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Medication treatment of patients
Medication for the treatment of epilepsy (anticonvulsants) is administered:
- to end continuous or recurrent epileptic seizures over a long duration (Status epilepticus)
- to prevent the recurrence of new seizures.
Medications are preferred that take immediate effect against continuous seizures (e.g. benzodiazepines such as Lorazepam (Tavor) or Diazepam (Valium)), or as a secondary option other intravenously applied substances (Phenytoin, Valproic acid). A doctor should normally administer the medication.
The regular intake of medication can result in effective protection from further seizures (seizure freedom) in ca. 70% of all epilepsy patients. The choice of suitable anticonvulsants is based on the correct diagnosis of the presenting form of epilepsy. When taken regularly and in sufficiently high dose the treatment can be effective. Not enough is however known about which medication is most effective in individual cases. For this reason the choice of medication is initially guided by consideration of the profile of side-effects. From this point of view, the newer anticonvulsants of the so-called second generation perform better in many cases than do the older substances.
The initial treatment of choice uses only one preparation (monotherapy). Should this prove to be insufficient, the combination of two substances often achieves better results, provided that the substances are well tolerated, than do each of the substances individually. Change of medication can normally be carried out in the out-patient clinic, in more difficult cases a hospital stay does have advantages.
When several medication treatments have been unsuccessful even at maximum dose tolerance (pharmaco-resistance) attention is turned to other therapeutic procedures (surgical treatment, vagus nerve stimulation, and especially in children the ketogenic diet).
Prof. Dr. A. Schulze-Bonhage
