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 antiepileptic 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.

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

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.