DR Medhat MRCP

- Complex partial seizures can take the form of automatisms, such as chewing
and swallowing, repeatedly scratching the head or searching for an object.
- Some people may even undress.
- They can occur as a result of seizure activity in any part of the brain but most
commonly arise in the temporal lobes.
• Traeatment:
Monotherapy should be attempted before combination therapy is started.
Caution should be exercised when combining sodium valproate (Depakine®) and
lamotrigine(lamictal®) as serious skin rashes such as Steven-Johnson's syndrome
may be provoked.
Most neurologists now start antiepileptics following a second epileptic seizure.
NICE guidelines suggest starting antiepileptics after the first seizure if any of the
following are present:
1) The patient has a neurological deficit.
2) Brain imaging shows a structural abnormality.
3) The EEG shows unequivocal epileptic activity.
4) The patient or their family or carers consider the risk of having a further
seizure unacceptable.
هام جدا جدا : Guidelines
o Na valproate (depakine®) is 1st line for generalised seizures & myoclonus
o Carbamazepine (tegretol®) is 1 st line for partial seizures.
o Lamotrigine (Lamictal®) is 2 nd line for all types.
1) Tonic-Clonic Seizures(Grand mal) :
- 1 st line : Sodium valproate (Depakine®).
- Second line: lamotrigine (Lamictal®), carbamazepine (Tegretol®)
2) Absence Seizures* (Petit Mal)
- 1 st line : Sodium valproate or ethosuximide (in isolated absences).
- Sodium valproate particularly effective if co-existent tonic-clonic
seizures in primary generalised epilepsy
3) Myoclonic Seizures:
- 1 st line : Sodium valproate.
- Second line : Clonazepam (Rivotril®), lamotrigine (lamictal®).
4) Partial Seizures:
- 1 st line : Carbamazepine (Tegretol®).
- Second line : lamotrigine**, sodium valproate.
- Gabapentin (Neurontin®, Gabarone®)
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