Seizure primary generalized

Adults (17 years of age and older) partial seizures, primary generalized tonic-clonic seizures, or Lennox-Gastaut syndrome-The recommended total daily dose as adjunctive therapy is 200 to 400 mg/day in 2 divided doses in adults with partial seizures, and 400 mg/day in 2 divided doses in adults with tonic-clonic seizures. It is recommended that therapy be initiated at 25 to 50... 

Primary generalized seizures are also heterogeneous with respect to their clinical features. Such seizures can impose as absence epilepsy, which is characterized by a brief interruption of consciousness due to highly synchronized neuronal activity involving thalamocortical networks without increases in neuronal firing rate. On the other hand, tonic-clonic convulsions with loss of consciousness are often also primarily generalized. 

If the entire cerebral cortex is involved in the seizure from the onset of the seizure, the seizure is classified as primary generalized. The following are types of primary generalized seizures. 

Juvenile myoclonic epilepsy (JME) A primary generalized epilepsy syndrome that usually starts in the early to middle teenage years and has a strong familial component. Patients have myoclonic jerks and tonic-clonic seizures and may also have absence seizures. 

It is useful as both adjunctive therapy for partial seizures and as monotherapy. It may also be a useful alternative for primary generalized seizures, such as absence and as adjunctive therapy for primary GTC seizures. 

It is indicated for use as monotherapy or adjunctive therapy for partial seizures in adults and as monotherapy and adjunctive therapy for partial seizures in patients as young as 4 years of age. It is also a potential first-line drug for patients with primary, generalized convulsive seizures. 

Phenytoin is a first-line AED for primary generalized convulsive seizures and for partial seizures. Its place in therapy will be reevaluated as more experience is gained with the newer AEDs. 

It is a first-line AED for patients with partial seizures. It is also approved for tonic-clonic seizures in primary generalized epilepsy. 

It is first-line therapy for primary generalized seizures, such as absence, myoclonic, and atonic seizures, and is approved for adjunctive and monotherapy treatment of partial seizures. It can also be useful in mixed seizure disorders. 

It is approved as adjunctive therapy for partial seizures, but it is potentially effective in a variety of partial and primary generalized seizure types. 

Tonic-clonic seizures- Adjunctive therapy for primary generalized tonic-clonic seizures in adults and children 2 to 16 years of age. 

Oxcarbazepine is a derivative of carbamazepine and although its precise mechanism of action is unknown it has similar properties as carbamazepine and is also used for the treatment of primary generalized tonic-clonic seizures and partial seizures. Also the adverse effects are similar to those of carbamazepine. However the drug interaction profile is different as oxcarbazepine has hardly any enzyme-inducing capacity. 

Phenytoin is effective against partial seizures and generalized tonic-clonic seizures. In the latter, it appears to be effective against attacks that are either primary or secondary to another seizure type. 

Valproate is now the most commonly used antiepileptic drug worldwide. It is the drug of choice in primary generalized epilepsy, particularly in the treatment of generalized absence, myoclonus and tonic-clonic seizures. Valproate is the drug of first choice in atypical absence and atonic seizures, for Lennox-Gastaut syndrome and myoclonic epilepsy. 

In an open study 25 patients with new-onset focal and primary generalized epilepsy were treated with clobazam at a single centre (2). After a mean follow-up of 16 months (range 7-24), 16 patients were seizure free, while five had more than a 50% reduction in seizure frequency. Sedation was the most common adverse event, reported by four patients however it was always mild and did not require withdrawal of clobazam. Other adverse effects, reported in one patient each, were weight gain, ataxia, loss of shortterm memory, and breakthrough seizures. 

Primary generalized tonic-clonic seizures (adjunctive adults and pediatric patients 2-16 years ot age)... 

Carbamazepine is usually regarded as the drug of choice for partial seizures (with or without secondary generalization) and it can also be valuable in preventing primary generalized tonic-clonic seizures. 

CPS, complex partial seizures PGS, primary generalized seizures Abs, absence JME, juvenile myoclonicepilepsy LGS, Lennox-Gastaut syndrome IS, infantile spasms ENL, effective, not labeled (although no indication exists, studies support its use in pediatric patients) NE, not effective , not studied (no well-performed pediatric studies exist for this indication). Data are from Ref 17. 

Single type of partial seizure (simple partial, complex partial, or secondary generalized tonic-clonic seizure) or single type of primary generalized tonic-clonic seizures... 

Place in Therapy. Carbamazepine should be considered a first-line therapy for patients with newly diagnosed partial seizmes and for patients with primary generalized convulsive seizures who are not in an emergent situation. 

I Place in Therapy. Tiagabine is considered a second-line therapy for patients with partial seizures who have failed initial therapy. It does not appear to have a role in primary generalized seizure types. 

---