Total daily doses as high as 4800 mg have been used with reduction in seizure frequency and without significant side effects. Ketogenic diet For children up to the age of 15 years with all types of seizures refractory to drug treatment but particularly the Lennox-Gastaut syndrome. There are many constraints, both dietary and medical, compliance is not easy to maintain and close supervision is necessary. Acetazolamide Probably most useful when given for 1 week before and during the menses for seizures with increased frequency at this time. Tolerance developes with chronic administration.
Paraesthesias are common with higher doses, perioral and fingers.
The drug of choice in children who only have seizures that satisfy strict criteria for absences. Gabapentin There have been observations of improved cognitive performance and increased alertness independent of seizure reduction, including observations in normal volunteers. GI distress, dizziness, drowsiness. Improvement in general behaviour, alertness and cognition has been noted in children unrelated to changes in seizure frequency. In patients on valproic acid the rash may be eliminated by stopping valproic acid, but v. next paragraph.