Management

• Immediate treatment of an attack of fit :
  • The patient should be protected from injury. He should be moved away from fire and sharp or hard objects.
  • A padded mouth gag should be inserted between the teeth to avoid tongue injury.
  • Tight clothing should be untied and an adequate clear airway should be maintained.
  • Diazepam 5-10 mg should be given slowly intravenously till the fits subside. It can be repeated if required. However, care should be taken as it may cause sudden respiratory arrest.

• Long term drug therapy :
  • The drugs should be given in adequate doses for an adequate period such that there is a cessation of convulsions. It should be continued for at least 3 years after the last fit.
  • Abrupt discontinuation of the drugs must be avoided as it may precipitate status epilepticus. Drugs must be increased or decreased gradually.
  • Preferably convulsions must be controlled with a single drug. However, if required, a combination of drugs may be given.
    • A. Grand-mal epilepsy can be controlled by one or more of the following drugs:
      • Phenytoin sodium 200-400 mg. daily.
      • Carbamazepine 600-1800 mg daily in divided doses.
      • Sodium valproate 0.25- 1.0 gm daily.
      • Phenobarbitone 60-180 daily.
      • Primidone 750-1500 mg daily in divided doses.
    • B. Focal epilepsy can be controlled by one or more phenobarbitone, phenytoin sodium, primidone, and carbamazepine. Sodium valproate is not very useful for focal epilepsy.
    • C. Petit mal epilepsy can be controlled by:
      • Ethosuximide 750-1500 mg daily.
      • Sodium valproate 250-1000 mg daily.

• Social and psychological aspects :
  • The patient and the relatives should be educated about the nature of the illness, its precipitating factors, and its consequences.
  • Restrictions should be minimum, especially for children as they are in danger of being overprotected. Cycling driving and swimming alone at sea should be avoided.
  • The patient should be advised to take occupations in which neither he nor the community is put at risk by the propensity of fits. Exposure to moving machinery and work at height should be avoided.