CHOICE OF ANTIEPILEPTIC DRUG

Magnitude of the problem

Epilepsy affects: approximately 1 in 50 children

and 1 in 100 adults.

PHARMACOTHERAPY OF EPILEPSY: The issues

Is treatment justified? When to start treatment? How to start drug treatment? Which AED? Which dosage? When should AED combinations be

used? Risks associated AED treatment? How long should treatment be

continued?

PHARMACOTHERAPY OF EPILEPSY:

The issues Is treatment justified? When to start treatment? How to start drug treatment? Which AED? Which dosage? When should AED combinations be

used? How long should treatment be

continued?

1840 1860 1880 1900 1920 1940 1960 1980 2000

0

5

10

15

20

BromidePhenobarbital

Phenytoin Primidone

Ethosuximide

Sodium valproate

Benzodiazepines

Carbamazepine

Vigabatrin

ZonisamideLamotrigine

FelbamateGabapentin

Topiramate Fosphenytoin

OxcarbazepineTiagabine

Levetiracetam

More

Year

AEDs

Antiepileptic drug Antiepileptic drug developmentdevelopment

Major considerations in choosing an AED

Type of seizure

Type of epileptic syndrome

Adverse effect profile

Age & gender

Ease of use (fast and easy dose titration)

Specific co-morbidities

Cost

Best first AED

Not a “ one size fits all” scenario Choice of drug:

Depends on : Efficacy Tolerability affordability

Best first AED

Efficacy:Determined by the type of seizure / epileptic syndrome

Step.1:To diagnose epileptic syndrome

Step 2. If not possible, try to exclude JME or absences

Carbamzepine & phenytoin will aggravate JME CBZ, phenytoin, tiagabine & vigabatrin will aggravate

Absences Step.3;

Valproate, lamotrigine or topiramate, Levitiracetum

Epileptic syndrome

The clinical event Ictal & interictal EEG characteristics Age of onset Characteristic evolution &

progression. Presence or absence of family history

Why should we identify the epileptic syndrome?

Whether to investigate the patient further or not

Which drug to choose for the control of seizure

To predict prognosis

Drugs of choice in certain epileptric syndromesEpilepsy syndrome Drugs of choiceFebrile seizure Rectal diazepam

West’s syndrome ACTH, Vigabatrin

Lennox-Gestaut Valproate, lamotrigine, topiramate, clobazam

BECTS Carbamazepine, Valproate

Early onset Benign Occipital seizures

Intermittent rectal diazepam

Late onset childhood occipital seizure

carbamazepine

Absence epilepsy Valproate, Ethosuximide, lamotrigine

Juvenile myoclonic epilepsy Valproate, Lamotrigine

Best first AED

Efficacy: Step.2:If not possible, try to exclude JME or absences Carbamazepine & phenytoin will aggravate JME

CBZ, phenytoin, tiagabine & vigabatrin will aggravate Absences

Step.3; If the seziure can not be typed


Best first AED

Efficacy:

Step.3: If not possible, find out the type the seizure

Partial seizure / primary generalized seizure

Choice of AED

Partial / GTC Seizure Carbamazepine, phenytoin, valproic acid

(sodium valproate ), phenobarbital and primidone are all effective CBZ –drug of choice

All forms of generalised seizure: Valproate; drug of choice

Absence seizures: Valproate, Ethosuximide

Best first AED

Differentiation of partial Versus Generalised epilepsy is not always possible in infants

Eg: Dravet’s syndrome ( severe myoclonic epilespy of chiildhood) usually presents with hemiconvulsion.

Infantile spasm: Pattern can change from generalised to partial

seizures

Best first AED

Efficacy:

If the seizure can not be typed


Best first AED

Tolerability: Valproate & Carbamazepine are better

toleratedthan Pheno or phenytoin

Affordability; Newer AEDs are costly compared older

ones

Newer AEDS

What is real advantage of these newer drugs?

Are they going to replace older drugs? Does high cost of these drugs justify

its usefulness? What are the situations where we can

use these drugs?

Newer drugs

No major differences in efficacy between drugs

Major differences in side effects profiles

Drug interaction potential also differs

Drug choice should be tailored to the patient

EFFICAY OF NEWER AED AS MONOTHERAPY RCT have shown no major difference in

seizure control between: LTG vs CBZ * LTG better tolerated LTG vs DPH * LTG better tolerated OXC vs CBZ * CBZ increased allergy OXC vs VPA * No difference OXC vs DPH * withdrawal more in DPH GBP vs CBZ * Withdrawal more in GBP GBP vs LTG TPM vs CBZ & VPA * No difference

UK NICE guidelines for the use of new AED

If established drugs have failed Typically carbamazepine or valproate

If most appropriate older drug is contraindicated

If older drugs could interact with other medications

If older drugs are already known to be poorly tolerated by the patient

If patient is a woman of child bearing potential

Newer AEDs in Epilepsy Management

Among the newer AEDs, is there a preference of any particular AED for a specific type of seizure?

Broad spectrum AED

Lamotrigine Topiramate Levitiracetum Clobazam

Newer AED for generalised seizure

Lamotrigine, Topiramate,

Zonisamide, and Levetiracetam

Oxcarbazepine, tiagabine and gabapentine are ineffective

AED for JME

Valproate is superior

Second choice

Levitiracetum Clobazam Topiramate Lamotrigine

JME

When on lamotrigine: If tonic-clonic seizures have been

controlled, but myoclonic seziures persist

Add clonezepam , before changing to valproate, topiramate or levetiracetam

Newer AED for Partial seizure

Lamotrigine, Oxcarbazepine, Clobazam Gabapentin and Topiramate is same as that of carbamazepine or

phenytoin.

NEWER AED FOR PARTIAL SEIZURE AAN guideline recommendations for

new onset partial seizure Gabapentin Topiramate Oxcarbamazepine Lamotrigine

However, levitiracetum, zonisamide & tiagabine are also effective

Drugs effective for both generalized & partial;

Valproate, LTG, Topiramate, Levetiracetum and Zonisamide.

Efficacy Spectrum of Available AEDsAbsences & certain myoclonic seizures

Broad spectrum

Partial & generalised

Partial seizures Absence only

Valproic acid

Ethosuximide

Sodium valproate

Lamotrigine* *

Carbamazepine

Phenytoin*

Ethosuximide

Topiramate Oxcarbazepine*

Levitiracetam Vigabatrin*

Zonisamide Gabapentin*

Tiagabine** May exacerbate myoclonic and absence seizures Vigabatrin is also effective in infantile spasms * * Lamotrigine may aggravate severe myoclonic epilepsy

TOLERABILTY OF NEW AEDS

Gabapentin Levetiracetum Lamotrigine

Oxcarbamazepine Tiagabine Topiramate Vigabatrin

Well tolerated

Higher treatment withdrawal

EFFECT ON COGNITION

Levetiracetum Lamotrigine Tiagabine

No significant effect on Cognition,

How long the AED will take to produce its effect?

Time to achieve steady state

Time to achieve steady stateof AEDsDRUG HALF LIFE TIME TO ACHIEVE

STEADY STATE

Phenytoin 15-30 hrs 5-15 days

Carbamazepine 11-17 hrs 3-5 days

Valproate 6-18 hrs 2-4 days

Oxcarbamazepine 8-10 hrs 3-4 days

Lamotrigine 10-15 hrs 5-15 days

Topiramate 20-24 hrs 5 days

Levetiracetum 7-8 hrs 2-3 days

Gabapentin 5-7 days 1-2 days

Inappropriate AED choice and

seizure worsening

Wrong selection of drugs can worsen seizure

AEDs which may aggravate some epileptic syndromes

Drug Syndrome

Carbamazepine Absence epilepsy Juvenile myoclonic epilepsyProgressive Myoclonus E.Rolandic Epilepsy

Phenytoin Absence epilepsy Progressive Myoclonus E

Phenobarbitone Absence epilepsy

Benzodiazepines Lennox-Gastaut syndrome

AEDs which may aggravate some epileptic syndromes

Drug Syndrome

Vigabatrin Absence epilepsy Epilepsies with myoclonus

Gabapentin Absence epilepsy Epilepsies with myoclonus

Lamotrigine Severe myoclonic epilepsy Juvenile myoclonic epilepsy

Paradoxical effects of AEDs CBZ in partial epilepsies;

FLE, BECTS, LKS, BEOP, Angelman’s syndrome Negative myoclonus & atypical absences Correlates with bilaterally synchronous

discharges in EEG I/V BZD precipitates tonic status in LGS,

even when child is already on oral BZDs

Paradoxical effects of AEDs VPA increases absences in CAE LTG:

Precipiates absence seziures in BECTS Myoclonic status in LGS

Levitiracetum Seizure exacerbation in refractory

epilepsy with LEV at doses more than 30 mg/kg/d

Are two drugs better than one?

Monotherapy can control seziures in 60%

When to start polytherapy?

When two monotherapy trials fail!

Which initial drug?

Initial treatment of idiopathic generalized epilepsy (expert committee)CLINICAL SITUATION GTCS ABSENCE S MYOCLONIC

EPILEPSY

Initial monotherapy ValproateLamotrigineTopiramate

ValproateEthosuximideLamotrigine

Valproate

Second monotherapy( Valproate failure)

LamotrigineTopiramateLevitirecetum

EthosuximideLamotrigine

ZonisamideLevitiracetumTopiramate

Second monotherapy( lamotrigine failure)

ValproateTopiramateLevitiracetumZonisamide

ValproateEthosuximide

Valproatezonisamide

Second monotherapy( Topiramte failure)

ValproateLamotrigine

ValproateEthosuximdeLamotrigine

Valproate

If valproate fails If valproate fails as the first AED

Lamotrigine monotherapy is unlikely to be successful (Nicolson et al. 2004)

Prefer Topiramate or levetiracetam.

With generalized tonic-clonic seizures alone the choice is wider includes carbamazepine or oxcarbazepine in

addition

Drugs recommended for focal epilepsy ( expert committee)SIMPLE PARTIAL

SEIZURECOMPLEX PARTIAL SEIZURE

SECONDARILY GENERALISED SEIZURE

Carbamazepine Carbamazepine Carbamazepine

Oxcarbamazepine Lamotrigine Oxcarbamazepine

Lamotrigine Oxcarbamazepine Lamotrigine

Levitiracetum levitiracetum Levitiracetum

ILAE /AES Guidelines According ILAE treatment guidelines,

First-generation AEDs carbamazepine, phenytoin, and probably valproic acid have demonstrated effectiveness as monotherapy for partial-onset seizures.

According to AAN/AES subcommittees, Of the second generation AEDS, lamotrigine,

oxcarbazepine, and topiramate may be effective for monotherapy, although the ILAE has added that gabapentin,

and vigabatrin may also be efficacious or effective as monotherapy.

Alternative choice in partial seizures

If carbamazepine is effective against seizures but poorly tolerated Try oxcarbazepine or lamotrigine next.

If carbamazepine fails to control seizures Levetiracetam or topiramate are likely to

be more powerful than gabapentin or lamotrigine

valproate remains an option.

SANAD STUDYStandard and New antiepileptic Drugs

SANAD was an unblinded randomised controlled trial in hospital-based outpatient clinics in the UK

Aim is to study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy:

SANAD STUDY

Lamotrigine is clinically better than carbamazepine for time to treatment failure outcomes

SANAD STUDY

Study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy:

SANAD STUDY

Valproate is better tolerated than topiramate and more efficacious than lamotrigine, and should remain the drug of first choice for many patients with generalised and unclassified epilepsies.


The issues Is treatment justified? When to start treatment? How to start drug treatment? Which AED? Risks associated AED treatment? Which dosage? When should AED combinations be


continued?

Pharmacoresistent epilepsy If Patient fails on 2 or 3

monotherapy trials:

Polytherapy

Which drugs for add-on?

RECOMMENDED AED COMBINATION

in Generalised seizureDRUG IN USE RECOMMEDED COMBINATION

Valproate LamotrigineTopiramateLevetiracetumzonisamide

Drugs found to be useful asAdd-on in Primary generalised seizures ( by RCTS) Lamotrigine, Topiramate Felbamate and topiramate in LGS

RECOMMENDED AED COMBINATION IN FOCAL SEIZURE

DRUG IN USE RECOMMEDED COMBINATION

Carbamazepine

LevetiracetumLamotrigineTopiramateZonisamide

SUCCESS RATES OF NEWER AED for Partial seizure (As add–on)

27-29%: WITH OXC, Levitiracetam, topiramate

12-20% WITH

LTG, Gabapentin , Zonisamide

COMPLAINTS RATES OF NEWER AED(as add on)

-28 TO -82 Gabapentin, Levitiracetam and

zonisamide

-113 to -205 OXC, topiramate and LTG

Hence the ideal drug is Levitiracetam.

OXC and Topiramate are equally effective but less tolerable.

EPILEPSY - MANAGEMENTCHOICE OF DRUGS

ARE SPECIFIC COMBINATIONS USEFUL?

* Combination of VPA & Ethosuximide -- in absences * Combination of VPA & clonezepam -- In myoclonic seizure * Combination of CBZ & vigabatrin -- In partial seizure

* Combination of LTG & Valproate -- In partial, generalized,

JME

How to combine drugs? Use AEDs with different mechanisms of action:

, e.g. a sodium channel blocker (carbamazepine) with a GABA-ergic agent (valproate);

Use AEDs with favourable pharmacokinetic interactions: e.g. valproate and lamotrigine.

(enabling lower doses of lamotrigine to be used);

Avoid combinations with similar mechanisms of action and/or unhelpful phamacokinetic interactions: e.g. Carbamazepine and phenytoin

Carbamazepine and Lamotrigine

If combination therapy fails!

Consider surgery!

If this is not an option; Go back to the combination that gave

optimum, control

INFANTILE SPASMS

ACTH, Vigabatrin Zonisamide ( open label studies) Levitiracetum




continued?

Getting the dosage right

As important as choosing the right drug!

Some AEDs require slow titration e.g. CBZ, LTG, TPM and TGB

Dosage should be tailored to meet individual needs

Monitoring drug levels may help with dose tailoring

EPILEPSY - MANAGEMENTDRUG DOSE & INTERVAL

May not always require the std dose. Gen. seizure requires less dose than partial Dose interval is determined by half -life

Eg: Pheno, DPH,LTG = OD

CBZ, VPA, Topiramate = BD Multiple AEDs = shorten half life Larger doses in children than adults

DRUG INTERACTION

DPH

PBPMD

CBZ VPA

ETX

Enzyme induction

Enzyme inhibition

DRUG INTERACTIONEffect of older AEDs on newer AEDs

GPBGabapentine

LTGLamotrigine

TPMTopiramate

TGNTiagabine

LEVLevetiracetam

ZONZonizamide

OXCOxcarbazepine

DPH

CBZ

PhenoPRM

None None

VPA None None None None None Slight

DRUG INTERACTIONEffect of Newer AEDs on old AEDs

New AEDs have no significant effect on the blood level of old AEDs.

Phenytoin, carbamazepine, pheno or primidone

Valproate level is decreased by 25%

DRUG –DRUG INTERCATION POTENTIAL OF THE AEDs

HIGH INTERMEDIATE MINIMAL OR NONE

phenytoin Topiramate Gabapentin

Carbamazepine lamotrigine Levitiracetum

valproate Tiagabine Vigabatrin

Phenobarbitone Oxcarbazepine

primidone zonisamide

Pharmacotherapy in children Both old & newer drugs can be used Requires dose adjustments;

Slow GI absorption. Higher volume of distribution Shorter clearance periods

Eg: dose of CBZ infants : 30-50mg/KG Vs 15-35 mg/kg in older children

Pharmacokinetics in children Pharmacokinetic Parametres in infants

VPA & Pb have favourable kinetics CBZ & DPH have unfavourable kinetics

CBZ dose is in higher & should be given tid dosage

DPH –difficult to determine adequate dose In view of non-linear pharmacokinetics Slight change in dose may produce toxicity/

subtherapeutic level Increased clearance of LTG and Topiramate




continued?

Side effect profile of AEDS Quality of life

Not only related to the magnitude of seizure reduction

but also to the impact of the AED on cognition, mood (eg, depression, anxiety, and

irritability), psychomotor dysfunction, sexual dysfunction, cosmetic effects, bone health, weight gain etc.

Risks associated with AED treatment Failure to achieve complete seizure

control

Dose-dependent CNS side effects

Idiosyncratic reactions

Chronic adverse effects

Adverse drug interactions

The devil that we do not know:Latency to discovery of some adverse effectsDrug Adverse Effect Incidence Latent Period

PHT Osteomalacia Up to 5% 1938 1967

FBM Aplastic anaemia 1:4000 1993 1994

VGB Visual field defects 33% 1989 1997

TPM intraocular ? 1995 2001

pressure

Side effects mandating stopping treatment:

Clobazam: Behavioral changes, irritabilty

Topiramate: Language disturbances, glaucoma

Levitiracetum: Mood and behavioral changes

Lamotrigine: Drug rash & SJ syndrome

Zonisamide: Mental slowing, hypohidrosis

Vigabatrin: Visual field defects

Tolerability in infants & children

Valproate Valproate hepatotoxicity

Increased below the age of 2 yrs Polytherapy Presence of associated psychomotor delay

Look for undiagnosed inherited metabolic diseases Carnitine deficiency/ Alper’s disease

(Valproate interferes with mitochondrial function)

Pharmacotherapy in children Valproate;

Preferably avoid in infants with Abnormal LFT, multiorgan failure, polytherapy or in those where exact aetiology is

unclear

Tolerability in infants & children

Pheno induced behavioural side effects 1/3 develop hyperexcitability / insomnia

Benzodiazepines induced paradoxical hyperexcitation Bronchorrhoea / dysphagia with clonezepam

Vigabatrin Hypotonia & somnolence Retinal toxicity is less inchildren

Topiramate Metabolic acidosis is more in infants.

PHT worsens PME ( both myoclonus & ataxia)

Emerging new AEDS

Brivaracetam. Derivative of levetiracetam. Mech of action;

It is a high-affinity synaptic vesicle protein 2A (SV2A) ligand

inhibitory activity at neuronal voltage-dependent sodium channels

High responder rate ( 55% versus 16%) Excellent tolerability

Emerging new AEDS

Carisbamate. Adjunctive treatment for partial-onset

seizures It inhibits voltage-gated sodium channels has a broad-spectrum of activity in a

number of animal models of seizure and drug refractory epilepsy Responder rate( 28% versus 6%)

Mode of action: unknown Efficacy & tolerability data are limited

Emerging new AEDS

Eslicarbazepine acetate. A voltage-gated sodium channel action

blocker, a prodrug that is structurally similar to

carbamazepine and oxcarbazepine. It has improved tolerability, Responder rate 41% versus 28% Once daily dosing is enough

Emerging new AEDS

Lacosamide. Approved by FDA Adjunctive therapy for partial-onset seizures Oral and intravenous forms of this drug are

available. Responder rate (41% versus 20%) Unique action:

It selectively enhances slow inactivation of voltage-gated sodium channels without affecting fast inactivation

Lack of sedation, high intolerance rate

Emerging new AEDS

Retigabine. Adjunctive therapy for partial-onset

seizures in refractory epilepsy, Acts on voltage-gated potassium

channels. It is a neuronal potassium channel opener

Responder rate (45% versus 15%) High discontinuation rate due to side

effects

Emerging new AEDS

Rufinamide. Approved by FDA Adjunctive treatment of seizures

In Lennox-Gastaut syndrome Acts on sodium channel.

Emerging new AEDS

Stiripentol.

This AED appears to enhance GABA release and has a positive effect on GABAA receptors.

It has been used in the treatment of Dravet syndrome (severe myoclonic epilepsy)i

Emerging new AEDS undergoing trials

Flurofelbamate Ganaxolone Huperzine A Losigamone Safinamide Talampanal Tonabersat Valrocemide

ADD SANAD STUDY

Thank You

Effect of non-AEDS on newer AEDs Rifampicin decrease the blood level

of lamotrigine; INH increases it.

Anti HIV agents increases the level of Lamotrigine, Levitiracetum & gabapentin

AED & oral contraceptives Topiramate,oxcarbazepine, and

felbamate are weak inducers & can reduce the oral contraceptive effect.

AEDs that are safe to use in the presence of oral contraceptives include valproate, gabapentin, lamotrigine,

levetiracetam, and zonisamide.

NEWER DRUGS IN STATUS:

i/v Valproate: i/v Levetiracetum; Oral Clobazam Oral Topiramate

NEWER DRUGS IN STATUS:I/V valproate

CSF penetration is similar to I/V diazepam

Good alternative to phenytoin. Seizure control in 80% of patients More effective than Phenytoin (66% vs

42%) No significant side effect:

No sedation, No hypotension.

NEWER DRUGS IN STATUS:I/V valproate Dose:

I/V bolus: adult dose: 15-30 mg/kg Children; 20-40 mg/kg

At the rate of 50mg /mt

Adverse effects: Hyperammonemic encephalopathy Pancreatitis Thrombocytopenia

Contraindication Children with acute liver failure Patients with inherited metabolic diseases

NEWER DRUGS IN STATUS:I/V Levetiracetum

Advantages: Rapid titration. No drug interaction Good safety profile Excellent choice in hepatic failure

I/V dose; 1000 mg i/v

Efficacy: 100% efficacy in BZD resistant SE

NEWER DRUGS IN STATUS:Topiramate

Oral loading Topiramate:

10mg/kg followed by 5mg/kg/day

USE & SIDE EFFECT PROFILE

OF NEWER AEDS

CLOBAZAM

Highly effective as an add-on Antiepileptic effect: Broad spectrum;

Partial, secondarily generalised, Absences, myoclonus LGS, ESES Alcohol withdrawal seizures Benign childhood partial epilepsies Intermittent therapy in catamenial

epilepsy

CLOBAZAM

Side effects; Behavioral disturbances, irritability Sedation Tolerance

Topiramate

Broad spectrum\: Partial, secondarily generalised Primary generalised LGS Childhood epilepsy syndromes Infantile spasms SMEI Atypical absence & tonic seizures

Topiramate induced cognitive & langauge problems Risk factors:

Dependent on the rate of dose escalation the risk of cognitive dysfunction with predominant

word finding difficulties can be reduced if the dose is built up by no more than 25 mg per week or fortnight,

a family history of psychiatric disorder Family history of epilepsy history of febrile convulsions and generalised

tonic-clonic seizures

Topiramate : other side effects Acute ocular problems;

Reduced visual acuity, myopia, and increased intraocular pressure

Combination of topiramate with valproate can be hepatotoxic.

Renal stones Hypohidrosis

Levitiracetum

Broad spectrum; Partial seizures, secondarily generalised Photosensitive epilepsy Idiopathic generalised epilepsy Absences Myoclonus-JME

Levitiracetum

Advantages: Highly effective Generally well tolerated No significant drug interaction

Main disadvantge: Mood & behavioral changes

Zonisamide

Broad spectrum: Particularly useful in:

LGS, infantile spasms, PROGRESSIVE MYOCLONIC EPILEPSY

Zonisamide;

Side effects; Ataxia, dizziness Mental slowing, Impaired concentration. Hypohidrosis-heat stroke Renal calculi Weight loss

Lamotrigine

Broad spectrum: Partial, generalised. LGS, Infantile spasm

Advantage: Moderate effectiveness, well tolerated.

Main side effect: High instance of rash (appears within 4

weeks) Slow titration

Extensive drug interactions

PHARMACOTHERAPY OF EPILEPSY: The issues

Is treatment justified? When to start treatment? How to start drug treatment? Which AED? Risks associated AED treatment? Which dosage? When should AED combinations be used? How long should treatment be

continued?

# Factors to be considered:

1. Probability of relapse 2. Presence of adverse

effect 3. Psychological attitude 4. Legal implications

DRUG TREATMENT -When to stop?

When to stop AED

Recurrence risk in all types of epilepsy after 2 years of seizure free period : 29%

Most Recurrences occur in the first year

If a patient is seizure free for more than 2 years after stopping treatment, subsequent recurrent risk is very low.

When to stop AED

RISK FACTORS FOR HIGH RECURRENCE : Patients with abnormal EEG Known structural lesion and /or

neurol.deficit Occurrence of many seizures before control Long duration between therapy & seizure

control More than one type of seizure Adult onset complex partial seizure The seizure type

When to stop AED

Early versus late withdrawal

( < 2 yrs)

Early discontinuation was associated with greater relapse rate in patients with partial epilepsy and in those with abnormal EEG

PROGNOSIS OF EPILEPSY PROGNOSIS OF EPILEPSY RELAPSE RATE: # MOST IMPORTANT

PREDICATORS:

* Seizure type

myoclonic/atonic/tonic * Symptomatic partial * Syndromic forms eg: JME

PROGNOSIS OF EPILEPSY PROGNOSIS OF EPILEPSY RELAPSE RATE:

# JME - 85 -95%

# GTC on awakening - 30-90% # Symptomatic partial - 25 -

75% # Childhood absence - 5 -25% # Benign rolandic epilepsy - 0%

PROGNOSIS OF EPILEPSY PROGNOSIS OF EPILEPSY GOOD PROGNOSIS IN:

1. Febrile seizure 2. Benign rolandic epilepsy 3. Absence seizures 4. Idiopathic gen. tonic

clonic seizure ( with onset between 1

- 10 yrs)

PROGNOSIS OF EPILEPSY PROGNOSIS OF EPILEPSY POOR PROGNOSIS IN:

1. Complex partial seizure 2. Symptomatic partial epilepsy 3. All forms of minor motor

seizures 4. Generalised tonic clonic

seizures ( With onset in infancy or

puberty)

Thank You

Documents

CHOICE OF ANTIEPILEPTIC DRUG