Chronic Management of Epilepsy

By Ken Hui Yee for PBL Group 7Case 26 - Seizures

Tonic-clonic or Partial Absence Myoclonic*

CarbamazepineLamotriginePhenobarbital

PhenytoinValproateTopiramate

EthosuximideLamotrigineValproate

Diazepam

Second Line (+ combination use)

GabapentinLamotrigineLevetiracetamOxcarbazepineTiagabine

ClonazepamEsclicarbazepineLosigamoneVigabatrinFelbamateRetigabineZonisamide

*limited data

Antiepileptic Drugs

Behavioural and psychological treatments◦ Pt & carer education

covering background information, diagnosis and management of epilepsy, day-to-day adjustments, seizure control, and stigma

◦ CBT◦ Relaxation therapy/Meditation◦ Yoga

◦ * no RCT on CBT, mediation or yoga

Non-Pharmaceutical Treatment

Surgery◦ Amygdalohippocampectomy for drug-resistant

temporal lobe epilepsy◦ Temporal lobectomy for drug-resistant temporal

lobe epilepsy◦ Vagus nerve stimulation as adjunctive therapy for

drug-resistant partial seizures

Non-Pharmaceutical Treatment