Primary generalised seizures :
First line treatment is
Valproic Acid
mode of action:-(icreases availability of GABA receptor)
Side effects :ataxia , hepatotoxicity, thrombocytopenia,GI irritation , hyponatremia.
Valproic acid (if not available)choices wud be :
Lamotrigine:
mode of action:decreases glutamate release
side effects: Stevens Johnson syndrome
Carbamazepine
Phenytoin
Absence seizures
first line therapy:Ethosuximide
if unavailable--> valproic acid
Myoclonic and tonic -->Valproic Acid
Pregnant best treated with Carbamazepin
Partial Seizures( Partial /Complex , with or without generalizations)
Carbamazepine and Phenytoin are first line therapy.Valproic acid and Lamotrigine are considered acceptable choices for partial seizures besides levetiracetem.Therapy may be stopped if patient never seizes for 2-3 consecutive years.Sleep deprived EEG helps us to determine if patient is at risk of recurrence.Negative EEG is associated with lower risk.
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