Seizure /Epilepsy

Question 1

Lamotrigine

Answer 1

Week 1 - 2 : 25 mg/day
Week 3 - 4 : 50 mg/day
Week 5 onwards increase by 50 mg/day every 1 to 2 weeks.
Maintenance dose - 225 - 375mg/day as bd
BW - SJS-TEN
Warning - asceptic meningitis, blood dyscrasias, DRESS, HLH
SE - N/V, ataxia, alopecia (zinc, selenium), tremor, rash, impaired coordination, dizziness, diplopia, blurred vision.
Monitor for any rash.

Question 2

Levetiracetam

Answer 2

Start with 500 mg bd or 1000 mg od.
Maximum daily dose 3 gm/day
Reduce dose if crcl <80
Warnings - psychiatric reactions, somnolence, fatigue, suicidal behaviour in depressed patients, skin reactions, anaphylaxis, angioedema, increased bp, poor seizure control during pregnancy.
SE - irritability, dizziness, asthenia, weakness, vominting (children & adolescents)

Question 3

Topiramate

Answer 3

Week 1 - 25 mg bd (ir)or 50 ng od (xr)
Week 2 - 4 - increase by 25 mg bd(ir) or 50 mg od each week
Week 5 and on - increase by 100 mg weekly until max dose or therapeutic effect.
Maximum - 400mg/day
Crcl <70 - decrease dose by 50 %
Warnings - hyperchloremic nagma, oligohydrosis, hyperthermia in children, nephrolithiasis, acute myopia and angle closure glaucoma, hyperammonemia, reversible visual problems, fetal harm
SE - somnolence, dizziness, difficulty with memory and concentration and attention, weight loss, anorexia, paresthesia
Monitor bicarbs, renal function, hydration status, eye exam