Emergency drug administration
Not every epileptic seizure must be treated immediately with emergency medication. As a rule, an epileptic seizure is not an emergency; it stops of its own accord. For bystanders it is therefore only important that seizure-related injuries are avoided.
Objects with a potential for injury should be removed from the surrounding area. If an epileptic seizure lasts longer than 5 minutes, it is by definition called a status epilepticus. This is an emergency.
The seizure no longer ends spontaneously and must be interrupted by medication. If you suspect an epilepticus status, you should always notify the emergency doctor! Most often benzodiazepines are used as emergency drugs.
They often work within a few minutes. In adults, lorazepam (tavor expedit 1.0 or 2.5mg) is the drug of choice. This is placed in the patient’s mouth as a highly soluble platelet which is then absorbed by the body.
Alternatively, diazepam may be used. The drug is administered in a small tube through the anus. It is available in 5mg and 10mg tubes.
Emergency doctors or paramedics usually inject the medication directly into the bloodstream through a venous access. If the status epilepticus remains despite (repeated) administration of the above-mentioned drugs, the doctor will administer a phenytoin infusion or alternatively another anticonvulsant drug. If the above-mentioned benzodiazepines are taken in saliva (e.g. tavor expedit) or administered rectally by means of a tube, the effect usually sets in after a few minutes. If the drugs are injected directly into the vein, the effect is seen after 1-2 minutes. However, it can also happen that the status epilepticus cannot be interrupted despite (repeated) administration of medication.
Prophylaxis
The therapy of epilepsy is mainly used prophylactically, i.e. it is intended to prevent further seizures by correctly taking the prescribed medication and thus achieve freedom from seizures. In addition to prophylactic medication, a change to a regular lifestyle is also necessary, which should eliminate possible triggers for epileptic seizures.Furthermore, after a seizure there is a driving ban of several months for the affected person. There are numerous medications that can be used to prevent seizures.
These are called antiepileptic drugs or anticonvulsants. Depending on the form of epilepsy, one must find the right medication and the right dosage for each individual patient. The dose is usually increased slowly.
If further seizures occur under the therapy with an antiepileptic drug (monotherapy), a combination of several drugs is useful in rare cases. A classic among the drugs used for seizure prophylaxis is phenytoin, which has been used successfully in the treatment of epilepsy for many years. Due to its side effects, however, it is rarely used.
Drugs such as carbamazepine and valproic acid are better tolerated; these have been on the market since the 1970s. However, they can also interact with other drugs. Therefore, today mainly “new” antiepileptic drugs are used, which are characterized by good long-term tolerance.
The most important representatives are gabapentin, lamotrigine and levetiracetam (e.g. Keppra ®)The drug lamotrigine has been used in the treatment of epilepsy since 1993. It is approved for the treatment of children over 12 years of age. The active substance is relatively new and there are few comparable drugs.
The substance blocks ion channels in the central nervous system, which are responsible for the release of the neurotransmitter glutamate. Neurotransmitters are biochemical substances that transmit stimuli from one nerve cell to another. This process is inhibited by lamotrigine.
In addition to the treatment of epilepsy, lamotrigine can also be used for the prophylaxis of seizures in cases of alcohol withdrawal or severe depression. It is usually very well tolerated. An impairment of the ability to think and concentrate is rare compared to other anti-epileptic drugs.
Known side effects are extensive skin rashes (exanthema), double vision, dizziness and impaired balance. However, these can usually be avoided if the drug is gradually introduced, i.e. the dose is increased only gradually. More detailed information about lamotrigine can be found on the following page: Lamotrigine, side effects of LamotrigineKeppra® is the trade name for a drug containing the active ingredient levetiracetam.
It belongs to the group of antiepileptic drugs and is also used to prevent seizures in epilepsy. It is approved for adolescents aged 16 and over. The drug can be administered both as a tablet and as an infusion.
It is metabolised independently of the liver and excreted in the urine. The exact mechanism of action has not yet been conclusively researched. The drug probably inhibits the transmission of stimuli at the synapses (= the junction between two nerve cells) and can thus prevent seizures.
Side effects include fatigue, headaches and concentration problems. Nausea and vomiting may also occur. Allergic skin reactions are also typical.
The drug must not be taken during pregnancy and in case of kidney dysfunction. Gabapentin is another seizure prophylaxis drug. Its mechanism of action is similar to the substances mentioned above, it blocks ion channels in the central nervous system and thus prevents the transmission of stimuli between nerve cells.
It is used as monotherapy for simple epileptic seizures. It can also be used for “nerve pain” (= neuropathic pain), shingles or phantom pain. The drug must not be taken during pregnancy and lactation, or if liver or kidney function is impaired.
It is important to know that the effect of gabapentin is enhanced when taken at the same time as alcohol or opioid painkillers. You can find out more about gabapentin here. Valproic acid is also a well-known anti-epileptic drug.
Its salt is called valproate. The drug is sold commercially under the names Ergenyl® or Orfiril®. In addition to various forms of epilepsy, valproic acid can also be used to treat mental illnesses such as mania and psychoses.
It is also used to treat Huntington’s disease. The drug can be administered in tablet form or directly via the bloodstream. It is metabolized via the liver.
For this reason, it must not be taken in cases of liver dysfunction. It is also not suitable as a medication for women of childbearing age, as it could damage the embryo in the event of an unplanned pregnancy. It should therefore not be taken during pregnancy either.
The drug Phenytoin is a well-established and effective drug for the treatment of epilepsy.It is also used to treat cardiac arrhythmia. Similar to the local anaesthetic lidocaine, phenytoin blocks an ion channel and thus slows down the transmission of stimuli between two cells. This works both in the central nervous system and in the heart.
Known side effects are dizziness, double vision, a disturbance in blood formation, liver dysfunction and allergic reactions. In addition, the drug often shows interactions with other drugs. It must therefore be said that in recent years it has been used less and less for the treatment of epilepsy, especially since many newer antiepileptic drugs with better long-term tolerance have come onto the market.
Another drug for epilepsy is carbamazepine. It can also be used to treat mental illness, so-called bipolar disorder and mania. The drug is also used to treat trigeminal neuralgia, facial pain in the area served by the trigeminal nerve.
Like most antiepileptic drugs, it acts on the ion channels in the central nervous system and thus reduces the excitability of the nerve cells. Side effects include allergic rashes, itching, disorders of the blood-forming system and mood swings. However, these can usually be avoided by carefully increasing the dose. However, it is important to know that the metabolism in the liver can lead to interactions with other drugs.
