Table 2.
Description of common first-line AED in resource-limited settings
| Drug | Indication and frequency of use | Required dosage | Remark | |
|---|---|---|---|---|
| Children | Adults | |||
| Phenobarbital | Recommended by WHO as first line AED for most seizure types, except absences; cheap and readily available [19, 26]. Used by 74.6% of PWE [65]. | Given once/twice daily Starting dose: 2–3 mg/kg/day Maintenance: 3–6 mg/kg/day |
Given once daily Starting dose: 60 mg/day Maintenance: 60–180 mg/day |
Steady state reached after 14–21 days. Possible side effects: Drowsiness, skin rash, lethargy and hyperactivity in children, hepatic failure, Stevens Johnson syndrome |
| Carbamazepine | Indicated for focal seizures, and could be used in generalized convulsive seizures [43]. Used by 27.4% of PWE [65] | Given twice daily Starting dose: 5 mg/kg/day Maintenance: 10–30 mg/kg/day |
Given twice daily Starting dose: 100–200 mg/day Maintenance: 400–1400 mg/day |
Steady state reached in 8 days. Possible side effects: allergic skin reactions, bone marrow suppression with long-term use, blurred vision, diplopia, ataxia, nausea. Contraindicated in absences and myoclonus [43] |
| Phenytoin | Indicated for treating some generalized seizures and status epilepticus [66]. Used by 22.2% of PWE [65] | Given once/twice daily Starting dose: 3–4 mg/kg/day Maintenance: 3–8 mg/kg/day (max 300 mg/day) |
Given once or twice daily Starting dose: 150–200 mg/day Maintenance: 200–400 mg/day |
Possible side effects: drowsiness, ataxia, slurred speech, motor twitching and mental confusion, coarsening of facial features, hepatitis, gum hyperplasia, hirsutism, skin reaction including Stevens Johnson syndrome |
| Valproate | A broad spectrum anticonvulsant that can be used for both focal and generalized onset seizures. Specifically indicated for absence, atonic and myoclonic seizures [66]. Preferred drug for nodding seizures [32]. Used by 14.7% of PWE [65] | Given twice daily Starting dose: 5–10 mg/kg/day Maintenance: 15–30 mg/kg/day |
Given twice daily Starting dose: 400 mg/day Maintenance: 400–2000 mg/day |
Possible side effects: sedation, tremor, transient hair loss, increase in body weight, impaired hepatic function. Use in women of childbearing age is discouraged |