![]() ![]() Lacosamide enhances inactivation of voltage-gated sodium channels.*enzyme-inducing AEDs (although topiramate and oxcarbazepine are weaker enzyme inducers). ![]() PBS = Pharmaceutical Benefits Scheme SJS = Stevens-Johnson syndrome. Typical doses are an approximate guide only. Phenobarbitone, primidone, acetazolamide, sulthiame, vigabatrin, tiagabine and ethosuximide are not often prescribed in adults. Oxcarbazepine:carbamazepine dose equivalence approximately 1.5:1 Hyponatraemia (more frequently than with carbamazepine) Lower dose requirement (approximately half) if also taking valproate Rash/SJS (risk reduced with slow titration to target dose over ~8 weeks refer to Product Information, Dosage and Administration) Use with caution in women of childbearing age Tolerance (reduced efficacy) may develop with long-term useĪvailable in standard-release and controlled-release formulations Non-linear pharmacokinetics (steady-state serum concentration not proportional to dose) Characteristics of AEDs approved for use in Australia prior to 2010 Medication Four AEDs have been registered more recently. Table 3 lists, in chronological order of development, AEDs approved for use in Australia prior to 2010 and still prescribed commonly in adults. These adverse effects resolve rapidly on discontinuation. All antiepileptic medications have dose-dependent, neurotoxic adverse effects, such as somnolence, cognitive impairment and ataxia, although the dose at which these emerge varies markedly between individuals. Newer medications have similar efficacy but lower incidence of adverse effects and less potential for pharmacokinetic interactions with other medications, compared with the older AEDs. Older medications, especially carbamazepine, phenytoin and valproate, remain in common use in Australia as first-line therapy, largely because of Pharmaceutical Benefits Scheme (PBS) restrictions on newer agents. Causes of provoked epileptic seizures Acute neurological insultĪlcohol (and other drugs) intoxication or withdrawal Most patients require lifelong treatment. Some other AEDs may control GTCS in this condition but can potentiate absence or myoclonic seizures. 7 Typically, excellent seizure control is achieved with low doses of some medications (eg. Juvenile myoclonic epilepsy is a common, under-recognised genetic generalised epilepsy syndrome in which myoclonic seizures, GTCS and sometimes absence seizures commence around adolescence. In structural/metabolic epilepsies, seizures are due to a structural brain lesion or metabolic disturbance the remaining epilepsies are proven or presumed to have a genetic basis and are hence termed genetic epilepsies. Normal EEG and neuroimaging do not exclude the diagnosis rather, abnormal findings assist in classifying the epilepsy syndrome. Generalised absence seizures (petit mal seizures) are frequent (>daily), brief (24 hours apart) or after one seizure if EEG or neuroimaging findings indicate a genetic or structural basis for a seizure tendency.Įpilepsy remains a clinical diagnosis. Post-ictal stertor, confusion and amnesia typically persist for several minutes. Cyanosis, tongue-biting and urinary incontinence are common during these seizures. All-limb jerking then occurs, lasting for up to 2 minutes. In the initial phase of stiffening, consciousness is lost for a few seconds, causing falls, often with a forced scream (ictal cry). However, this result isn't always conclusive.Patients most commonly seek medical attention for generalised tonic-clonic seizures (GTCS grand mal seizures). During the postictal phase, an EEG will usually show slowed brain activity on the side of the brain where the seizure originated. Electroencephalogram (EEG) involves placing small discs (electrodes) on the scalp to measure electrical activity in the brain.Brain imaging, such as magnetic resonance imaging (MRI) or computed tomography (CT scan), can look for abnormalities that can contribute to seizures, such as a brain tumor.This fluid can then be tested for infections and conditions that affect the nervous system and can cause seizures. Lumbar puncture(LP), or spinal tap, involves inserting a needle into the lower back to collect a sample of cerebrospinal fluid that surrounds the spinal cord and brain.Blood tests may be done to check for various things, including markers of infections or certain genetic conditions that can result in seizures.This can include asking you to name things or tests of physical movements, strength, and reflexes. Neurological exams are often done after a seizure to check mental and motor functioning and to see if there are impairments. ![]()
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