Yesterday, the world was invited to wear purple for the annual Purple Day to raise awareness of the common neurological condition, epilepsy.

Seizures can be controlled by medicines in 60%-70% of people diagnosed with epilepsy. First-line therapy for tonic-clonic seizures, or where generalised or partial (focal) onset is unclear, is recommended as the broad spectrum sodium valproate, which is second to carbamazepine for partial (focal) seizures.

The initial dose of sodium valproate should be slowly titrated to the lowest effective dose, up to 3000mg/day, at which point a second agent may be added.

The most common adverse reactions to sodium valproate are tremor, hair loss, sedation and weight gain. However, several factors to be considered by women of childbearing age include:

  • It may be taken with the contraceptive pill as it does not induce the hepatic metabolism of oestrogens and progestins, as do many other antiepileptics
  • It should be avoided, or reduced, where possible during pregnancy due to an increased risk of major congenital malformations
  • Supplementing folic acid may help prevent neural tube defects; and
  • Hepatotoxicity is more likely in infants.

Other drugs that can provoke seizures (e.g. bupropion, tramadol, pethidine) or lower the seizure threshold (e.g. tricyclic antidepressants) should be avoided where possible.

Several brands of oral tablets, enteric coated tablets, and oral liquid are subsidised by the Pharmaceutical Benefits Scheme, whereas crushable tablets and powder for injection are only available on private prescription.

With 3-4% of Australians likely to experience epilepsy within their lifetime, familiarity with the first aid management of seizures can only be encouraged.

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