Treatment of Epilepsy

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Treatment of Epilepsy

• Something Ancient,
• Something Old,
• Something New

2
Treatment of EpilepsyWhy to Treat

• The GOAL of successful treatment is to reduce the
  frequency and severity of the seizure episodes
• Preventing all seizures may not be possible
• Another reason for failing to control epilepsy is
  improper medication

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The 2 Basic, Initial ApproachesWhen to Treat

• Some believe that the seizure pathway is
  learned therefore, initial treatment is begun
  after the first seizure, minimizing the
  likelihood of future seizures
• Others believe that (with mild seizures)
  treatment should be withheld until the seizures
  occur often enough that a response to medication
  can be seen

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Choices in TherapyHow to Treat

• Anticonvulsant Drugs
• Supportive Measures
• Diet
• Parasite Control
• Complementary Alternative Medicine
• Acupuncture
• Homeopathy
• Western Herbal Medicines

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Anticonvulsant Drugs

• Phenobarbital
• Potassium Bromide (KBr)
• Felbamate
• Primidone
• Diazepam
• Others
• Phenytoin, Valproic acid, Gabapentin, Lamotrigine

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PhenobarbitalThe Old Standby

• The safest, most reliable and cheapest
• Dosage is 1-4 mg/kg every 12 hours
• mild seizures- -start low
• severe seizures- -start high
• Effective blood level is 20-40 µg/ml
• 60 protein bound (10 displaceable)

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KBrAn Old Chemical Made New

• Made from chemical grade material
• Dosage as primary anti-convulsant is 22 mg/kg
  every 12 hours
• Effective blood level is between 1200-2000 µg/ml
• Few side effects

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DiazepamAgent to Help Stop Seizures

• Rapid action, but short acting in dogs (15-30
  minutes)
• Can be given
• orally
• intravenously
• rectally (injectable or suppository)
• intranasally
• Dosage is 0.5-1/5 mg/kg

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Supportive Measures

• Diet
• low protein/balanced food
• antioxidants
• beta carotene, vitamin E, vitamin C, selenium
• ginkgo biloba
• Parasite Control
• avoid organophosphates (and other toxins)
• avoid Heartgard, Sentinel, Program, Advantage

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Acupuncture Homeopathy

• Acupuncture
• insertion of small needles or implantation of
  gold beads into acupuncture points
• can reduce (or, in some cases, replace) the need
  for anticonvulsant medications
• Homeopathy
• remedies are based upon constitution, symptoms
  and signs of each patient
• uses like to treat like

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Valerian Root

• Herbal equivalent to phenobarbital
• Used in the past to control seizures prior to the
  discovery of the barbiturates
• Dosage is 2-4 mg/kg of standardized extract (120
  mg 450-550 mg dried herb) every 12 hours
• Does not affect liver function like phenobarbital

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Other Western Herbs

• Passionflower
• herbal equivalent of diazepam
• Kava Kava
• may be cross between phenobarbital and diazepam
  (general CNS depressant)
• should only be used for 3 weeks of the month
• Milk Thistle
• may protect the liver from chemical damage

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Vagal PacemakerVagus Nerve Stimulation

• Similar to cardiac pacemaker
• Electrode implanted around vagus nerve and
  control unit placed on chest wall
• Used to treat refractory epilepsy
• Expensive

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Status EpilepticusA Neurologic Emergency

• A malignant seizure condition where the patient
  seizures constantly or has seizure after seizure
  without abatement
• Should consider when any generalized seizure last
  longer than 5 minutes or when more than 3
  seizures occur within 1 hour
• Seek immediate emergency care

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Status EpilepticusGoals of Treatment

• STOP the seizures!
• Maintain airway and ventilation support
• Lower the temperature (if elevated)
• Prevent further brain damage by using antioxidant
  medication (methylprednisolone or
  n-acetylcysteine)

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Conclusions

• The initial anticonvulsant therapy will usually
  effectively control 75-80 of epileptic patients
• Adding a second agent can control an additional
  15-20 of the patients
• Most epileptics can lead long and healthy lives