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Topic: Seizure
Subject: Medicine
A 52-year-old male with a history of seizure attacks suffered from loss of consciousness and tonic-clonic muscular contractions. His tongue fell back into his throat and he choked.
What is the medication of choice for the treatment of this patient's condition?

A. Phenytoin

B. Valproic acid

C. Tiagabine

D. Phenobarbital

Correct Answer : B.


Valproic acid is considered the agent of first choice for the treatment of grandmal (tonic-clonic) seizures. It increases the levels of GABA by affecting the potassium channels and also creates direct membrane stabilizing effect. Since it acts through GABA it is the best medication for grandmal seizures with fewer side effects. It is administered orally with a dose of 1000-3000 mg in divided doses. Medication should be taken with food to reduce the GI upset.
> Phenytoin (choice A), followed by topiramate, carbamazepine (choice E), and zonisamide are suitable alternatives.
> Tiagabine (choice C) is a weak medication for the treatment of grandmal seizure and it is effective for the treatment of petitmal seizures.
> Phenobarbital (choice D) is also not the choice of medication for grandmal seizure but it is a good choice for status epilepticus.

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