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Disease EPILEPSY
   
Quotation “Cassius-‘but soft, I pray you, what did ceaser’s wound?’
   
Definition Recurrent Seizures due to a chronic underlying process, charecterised by motor jerks or twitches, to major convulsions with loss of conciousness. Paroxysmall discharge of cerebral neurons is the common event in all seizures.
   
Prognosis In an individual case, depends upon the pathophysiologu. About 2/3 rds of the adult patients may be taken of drugs after seizure-free 2 years, but about a third can have recurrences of fits after being free of medication for 3 years. Good prognostic signs are mild infrequent seizures, alcohol, drug, and metabolic seizures, benign rolandic epilepsy, primary generalized epilepsy, absence seizure, and those who have initiation of warly treatment. Bad prognostic signs are diffuse cerebral disease, complex partial seizures, multiple seizure type, long untreated epilepsy, post traumatic and post surgical seizures, also, a history of status in the past. It generally takes more than a year to control seizures.
   
Treatment

If a patient has repeated attacks of convulsions or abnormal EEG pattern, he should be put on regular anti-epileptic treatment.

 

Tab. DILANTIN 100mg. 1 OD to 1 tds.

Tab. Gardenal 60mg 1 HS to 1 tds.

 

If Epilepsy is not controlled instead of Phenytoin, Give

Tab. TEGRETOL 200mg ½ to 2 tds.

 

If still not controlled.

Tab. Mysolin 250mg ½ HS to 2 HS.

 

Instruction to Epilectic patients:

 

Do not miss the treatment even for one day.

Avoid places where convulsions can be dangerous. E.g. Swimming, Driving vehicles, Climbing heights, Standing in train or bus doors, work near fire.

Drugs to be continued for at least 5 years after the last fit, and then slowly tapered off over 6 months.

 

If treatment is stopped suddenly, rebound may occur and patient may even go into status epilepticus. So stress repeatedly, the importance of taking treatment regularly.

 

The treatment may be started with carbamazepine, instead of Phenytoin particularly in children to minimize neurological deterioration.

 

Instruct all relatives about the possibility of recurring fits, If they see the patient getting convulsions, support him immediately and make him lie on the ground, Then put a spoon or wooden ruler between the teeth between the teeth and wait for convulsion to stop.

 

If Patient has Petit Mal Epilepsy:

 

Tab. Valparin 200mg 1-2 tds (Sodium Valproate) or

Syp. Zarontin 1 tsp OC to BD or

Cap. Tridione 1-2 tds (Trimethadiaone)

Tab. Gardenal 15 to 60mg HS.

 

Tab. Gardenal

Tab. Mysolin

Tab. Valparin

Syp. Zarontin

Cap. Tridione


 

 

DILANTIN TEGRETOL 
   
General Measures During an episode of fit: With patient semi-prone, turn the patient’s head to a side to avoid his tongue falling back and choking him. Loosen clothing around his chest and neck. Prevent the patient biting the tongue by introducing a rolled up cloth or rubber between patient’s teeth, if possible. Never try open the mouth. Maintain airway at all costs. 
   
Advice to Patient Right from the beginning the patient should be convinced of the need for treatment and must actively support it.The physician should stress at every visit the importance of compliance with anticonvulsant medication. Seizure free periods, will often be misconstrues as cure and the therapy will be abandoned.Make the maintenance of a seizure calendar mandatory.Highlight dangers of sudden withdrawl.Educate on the avoidance of life situations that  can endanger the patient’s life (swimming, standing in driven vehicles, climbing unprotected heights, handling dangerous appliances and machinery), or the other people’s lives (like driving public transport). Some of these activities are permissible if there is someone alongside.The relatives are to be taught on their role during a seizure episode. Then can do harm to the patient by violent control of seizures, putting in metallic objects like spoon between teeth and so on.
   
Follow Up Regular monitoring of medication compliance, and advance reaction to the drugs.Regular monitoring of anti convulsant blood vesels.Depending on drugs used, monitoring liver function tests, and CBC.
   
Inadequate Response Most often the patient falling to take drugs regularly.Misdiagnosis of fits in the first place.Progressice oraganic brain lesion in the background, missed or inadequately treated.
   
Prevention Maintenance of adequate anti convulsant therapy.Prophylacticall, following severe head injuries.Prophylactically, following neurosurgery.
   

 

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