Hesperian Health Guides
Medicines to Prevent Seizures
There are no medicines that ‘cure’ epilepsy. However, there are medicines that can prevent the seizures of most children—as long as they keep taking the medicine regularly. As long as a child has epilepsy—which may be for years or all his life—he must continue to take anti-seizure medicines.
Sometimes preventing seizures for a long time seems to help stop epilepsy permanently. For this reason, if the child has had many seizures in the past, it is usually wise for him to keep taking anti-seizure medicines regularly for at least one year after the last seizure. Only then should you gradually lower and stop the medication to see if he still needs it.
The best medicine (or medicines) for a child with epilepsy is one that is:
WARNING! When child is having a seizure do not put his feet into a fire, it will not ‘frighten him back to life’ but will severely burn him.
Many different medicines are used for epilepsy. Some types of seizures are controlled better by one medicine and some by another medicine, or by a combination of medicines. Some children’s seizures are easy to control. Others are very difficult. It may be necessary to try different medicines and combinations to find the most effective treatment. In a few children, no medicines will control the seizures completely.
The best medicine to try first for almost all types of seizures is usually phenobarbital. Often it is very effective, and is relatively safe, cheap, and easy to take. Usually it is taken 2 times a day, but with some people only once a day at bedtime is enough.
The next best medicine for ‘big’ seizures is usually phenytoin. It is also fairly safe, cheap, and usually needs to be taken only once each night. (For some kinds of epilepsy, however, phenytoin may make seizures worse.)
For most epilepsies, phenobarbital and phenytoin are often the best drugs. First try each alone, and if that does not work, try both together. Most other drugs are less likely to be effective, are often less safe, and are much more expensive.
Unfortunately, many doctors prescribe more expensive, less safe, and often less effective medicines before trying phenobarbital or phenytoin. Partly this is due to drug companies that falsely advertise their more expensive products. In some countries, phenobarbital is difficult to get—especially in pill form. The result is that many children’s seizures are poorly controlled, using drugs that cause severe side effects and that are very costly. Rehabilitation workers need to realize this and do what they can to help provide the safest, cheapest medicines that will effectively control each child’s seizures.
It is usually best to start with only one anti-seizure medicine—usually phenobarbital, if available. Start with a low to medium dose, and after a week, if seizures are not controlled and if there are no serious side effects, increase to a higher dose. After a few days, if the seizures are still not controlled, add a second medication—usually phenytoin, for ‘big seizures’. Again, start with a low to medium dose and gradually increase as needed.
WARNING! All anti-seizure medicines are poisonous if a child takes too much. Be careful to give the right dose and to keep medicines out of reach of children.
|INFORMATION ON DOSAGE AND PRECAUTIONS FOR ANTI-SEIZURE MEDICINES|
|Phenobarbital (phenobarbitione, Luminal)|
|For all types of seizures. Usually comes in:|
|tablets of 15 mg||tablets of 30 mg||(It costs less to buy 100 mg tablets and cut them into pieces.)|
|tablets of 60 mg||tablets of 100 mg|
|Dosage: Because tablet sizes differ, we give the dosage in milligrams (mg).|
The usual dose is 3 to 8 mg for each kg of body weight every day (3 to 8 mg/kg/day)— usually given in 2 doses (morning and evening):
Give 2 doses a day. In each dose give:
|children over 12||50 to 150 mg|
|children 7 to 12 years||25 to 50 mg|
|children under 7 years||10 to 25 mg|
|Some children do better with 1 dose a day instead of 2 doses. Give twice the amount listed here at bedtime. But if the seizures return or the child has problems going to sleep or waking up, go back to 2 doses a day of the regular amount.|
|SIDE EFFECTS AND COMPLICATIONS|
CAUTION! If tablets of 100 mg are used, be very sure the family understands that they must be cut into pieces. Show them first and then have them do it.
|Giving a whole tablet instead of a small piece can poison the child.|
|Phenytoin (diphenylhydantoin, Dilantin)|
|For many types of seizures except brief seizures that suddenly throw the child out of balance (‘jolt seizures’) or ‘minor seizures’ with staring, blinking, or fast movement of eyes. (Phenytoin may make these kinds of seizures worse.)|
|Usually comes in:||capsules or tablets of 25 mg, 50 mg,and 100 mg syrup with 30 mg in each 5 ml (1 teaspoon)|
|Dosage: Give 5 to 10 mg/kg/day in 2 divided doses, but do not exceed 300 mg/day.|
Start with the following dose once a day:
|children over 12 years||100 to 300 mg|
|children 7 to 12 years||100 mg|
|children 6 or under||50 mg|
|After 2 weeks, if the seizures are not completely prevented, the dose can be increased little by little, but not to more than twice the amount. The difference between not enough and too much can be very small. If child has no seizures during several weeks, try lowering the dose little by little until you find the lowest dose that prevent the seizures.|
|SIDE EFFECTS AND COMPLICATIONS|
WARNING! Watch for dizziness, eye-jerking, seeing double, and severe sleepiness. Lower the dose if any of these occur. They are early signs of poisoning, which could cause permanent brain damage.
||very swollen, sore gums almost covering teeth—caused by not keeping teeth clean while taking phenytoin|
WARNING! Sudden stopping of phenytoin may cause the child to have a long-lasting seizure. Therefore, when stopping or changing the medicine, lower the dosage gradually.
|Useful for almost all types of seizures as a second choice, or in combination. Especially useful for ’psychomotor’ seizures. High cost is a disadvantage. (Unfortunately, many doctors prescribe it as first choice when cheaper drugs such as phenobarbital are likely to work as well or better.)
Dosage: 10 to 25 mg/kg/day divided into 2 to 4 doses. Or you can start with these doses 4 times a day:
|children 10 to 15 years||200 mg|
|children 5 to 10 years||150 mg|
|children 1 to 5 years||100 mg|
|children under 1 year old||50 mg|
|It is best to take it with meals. The dose of carbamazepine should be adjusted to the individual. Depending on how well it controls the seizures, it can be raised to 30 mg/kg/day (but no higher) or dropped to 10 mg/kg/day. Try to give the lowest amount of medicine that stops the seizures.|
|SIDE EFFECTS AND COMPLICATIONS|
OTHER DRUGS SOMETIMES USED FOR EPILEPSY
- Primidone (Mysoline) For all seizures. Start with low doses and gradually increase to 10 to 25 mg/kg/day in 2 to 4 divided doses. May cause sleepiness, dizziness, vomiting, or rash.
- Ethosuximide (Zarontin) First choice for ‘absence seizures’ with blank staring, eye-fluttering, and perhaps strange motions—especially if the seizures occur in groups in the morning and evening. Give 10 to 25 mg/kg/day in 1 or 2 doses, with food to avoid stomach ache. Rarely causes liver damage.
- Valproate (Depakene) Used alone or in combination with other anti-seizure drugs, except carbamazepine, for ‘minor seizures’ with blank staring or ‘absences,’ especially when the seizures occur in groups. For children between 1 and 12 years. The dosage for a child who weighs up to 20 kg is initially 20 mg/kg/day in 2 to 3 divided doses. (For example, a child weighing 10 kg would take 200 mg a day, and a child weighing 20 kg would take 400 mg a day.) Children over 20 kg can start with 400 mg a day in divided doses, and the dose can be increased until the seizures are controlled (usually up to 30 mg/kg/day). Never give more than 60 mg/kg/day. Few side effects. May cause liver damage, especially for children younger than 2 years old, so do not use for small children, women, or girls who could get pregnant.
- Corticosteroids (or corticotropin) These are sometimes tried for ‘baby spasms’ and ‘jolt seizures’ that are not controlled by other medicines. Long-term use of these medicines causes serious and possibly dangerous side effects. They should be used only with highly skilled medical advice when all other possible medicines have failed.
- Diazepam (Valium) Sometimes used for ‘newborn seizures’ or ‘baby spasms’, but other medicines should be tried first. May cause sleepiness or dizziness. Mildly habit forming. Give about 0.2 mg/kg/day in divided doses.
TREATMENT FOR A LONG-LASTING SEIZURE
When a seizure has lasted more than 15 minutes:
- if someone knows how, inject IV diazepam (Valium) or phenobarbital into the vein.
|Doses for injectable diazepam:|
|Adults||5 to 10 mg|
|Children 7-12 years||3 to 5 mg|
|Children under 7||1 mg for every 5 kg of body weight|
|Doses for injectable phenobarbital:|
|Children 7-12 years||150 mg|
|Children 2-6 years||100 mg|
|Children under 2 years||50 mg|
- or put a ‘suppository’ of diazepam, paraldehyde, or phenobarbital up the rectum.
|Putting diazepam up the rectum (without a needle!) works faster than injecting it into a muscle.|
Note: These medicines do not work as fast or well when they are injected into a muscle. If you only have injectable or liquid medicine, put it up the rectum with a plastic syringe without a needle. Or grind up a pill of diazepam or phenobarbital, mix with water, and put it up the rectum.
If the seizure does not stop in 15 minutes after giving the medicine, repeat the dose. Do not repeat more than once.