Primidone, which is a deoxybarbiturate, is a useful agent in the treatment of grand mal and psychomotor epilepsy. It is generally given in combination with diphenylhydantoin in order to achieve better results in the treatment of grand mal epilepsy and myoclonic seizures.
Primidone (Mysoline)
Dosage : The average daily oral dose of primidone is 0.5 to 2 g.
Adverse Effects : The most common complaint is a feeling of lethargy, drowsiness, and dizziness. Sometimes the drug may cause visual disturbances.
Precautions
The drug should be stopped immediately if there is any sign of an allergic reaction.
It should not be administered to a patient who has any previous history of mental illness or has an unstable personality.
Lamotrigine (Lamitor 25 mg, 50 mg)
A broad spectrum anti-epileptic effective in refractory cases. Its adverse effects are dizziness, unsteadiness, double vision and skin rash.
Gabapentin (Neurontin)
It is an add-on drug for the treatment of resistant partial seizures. It can be used as first line drug for diabetic neuropathic pain and post-theraupetic neuralgia. It is also useful in manic depressive illness and prevention of migraine. Its unwanted effects are mild sedation and unsteadiness.
Topiramate
It is used as an add-on drug for the treatment of refractory grand mal and partial seizures. Adverse effects are poor concentration, unsteadiness, sedation, weight loss and occasional formation of kidney stones. Psychitric symptoms may also appear.
Tiagabine, Vigabatrin and Levetiracetum are some of the other drugs.
Drugs Used in Petit mal (Minor) Epilepsy
Ethosuximide (Zarontin)
This drug is a succinimide, which is preferred in the treatment of patients suffering from petit mal (absence seizures) epilepsy. Ethosuximide has gained more popularity because of its less toxic than other drugs. It is also used in combination with diphenylhydantoin or primidone (described earlier in this chapter) to control unmasked grand mal convulsions which occur in the majority of patients suffering from petit mal epilepsy.
Dosage : The average daily oral dose of ethosuximide is 0.5 to 1.5 g.
Adverse Effects: In many patients it causes nausea, vomiting, and abdominal distress. Some patients may experience drowsiness, dizziness, or headache, but these usually decrease on continued use. In some cases of unstable personalities, these agents may cause aggressiveness, agitation, anxiety, restlessness, or euphoria (a false sense of well-being). A few cases of depression of the bone marrow due to an allergic reaction have also been reported.
Precautions
It should not be taken on an empty stomach.
Patients with an unstable personality should be carefully observed for development of abnormal behavior. The drug should be stopped immediately if symptoms like anxiety or agitation appear.
The drug should be stopped as soon as any symptoms of allergy such as skin rash or agitation appear.
Total and differential white blood cell count should be done periodically.
By Ricky Hussey