Epilepsy

Clinical Description

This is a condition characterized by recurrence of seizures. This can be due to a brain insult which might have resulted from infections, stroke, perinatal causes, tumours, head trauma or genetic causes.

Treatment

• Treatable causes should always be ruled out.
• Treatment can be initiated in patients at risk of further seizures as described above.

Antiepileptic medications

• Initiate treatment with one antiepileptic drug at either its recommended dosage (mg/kg) or minimal dose and titrate to recommended dosage.
• If seizures persist at the maximum tolerable dose of the initial drug, then add another antiepileptic drug as described above.
• Treatment resistant forms of epilepsy may require more than 1 antiepileptic medications.
• Some antiepileptic medications are teratogenic. Women of childbearing age should always be encouraged to use family planning methods when on such drugs i.e.

Sodium Valproate

• Folic acid must always be given to women on Antiepileptic drugs.
• Some antiepileptic drugs induce hepatic enzymes which may lead to reduction in blood levels of Antiretroviral medications or family planning drugs. Clinicians need to make necessary changes in such patients.
• Treatment should not be stopped because of pregnancy: it is more dangerous for the mother and foetus to have uncontrollable seizures than to continue the anti- epileptic medicine.
• Treatment should never be stopped suddenly due to risk of status epilepticus, but rather tapered- off over weeks or months.

Available AEDs in Malawi

• Phenobarbitone sodium 60-180 mg at night

Alternatively

• Carbamazepine 100 -200mg 1- 2 times daily. Increase by 100 - 200 mg weekly until dose is 800 mg - 1200mg per day.

OR

• Sodium Valproate 600 - 2000mg daily divided in 2 doses.

OR

• Phenytoin 150 - 300mg daily divided in 1-2 doses. Can be increased to 500mg daily.

Note: counselling on safety should always be done to patients.