Epilepsy: treatment
Most neurologists now start antiepileptics following a second epileptic seizure. NICE guidelines suggest starting antiepileptics after the first seizure if any of the following are present:
Sodium valproate is considered the first line treatment for patients with generalised seizures with carbamazepine used for partial seizures
Generalised tonic-clonic seizures
Absence seizures* (Petit mal)
Myoclonic seizures
Partial seizures
*carbamazepine may actually exacerbate absence seizure
- the patient has a neurological deficit
- brain imaging shows a structural abnormality
- the EEG shows unequivocal epileptic activity
- the patient or their family or carers consider the risk of having a further seizure unacceptable
Sodium valproate is considered the first line treatment for patients with generalised seizures with carbamazepine used for partial seizures
Generalised tonic-clonic seizures
- sodium valproate
- second line: lamotrigine, carbamazepine
Absence seizures* (Petit mal)
- sodium valproate or ethosuximide
- sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy
Myoclonic seizures
- sodium valproate
- second line: clonazepam, lamotrigine
Partial seizures
- carbamazepine or lamotrigine
- second line: sodium valproate
*carbamazepine may actually exacerbate absence seizure