Notes

Common insults causing seizures include cerebral ischaemic damage, space occupying lesions, drugs or drug/alcohol withdrawal, metabolic encephalo-pathy (including hypoglycaemia), and neurosurgery. Anticonvulsants provide control of seizures but do not replace removal of the cause where this is possible.

Onset of seizure control may be delayed by up to 24h with phenytoin but a loading dose is usually given during the acute phase of seizures.

Magnesium sulphate is especially useful in eclamptic seizures (and in their prevention).

Phenytoin has a narrow therapeutic range and a non-linear relationship between dose and plasma levels. It is therefore essential to monitor plasma levels frequently. Enteral feeding should be stopped temporarily while oral phenytoin is administered. Intravenous use should only occur if the ECG is monitored continuously.

Carbamazepine has a wider therapeutic range than phenytoin and there is a linear relationship between dose and plasma levels. It is not, therefore, critical to monitor plasma levels frequently.

Plasma concentrations of sodium valproate are not related to effects so monitoring of plasma levels is not useful.

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