Article Figures & Data
Tables
SEIZURE CHARACTERISTICS TYPES Partial or focal seizures Simple: without loss of consciousness or Complex: with loss of consciousness Motor
Sensory
Autonomic
AffectiveGeneralized (with loss of consciousness) Primary or secondary (following partial seizure)
With or without auraNonconvulsive: -
Absence or petit mal
Convulsive:-
Grand mal or tonic-clonic
-
Clonic (upper limb, neck, and face contractions)
-
Myoclonic (limbs)
-
Tonic (generalized rigidity and falls)
-
Atonic (sudden loss of muscle tone)
-
Data from Caraceni et al.5
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SEIZURE TYPE FIRST-LINE TREATMENT SECOND-LINE TREATMENT Partial (with or without secondary generalized seizure) Carbamazepine
Phenytoin
Oxcarbazepine
Valproic acid (for secondary generalized seizure)Phenobarbital
Clobazam (for simple partial seizures)
Gabapentin
Topiramate
Lamotrigine
LevetiracetamGeneralized • Absence Valproic acid
ClonazepamClobazam
Topiramate
Lamotrigine• Myoclonic Valproic acid
ClonazepamClobazam
Topiramate• Tonic-clonic Carbamazepine
Phenytoin
Valproic acidPhenobarbital
Oxcarbazepine
Topiramate-
Data from Beaulieu and Nadeau,3 and Caraceni et al.5
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ANTICONVULSANT STARTING DOSE USUAL EFFECTIVE DOSE SIDE EFFECTS Phenytoin NA 200–500 mg/d in single or divided doses Drug-drug interactions including dexamethasone, CNS (ataxia), liver, GI, dermatologic, hirsutism, anemia, osteoporosis Carbamazepine 200 mg/d; increase by 200 mg/wk 300–1600 mg/d in 3–4 divided doses or 2 divided doses if long-acting Drug-drug interactions, SIADH, CNS (sedation, vertigo, ataxia, diplopia), myelotoxicity Valproic acid 15 mg/kg daily; 250–500 mg/d, increased weekly by 250 mg/wk 1000–3000 mg/d, up to 60 mg/kg daily (check serum levels) in 3 divided doses or 2 divided doses if long-acting; decrease dose if hepatic failure occurs Drug-drug interactions, CNS (ataxia, tremors, sedation), weight gain, hair loss, GI, thrombocytopenia, liver toxicity Oxcarbazepine 300–600 mg/d 900–2400 mg/d; decrease dose if renal failure occurs Hyponatremia, dizziness, somnolence, nausea, ataxia, diplopia Phenobarbital NA 60–250 mg/d, maximum 600 mg/d (1–5 mg/kg in adults) in single or divided doses; decrease dose if renal or hepatic failure occur Drug-drug interactions, CNS depressor, respiratory depression, somnolence, rash Gabapentin NA 300–3600 mg/d as monotherapy; up to 1800 mg/d as adjuvant therapy, in 3–4 divided doses; decrease dose if renal failure occurs Interaction with antacids; decrease in memory and concentration; somnolence, ataxia, dizziness, edema, weight gain Lamotrigine 50 mg/d for 2 wk, then increase by 25–50 mg/wk 100–500 mg/d in 2 divided doses; decrease dose if renal or hepatic failure occur Rash, especially if dose escalation is rapid Topiramate 25 mg/d; increase by 25–50 mg/wk 75–400 mg/d in 2 divided doses; decrease dose if renal failure occurs Drug-drug interactions, somnolence, confusion, weight loss, metabolic acidosis, angle-closure glaucoma Levetiracetam 750–1000 mg/d 1000–3000 mg/d in 2 divided doses; decrease dose if renal failure occurs Anxiety, aggressivity, somnolence, asthenia, dizziness Clobazam 10 mg/d 10–30 mg/d, maximum 60–80 mg/d in 2 divided doses Same as for benzodiazepines; rash Clonazepam NA 1–6 mg/d in 2–3 divided doses Same as for benzodiazepines; paradoxical excitation -
CNS—central nervous system, GI—gastrointestinal, NA—not applicable, SIADH—syndrome of inappropriate antidiuretic hormone secretion.
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Data from Beaulieu and Nadeau,3 and Caraceni et al.5
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