Posttraumatic Epilepsy Medication

  • Author: Ewa Posner, MD, MRCP; Chief Editor: Selim R Benbadis, MD   more...
 
Updated: Jun 7, 2011
 

Medication Summary

Early posttraumatic seizure (PTS) is treated with phenytoin, sodium valproate, or carbamazepine. In most cases, administering the medication via the intravenous (IV) route is desirable, as the patient is still in the recovery stage from the head injury; phenytoin is the drug of choice for IV administration.

No evidence suggests that antiepileptic drugs (AEDs) influence the incidence of late PTS; therefore, prophylaxis has no place in caring for patients with head injuries. However, AEDs are effective in patients who develop posttraumatic epilepsy (PTE). The main drugs used for PTE are valproate and carbamazepine.

Also see Antiepileptic Drugs.

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Anticonvulsants

Class Summary

These agents prevent seizure recurrence and terminate clinical and electrical seizure activity.

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Sodium valproate (Depakote, Depakene, Depacon, Stavzor)

 

Valproate is chemically unrelated to other antiseizure drugs. Its mechanism of action has not been established; it may be related to increased brain levels of gamma-aminobutyric acid (GABA) or to enhanced GABA action. Valproate may potentiate postsynaptic GABA responses, affect the potassium channel, or have a direct membrane-stabilizing effect.

For conversion to monotherapy, the concomitant AED dose is ordinarily reduced by about 25% every 2 weeks. Reduction may start with therapy or delayed 1-2 weeks if seizures are possible with reduction; closely monitor patients during this time for increased seizure frequency.

As adjunctive therapy, valproate may be added to the regimen at 10-15 mg/kg/d. The dosage may increase by 5-10 mg/kg/wk for optimal clinical response. Optimal clinical response is usually achieved at a dose of less than 60 mg/kg/d.

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Carbamazepine (Tegretol, Carbatrol, Equetro, Epitol)

 

Carbamazepine is indicated for complex partial seizures. It may block posttetanic potentiation by reducing summation of temporal stimulation. After therapeutic response, the dose can be reduced to the minimum effective level, or discontinued at least once every 3 months.

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Phenytoin (Dilantin, Phenytek)

 

Phenytoin may act in the motor cortex, inhibiting spread of seizure activity; it may inhibit activity of brainstem centers responsible for the tonic phase of grand mal seizures.

Dosages must be individualized. Administer a larger dose before sleep if the dose cannot be divided equally. To minimize GI irritation, administer with or immediately after meals. Rapid injection or direct IV injection may cause severe hypotension or CNS depression.

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Topiramate (Topamax)

 

Topiramate is a sulfamate-substituted monosaccharide with a broad spectrum of antiepileptic activity that may have state-dependent sodium channel blocking action, potentiating the inhibitory activity of the neurotransmitter gamma-aminobutyrate (GABA). It may block glutamate activity.

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Levetiracetam (Keppra)

 

Levetiracetam is used as adjunctive therapy for partial seizures and myoclonic seizures. It is also indicated for primary generalized tonic-clonic seizures. Its mechanism of action is unknown.

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Contributor Information and Disclosures
Author

Ewa Posner, MD, MRCP  Consultant Pediatrician, Department of Pediatrics, University Hospital of North Durham, UK

Ewa Posner, MD, MRCP is a member of the following medical societies: European Paediatric Neurology Society and Royal College of Paediatrics and Child Health

Disclosure: Nothing to disclose.

Coauthor(s)

Nicholas Lorenzo, MD  Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and American College of Physician Executives

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jose E Cavazos, MD, PhD, FAAN  Associate Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, Program Director of the Clinical Neurophysiology Fellowship, University of Texas School of Medicine at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center, University Hospital System; Director of the San Antonio Veterans Affairs Epilepsy Center of Excellence and Neurodiagnostic Centers, Audie L Murphy Veterans Affairs Medical Center

Jose E Cavazos, MD, PhD, FAAN is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, and American Neurological Association

Disclosure: GXC Global, Inc. Intellectual property rights Medical Director - company is to develop a seizure detecting device. No conflict with any of the eMedicine articles that I wrote or edited.

Chief Editor

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

References

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