Regarding Treatment For Epilepsy

Regarding treatment for epilepsy select the drugs from the list given below for the given clinical scenarios:

A. Clonazepam
B. Ethosuximide
C. Levetiracetam
D. Sodium valproate
E. Phenytoin
F. Lamotrigine
G. Gabapentin
H. Carbamazepine

1. A 24-year-old man with complex partial seizures:
Answer: Carbamazepine

2. First-line anti-epileptic in a 17-year-old girl with tonic-clonic seizures. She has the Depo-Provera injection for contraception
Answer: Sodium valproate (If there was a high-risk of pregnancy (for example just using condoms for contraception) lamotrigine may be a more suitable choice.)

3. Useful in patients with absence seizures who are intolerant of sodium valproate
Answer: Ethosuximide

Discussion:
Epilepsy: Treatment
Most neurologists now start antiepileptics following a second epileptic seizure.

NICE guidelines suggest starting antiepileptics after the first seizure if any of the following are present:

 the patient has a neurological deficit
 brain imaging shows a structural abnormality
 the EEG shows unequivocal epileptic activity
 the patient or their family or carers consider the risk of having a further seizure unacceptable

Sodium valproate is considered the first line treatment for patients with generalized seizures and carbamazepine is used for partial seizures

Generalised tonic-clonic seizures 
 sodium valproate
 second line: lamotrigine, carbamazepine

Absence seizures (Petit mal) 
 sodium valproate or ethosuximide
 sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy

Myoclonic seizures 
 sodium valproate
 second line: clonazepam, lamotrigine

Partial seizures 
 carbamazepine
 second line: lamotrigine, sodium valproate