The incidence of epilepsy in childhood is about 8 ‰. The initial drug selection for epilepsy treatment is very critical. To achieve satisfactory therapeutic effect, children must follow the principle of antiepileptic drug treatment and select drugs according to type.

1. Ankylotic clonic seizures (grand mal) are characterized by loss of consciousness and generalized convulsions, and are commonly characterized by foaming at the mouth, eye roll up, limb twitching, screaming, etc. Phenytoin sodium is the first choice drug for grand mal, carbamazepine, phenobarbital, promidone, sodium valproate, etc. are traditional effective drugs for grand mal, and oxcarbazepine, topiramate, lamotrigine, levetiracetam are new effective drugs.

2. Typical absence seizures (mini seizures) are mainly seen in children, which are characterized by sudden interruption of mental activity, loss of consciousness, and can be accompanied by myoclonus or automatism, with a seizure lasting for several seconds to more than ten seconds at a time. Ethsuccinamine or sodium valproate are preferred, and clonazepam, trimethyldione, topiramate, and lamotrigine are effective drugs. Phenytoin sodium has a tendency to aggravate minor seizures and should be used with caution.

3. Atypical absence attack is slower than typical absence attack in the process of attack and stop, and the medication is the same.

4. Myoclonic seizures usually occur in children under the age of 4 years. It is characterized by the sudden contraction of a muscle or muscle group, causing sudden and rapid twitching of the face, trunk or limbs. Nitrazepam or clonazepam are generally the first choice. Phenobarbital, sodium valproate, topiramate, lamotrigine, and levetiracetam also have certain effects.

5. Simple localized seizure A tonic or clonic seizure of a part or one of the limbs, which lasts for a short time and is clearly conscious. The medication is the same as that for grand mal.

6. Multiple localized seizures (psychomotor seizures) often have different levels of consciousness disorders and obvious thinking and perception disorders, which can lead to injuries, self injury and other violent acts. The first choice is carbamazepine. The commonly used drugs are phenytoin sodium, phenobarbital, promidone, sodium valproate, oxcarbazepine, lamotrigine, levetiracetam, etc. This type of epilepsy often requires combined medication.

7. The status epilepticus recurred in a short period of time, and the disturbance of consciousness did not recover between the two seizures or the seizure lasted at least 30 minutes. Intravenous injection of diazepam is the first choice, and midazolam, clonazepam, phenobarbital or phenytoin sodium can also be used.

8. Mixed seizures can not be controlled by one drug, and 2-3 or more drugs are often required.

For anti epilepsy, single drug treatment is the first choice. If single drug can not be controlled, combined medication should be considered.

Zhou Zhihong, Pharmacy Department of Hunan Children's Hospital