboratory examination is required. Side effects of lamortrigine are headache, nausea, dizzy and skin rash.
Lacosamide
Lacosamide is used as an additional medication in the treatment of partial seizures in patients aged more than 17 years. This drug is available in oral and injectable form and is usually taken twice a day. Side effects of lacosamide are Vertigo, Diplopia, Somnolence, Confused, Headache, Nausea and vomiting
Tiagabine
This medication is used as an adjunctive therapy in partial seizures. Mechanism of action of these drugs may be associated with the effect of GABA in the brain substance. It is available in oral bentu and should be given at doses that have been divided by 2 to 4 times a day. There is no laboratory examination is required. The side effects are dizzy and somnolence.
Levetiracetam
This medication is used as an additional medication in the treatment of partial seizures in patients with epilepsy aged children 4 years and older and adults. This medication is available in tablet and oral liquid are used in children who can not swallow tablets, taken twice a day. The side effects of levetiracetam is confused, balance disorders and personality changes usually disappear after the first month of therapy.
Oxcarbazine
This drug is indicated for single-dose therapy and adjunctive therapy in adult epilepsy patients with partial seizures and as adjunctive therapy in children aged 4 years and older with partial seizures. Side effects of oxcarbazine are Abdominal pain, nausea, vomiting, dizzy, Diplopia, Drowsiness, confusion, Hyponatremia, Impaired gait.
Zonisamide
This medication is used as an adjunctive therapy in adult patients with partial epilepsy seizures. This medication is used twice a day. The side effects of this drug are dizzy, balance disorders, weight loss, and confusion.
Pregabalin
This medication is used as an adjunctive therapy in partial seizures in adult with epilepsy. This drug can be used 2 to 3 times a day. The side effects of this drug are Blurred vision, Difficulty concentrating, dizzy, Dry mouth, Difficulty in swallowing and Somnolence
