Table 1.
Main Drugs used in Epileptic Encephalopathies. MHD: Oxcarbazepine Metabolite 10-Hydroxycarbazepine; Im: Intramuscularly
| DRUG | Seizure Type | Oral Dose (mg/Kg/Day) | N° of Daily Doses | Therapeutic Serum Level | Side Effects and Toxicity |
|---|---|---|---|---|---|
| Clobazam | -Add-on / wide spectrum | 0, 25-1 | 1-3 | nd | Drowsiness, dizziness, constipation, dry mouth, tremor. |
| Clonazepam | -Add on / wide spectrum | 0, 05 - 0, 15 | 2-3 | 20 - 80 µg/ml | Fatigue, drowsiness, hypotonia, behavior disturbances, salivary, bronchial hypersecretion, respiratory depression. |
| Felbamate | -Add-on / Lennox-Gastaut syndrome | 15 - 45 | 2-3 | 25 -100 µg / ml | Somnolence, anorexia, gastric discomfort, nervousness, aplastic anemia, hepatotoxicity. |
| Gabapentin | -Add-on/ focal and secondary generalized | 10 - 30 | 2-3 | 6-10 µg/ml | Somnolence, headache, tremor, nystagmus, fatigue and weight gain, rarely beahavioural disorders. |
| Lamotrigine |
- Add on/ idiopathic
general - Add on/ focal - Add on/ Lennox Gastaut syndrome |
1 - 15 | 2-3 | 3 -10 µg/ml | Dizziness, diplopia, ataxia, somnolence, rash, Stevens-Johnson syndrome, Lyell’s syndrome. |
| Levetiracetam | -Add-on/ focal | 10 - 60 | 2 | 5 - 45 µg /ml | Dizziness; irritability; anxiety, headache., weakness; nausea; psychotic events (rare) |
| Nitrazepam | - Monotherapy infantile spasms | 0, 25 - 2, 5 | 2 | 40 -180 ng/ml | Hypotonia, drowsiness, aspiration, pneumonia. |
| Oxcarbazepine |
-Add on / focal - newly diagnosed / focal |
10 - 45 | 2-3 | 12-35 ng/ml (MHD) | Somnolence, headache, ataxia, vomiting, hyponatriemia, rash. |
| Rufinamide | -Add-on / Lennox-Gastaut syndrome | 5-45 | 2 | nd | Dizziness, headache, nausea, somnolence, double vision, fatigue, ataxia, vomiting. |
| Stiripentol | -Add on / Dravet’s syndrome | 50 - 100 | 2-3 | nd | Drowsiness, loss of appetite. |
| Tiagabine | - Add on / focal | 0, 5 -2 | 2-3 | 20-100 µg/ml | Dizziness, abdominal pain, nervousness, difficulty with concentration, non convulsive SE. |
| Topiramate |
-Add-on / generalized Tonic clonic -Add-on/ focal -Add-on /Lennox Gastaut -Monotherapy in newly diagnosed focal |
1- 12 | 2-3 | 4 - 25 µg/ml | Weight loss, paresthesias, emotional lability, difficulty concentrating and word-finding, hypohidrosis, kidney stones. |
| Valproate | - Monotherapy /generalized | 15-60 | 2 | 40-100 µg/L | Hepatic failure, pancreatitis, thrombocytopenia, weight gain, tremor, menstrual irregularities. |
| Vigabatrin |
-Monotherapy/ infantile
spasms -monotherapy/newly diagnosed, focal |
40-100; 100-150 for infantile spasms |
2 | nd | Excitation, drowsiness, weight gain, psychosis (rare), visual field defects. |
| Zonisamide | - Add on / wide spectrum | 2-12 | 2 | 27-43 µg/ml | Somnolence, dizziness, ataxia, abdominal discomfort, decreased spontaneity, rash, hypohidrosis, psychiatric disorders. |
| ACTH | - Monotherapy/ infantile spasms | 1, 5-3 UI/Kg/day im for 1-2weeks | 2 | -- | Hyperglycemia, hypertension, electrolyte abnormalities, gastrointestinal disturbances, infections |
| Prednisone | -Monotherapy/ infantile spasms | 2mg/Kg/day | 2 | -- | Obesity, infections, hypertension, aggression, weight gain. |
| Hydrocortisone | -Monotherapy/ infantile spasms | 5-20 mg/Kg/day | 2 | -- | Cushing syndrome, irritation, sleep problems, weight gain, hypertension. |