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Treatment of Epilepsy

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The GOAL of successful treatment is to reduce the frequency and severity of the ... Kava Kava. may be cross between phenobarbital and diazepam (general CNS depressant) ... – PowerPoint PPT presentation

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Title: Treatment of Epilepsy


1
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

3
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

4
Choices in TherapyHow to Treat
  • Anticonvulsant Drugs
  • Supportive Measures
  • Diet
  • Parasite Control
  • Complementary Alternative Medicine
  • Acupuncture
  • Homeopathy
  • Western Herbal Medicines

5
Anticonvulsant Drugs
  • Phenobarbital
  • Potassium Bromide (KBr)
  • Felbamate
  • Primidone
  • Diazepam
  • Others
  • Phenytoin, Valproic acid, Gabapentin, Lamotrigine

6
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)

7
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

8
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

9
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

10
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

11
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

12
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

13
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

14
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

15
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)

16
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
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