The treatment of epilepsy

General principles of treatment. A patient with epilepsy have been continuously and systematically to treat complex method. Such treatment in most cases you can achieve the disappearance of seizures (forever or for a long period), or to bring them to the minimum. Important and from General hygienic mode.
When seizures associated with swelling of the brain from different reasons or water retention in General, shown dehydration (fluid restriction, the appointment of hypertonic solutions, less Mercosul). Currently in severe epileptic status sometimes as a powerful dehydrating intravenously injected 30% solution of freeze-dried urea 10% glucose solution at the rate of 0.5-1 g of urea per 1 kg of body weight of the patient. F. I. Brodsky was offered a combination of anti-epileptic funds markusele (water - 200 g, calcium chloride - 15 g, phenobarbital -0,8 g, sodium borate - 1 g, metilskopina - 0.4 g and 2 ml solution Mercosul; take 1 tablespoon 3 times a day). In some cases this complex really reduced the frequency of seizures. From other dehydrating funds used 10% solution of calcium chloride inwards to 1 tablespoon 3 times a day and intravenously for 10 ml injection of magnesium sulfate (25% solution at 10-15 ml intramuscularly to adults), diacarb (diamox, Favorit) 1 / 2 tablets (0,13 g) 1-2 times a day for 10 days (periodically). It is necessary to consider contraindications (kidney disease and others), as well as the method of preparation of medicines.
In the case of more fresh neuroinfections (meningoencephalitis, diffuse encephalitis, arachnoiditis, and so on) you can have a course of intravenous injections (12) 40% solution of hexamethylenetetramine (5 to 10 ml), 0,5ml 1% of fluacizine (triplewin), 1% of colloid (1 ml), antibiotics (penicillin, biomitsin and others).
In traumatic and cortical (focal) epilepsy inflammatory nature use different types of tissue therapy (aloe, palaeodietary or phibbs, and so on). During focal (including trauma) and diencephalic epilepsy is possible in certain cases to appoint a local x-ray treatments (anti-inflammatory dose). When the so-called total (Hesse) epilepsy treatment activities are mainly symptomatic treatment in neprivaloma condition, and if possible to treatment etiopathogenetic nature, and impact on the most seizures or epileptic status.
Drug treatment of epilepsy in megprobalja period. With a total of epilepsy (chronic) have to resort to long-term use of phenobarbital, bromine, sodium borate, geksamidina, benzonal, difenina, trimetina, hlorakona. Pure bromine apply now rare. Usually give salt brine (sodium, potassium, calcium, lithium, strontium), or mix them with 2-4 g / day and more with the restriction of food salt. Against the phenomena of bromizma prescribed small doses of arsenic. C. M. Bekhterev was offered the use of a combination of bromine with Adonis: Inf. herbae Adonidis vernalis ex 2,0 : 200,0, Natrii bromati 12,0, Codeini phosph. 0,1; 1 tablespoon 3 times a day.
In high doses, bromine quite toxic. The elimination of bromides from the body is very slow. This explains the fact that status epilepticus is rare, even with quick and complete abolition of bromine. Also recommend chemically pure borate sodium 2 - 4 g or more per day. However, this drug is the drug of the second plan and it is better to appoint a rare, large and small seizures, in case of intolerance or failure of other means. It is also recommended that the following combination recipe: bromide of potassium - 0,3, sodium bromide -0,3, calcium phosphate - 0,2, borate sodium - 0,3, phenobarbital -0,1, caffeine-benzoate sodium -0,01. The primary drug for the treatment of Grand Mal seizures is phenobarbital. On the small epilepsy and seizures automaticity phenobarbital for the most part has no significant impact. The dosage depends on the frequency and severity of seizures. Usually adults are at 0.05 g of phenobarbital 2-3 times a day at designated 0.1 grams of phenobarbital 2-3 times a day, but not more than 0.5 g / day; with exclusively nocturnal seizures -0,12 grams of phenobarbital at night or in the evening. Children under 8 years of age receive a dose of 0.01-0.03 to 0.1 grams per day depending on the age and frequency of seizures. At this dose, even very long-term (in years) phenobarbital application is not accompanied by a noticeable signs of intoxication (drowsiness, constipation, dizziness, ataxia, rash, arthralgia). Sometimes when sleepiness to phenobarbital add a small dose of caffeine (0,01-0,02 g). Some authors consider, that the therapeutic effect of phenobarbital increases in combination with belladonna.
Phenytoin (dilantin, epanutin) has a positive effect in case of large seizures, but he is little effective against absences and equivalents. The optimal dose of 0.1 g per reception 3 times a day. Children over 6 years is prescribed dose is less than half are under the age of 6 years -0,03, Difenin noticeable cumulative has therefore it can be used for a long time. As toxic complications when receiving phenytoin may be tremor, ataxia, dysarthria, diplopia, nystagmus, dizziness, headaches, giperplazia gums and t, doctor In rare cases, there are apathy, drowsiness, oglushennosti and other Complications are more often in children and in people over the age of 45-50 years. In some cases it is appropriate to combine the treatment with phenytoin (0.3 g / day) with phenobarbital (0.1-0.3 g / day).
For the treatment of epilepsy apply also primidone (mycolin - Mysoline) - 4,6-dioxo-5-ethyl-5-phenyl-tetrahydropyrimidine. The drug has anticonvulsant properties, but, unlike phenobarbital, has expressed no hypnotic action. Primidone applied mainly for the treatment of Grand Mal seizures. At low epilepsy only in some cases there is a pronounced therapeutic effect. Primidone appointed interior. Adults in the 1st and 2nd day of the treatment given to 0,125 g (during the day or at night), 3-day offer 0.25 g, then the daily dose gradually (at intervals of 3-7 days) increased by 0.25 g total daily dose of 0.5-1.5 g (0.25-0.5 g 2-3 times a day). Dose should be strictly customized to meet portable products. Doses for children aged 3 to 6 years -0,25-0.75 g; from 7 to 10 years 0.5 - 1 g; And from 13 years-0,75-1,25 g; from 14 to 16 of-0.75-1.5 g per day.
Recently proposed benzonal (synonym N-benzoylamino). Unlike phenobarbital, the drug does not cause lethargy, drowsiness, General weakness, etc. Used in convulsive forms of epilepsy different origin and bessoudorozhnye its forms (twilight disorders of consciousness and automation equipment). Assign inside adult for the 0.1-0.2 - 0.3 g per reception. Children, depending on age -0,025-0,075, the Highest daily intake for children is 0.3 g, for adults - 0,9, Treatment start with small doses.
A number of authors in epilepsy (especially children and adolescents with mental degradation) appoint glutamic acid in combination with anticonvulsants.
Good effect at low epilepsy network trimethadione. Usual dose trimetina for adults from 0.9 to 1.2 grams, for children up to 2 years-0.3 g per day, from 2 to 5 years and-0.6 g and over 5 years -0,9 was Very small doses trimetina usually ineffective. Used drug in capsules and tablets at 0.3 g during meals. In its application may be a number of toxic effects (drowsiness and insomnia, gastrointestinal disorders, skin rashes, photophobia, ataxia, depression, and so on). Also described cases of agranulocytosis. If the number of cells rapidly declining or below 4000, the dose should be reduced for the period from several days to 1-2 weeks or give the drug 1-2 days, one week later, you can give trimethadione every second or third day. At low epilepsy appoint milotin (nitrogen-methyl-alpha-phenyl-succinimide), celontin, prendera, paration.
Some anticonvulsant action has also beclamide (N-benzyl-beta-chloropropionate). Used mainly in large seizures inside of 1 g 2-3 times a day (dose for adults).
Combined recipes are often based on the importance of the regulatory impact on both neurodynamic process (excitation and braking), the underlying epilepsy. Along with phenobarbital, bromizovala include caffeine, papaverine, strychnine, phenaminum, Tinatin, etc., in various combinations. On combinations of drugs based treatment of epilepsy on methods M. Ya. Serijskog (three versions), S. P. Vorobyov (three variants), tablets I. E. Karmanova (1 and 2), to the copies D. A. Markov and others


Treatment of status epilepticus. Status epilepticus can be triggered by many factors (accidental infection, sleepless night, a trauma, a break from taking phenobarbital, and so on). It can also be a manifestation of rough-organic affection of Central nervous system-traumatic brain injury (especially open), tumors of the brain, and so on, If the patient is freely swallow, then you can assign medicine: chloral hydrate 8 g, potassium bromide 10 g, scopolamine Hydrobromic 0,003 grams water 100 g; take 1 teaspoon 3-5 times a day. You can apply enema of chloral hydrate (adult -2 g), phenobarbital (0.3 g), of Barbara; intravenous enter 10 ml of 10% sodium bromide; to inject scopolamine under the skin (0,05%; 0.5 ml 1-2 times a day); to do a lumbar puncture with a gradual release of the liquid to 20 ml With the continuing seizures can be administered intravenously or intramuscularly (very slowly) 5-10 ml 10% solution geksenala.
After geksenala (or independently of it) can be applied (im) injection 5-10-15 ml of 25% magnesium sulfate (rather slow). This combination can leverage and extend hypnotic-sedative effect of the drug. It is advisable to enter into a vein (J. S. Rabinovich) 10 ml of 10% solution of calcium chloride (and again in a few hours).
In appropriate cases it is necessary to apply heart drugs, oxygen, etc. camphor Injections, morphine is contraindicated. When pulmonary edema, high blood pressure, cyanosis make the venipuncture. In extreme cases - General of the ether or chloroform anesthesia (light Rausch-anesthesia) or thiopental in Vienna (5%, 10 ml, enter slowly). When epileptic status due to organic lesion and in the absence of positive results from conservative treatment is necessary to resort to surgical intervention.
Surgical treatment of epilepsy. If there mainly rough obolochechnykh of cicatrices, defects of bones of the skull and Dura resort to resect the scar, meningoencephalitis, plastic closure of the defect Dura mater, the bones of the skull. To ensure Kozhevnikovsky epilepsy - operation HORSLEY, and recently - talamancae. To develop methods of surgical treatment of the temporal and other forms of epilepsy under the control of electrocorticography.