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Epileptic Seizure Management

By Dr Ananya Mandal, MD

People who experience an epileptic seizure need immediate management and a treatment plan arranged in order to prevent future seizures. Details of how seizures are managed and the maintenance therapies administered are given below:

Immediate management

The immediate management of epileptic seizures depends upon the type of seizure. In most cases of generalized seizure, muscle spasms and convulsions occur, placing the sufferer at risk of falling and injuring themselves or choking.

The most common form of generalized seizure, tonic-clonic seizure, causes violent movements that should not be stopped, suppressed or controlled. No form of restraint should be attempted and nothing should be placed in the individual's mouth, even if they are biting their tongue. Sharp or dangerous objects and electrical equipment should be moved away from the epileptic's immediate surroundings.

As soon as the seizure is over, the person may be drowsy and not fully alert. They should then be placed in the recovery position. Typically, if the sufferer is a known epileptic patient and the seizure was shorter than 5 minutes, there is no need for hospitalization whereas a seizure lasting longer than 5 minutes requires medical assistance.

Maintenance therapy and management of seizures

Epilepsy treatment is aimed at preventing seizures and controlling ongoing seizures. Sometimes, simply avoiding triggers that precipitate a seizure such as sleep deprivation or alcohol consumption, may be the only measure required to prevent seizures from recurring and medication may not be required. However, some people with recurrent seizures may require treatment for the rest of their lives.

Antiepileptic drugs (AEDs) are the first choice of treatment. A wide range of AEDs with different mechanisms of actions are available. These agents are successful at preventing and controlling seizures in over 70% of all individuals with epilepsy. Treatment with AEDs is usually uninitiated after the second attack, as the experience of one single seizure is often not sufficient to make a confirmed diagnosis of epilepsy.

These agents work by controlling the electrical impulses within the brain to reduce the risk of a seizure occurring. There are first- and second- line drugs for the treatment of seizures. First-line drugs are the older, more established agents and the newer drugs are kept in reserve for use as second-line treatments.

Some examples of the first-line treatments include sodium valproate, carbamazepine, phenytoin and phenobarbitone. The more recent, second-line AEDs include lamotrigine, levetiracetam, tiagabine, topiramate, gabapentin, oxcarbazepine and vigabatrin.

If a person has been seizure-free for over two years, a physician may sometimes decide to stop treatment. In poorly controlled epilepsy, brain surgery is another treatment option. Focal epilepsies, which affect only a limited area of the brain, may be treated using surgery. Surgery is considered most successful if the affected part of the brain can be surgically treated without causing any significant loss of brain function.

Reviewed by , BSc

Further Reading

Last Updated: Jan 14, 2014

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