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Epilepsy (Chronic Management)

Also known as: seizure disorder · recurrent seizures

A tendency to recurrent unprovoked seizures. Diagnosis is largely clinical (a good witnessed account) and classification (focal vs generalised) guides drug choice; most people become seizure-free on a single well-chosen anti-seizure medication.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Any age (bimodal — young and elderly); causes include genetic, structural (stroke, tumour, trauma, malformation), infective (neurocysticercosis — important in India) and metabolic.

Red flags — escalate / refer

Status epilepticus (see that guideline), a first seizure with focal signs/red flags, or seizures in pregnancy → urgent/specialist pathway; poor control raises the risk of sudden unexpected death in epilepsy (SUDEP).

Work-up / diagnosis

1A clinical diagnosis from a witnessed account; classify the seizure/epilepsy type.
2Investigate the cause — EEG (supports classification), MRI brain (structural cause), and consider neurocysticercosis where endemic; exclude provoked seizures (glucose, sodium, alcohol).

Management — overview

Usually start an anti-seizure medication after a second seizure (or after a first if recurrence risk is high), choosing by seizure type and the person (avoid valproate in women of childbearing potential).
Aim for monotherapy at the lowest effective dose; counsel on adherence, triggers, driving and safety.
Manage women's/pregnancy issues (folic acid, teratogenicity), treat the cause, and consider withdrawal after prolonged seizure-freedom.

In-depthFull dosing & advanced protocol

Drug dosing

Anti-seizure medication (by seizure type)

Prevent recurrent seizures

Adult dose: Monotherapy first, lowest effective dose, per protocol
Route: Oral

Caution: Valproate is highly teratogenic — avoid in women of childbearing potential.

WHOWHO mhGAP Intervention Guide (mental health in non-specialist settings) ↗

Classification drives the drug; counsel widely

Focal vs generalised classification guides drug choice.
Valproate is highly teratogenic — avoid in women of childbearing potential.
Counsel on driving, adherence and SUDEP; consider neurocysticercosis in endemic areas.

WHOWHO mhGAP Intervention Guide (mental health in non-specialist settings) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Anti-seizure medication (by seizure type)

📈 Classification drives the drug; counsel widely

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Anti-seizure medication (by seizure type)

📈 Classification drives the drug; counsel widely

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Classification drives the drug; counsel widely

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Classification drives the drug; counsel widely

References