# Epilepsy (continuing therapy) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Nervous System Disorders 2025, carbamazepine monograph (chapter PDF p27) · Egyptian National Drug Formulary - Nervous System Disorders 2025, lamotrigine monograph (chapter PDF p40) · Egyptian National Drug Formulary - Nervous System Disorders 2025, levetiracetam monograph (chapter PDF p63) · Egyptian National Drug Formulary - Nervous System Disorders 2025, valproic acid monograph (chapter PDF p83) · Lovik K, Murr NI. Seizure. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; last update February 7, 2023. - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Nervous System Disorders 2025, carbamazepine monograph (chapter PDF p27) - Egyptian National Drug Formulary - Nervous System Disorders 2025, lamotrigine monograph (chapter PDF p40) - Egyptian National Drug Formulary - Nervous System Disorders 2025, levetiracetam monograph (chapter PDF p63) - Egyptian National Drug Formulary - Nervous System Disorders 2025, valproic acid monograph (chapter PDF p83) - Lovik K, Murr NI. Seizure. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; last update February 7, 2023. ## Treatment metadata - Levetiracetam — 500 mg — oral.solid - Carbamazepine — 200 mg — oral.solid - Lamotrigine — 50 mg — oral.solid - Valproic acid — 500 mg — oral.solid ## Complete treatment card ```text EPILEPSY (CONTINUING THERAPY) Sources: Egyptian National Drug Formulary - Nervous System Disorders 2025, carbamazepine monograph (chapter PDF p27) · Egyptian National Drug Formulary - Nervous System Disorders 2025, lamotrigine monograph (chapter PDF p40) · Egyptian National Drug Formulary - Nervous System Disorders 2025, levetiracetam monograph (chapter PDF p63) · Egyptian National Drug Formulary - Nervous System Disorders 2025, valproic acid monograph (chapter PDF p83) · Lovik K, Murr NI. Seizure. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; last update February 7, 2023. Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (11) - The usual description of a convulsive attack is abrupt loss of awareness with movement - A generalised motor attack stiffens first, then breaks into rhythmic jerking - There may be a noise or a cry as it begins - Some patients feel a warning or aura beforehand - Wetting may or may not happen, so its absence proves nothing [urinary incontinence] - When the tongue is bitten it is usually bitten at the side - Afterwards there is a spell of altered awareness, the postictal state - Any brief change in awareness, odd behaviour or strange perception may equally be a seizure [seizures] - A seizure with dyscognitive features - the complex partial one - alters awareness, may show no more than lip-smacking or small movements of a limb, and can arrive as an isolated confusional state [confusion · seizures] - A partial seizure starts in one area of the cortex and can show simple motor or sensory phenomena before it spreads to the rest; a generalised one starts across the cortex at once [seizures] - In adults the commonest type by far is a partial-onset seizure that generalises quickly [seizures] SIGNS - what you find (4) - A witness may describe open eyes, no reaction to voice or pain, and rhythmic movements in step - Examine generally and neurologically, hunting for a focal deficit - Red flag for ongoing status: consciousness that stays altered after a suspected seizure [seizures] - That subtle form may show only flickering eyes, facial twitching, limb twitches, or no movement at all TESTS (12) - First ask the carer whether the event was a seizure at all, or some other passing episode - Once it is a seizure, the next question is whether something provoked it - What happened in the lead-up matters, and friends, family or workmates may hold that history - In known epilepsy, ask straight away whether medication has been taken irregularly - Ask about alcohol and illicit drugs, and about immunosuppression or cancer - Ask about unresponsive spells in the past, which in hindsight may have been seizures - Bloods including electrolytes are usually sent - Lumbar puncture where there is fever, immunosuppression, or anything else pointing to brain infection - Brain imaging yields most when the history or a focal neurological finding points that way - Image for head injury, cancer, low immunity, fever, ongoing headache, anticoagulants, age over 40, or focal onset - After a first seizure in a healthy adult back to normal: check blood glucose and sodium, and a pregnancy test where relevant - EEG is the marker: focal or generalised epileptiform discharges are its hallmark IF NOT THIS - what else fits (8) - Fainting is the key distinction; both start abruptly - A faint usually has a trigger, the blackout is short, and awareness returns at once without confusion - Wetting happens in either, so it does not tell them apart - A faint can be accompanied by movements that look like a fit - Psychogenic non-epileptic seizures - Convulsion at the moment of a head impact - A movement disorder, or movements arising out of sleep - Rigors, convulsive concussion, convulsive syncope and sleep-related events all belong on the differential of a transient event with movements Source StatPearls "Seizure" - disease-level clinical article Status traced to the source above 1. LEVETIRACETAM [1st line] Adult 16 years and older: 250-500 mg twice daily, increased by 250-500 mg twice daily at 2-week intervals to a recommended 1500 mg twice daily - Long term, specialist-directed Peds 1 to under 6 months: 7 mg/kg twice daily, up to 21 mg/kg twice daily 6 months to under 4 years: 10 mg/kg twice daily, up to 25 mg/kg twice daily 4 to under 16 years: 10 mg/kg twice daily, increased every 2 weeks to 30 mg/kg twice daily (Age-banded, so no weight card is drawn - the bands differ and a single mg/kg figure would contradict them. The formulary doses PER DOSE, twice daily. 4 to 16 years: 10 mg/kg twice daily, increased every 2 weeks to 30 mg/kg twice daily. 6 months to under 4 years: 10 mg/kg twice daily up to 25 mg/kg twice daily. 1 to under 6 months: 7 mg/kg twice daily up to 21 mg/kg twice daily.) Choice Alternatives. Levetiracetam is broad-spectrum, has few interactions, and is the option of first choice in a woman who might become pregnant - carbamazepine is not. Source Egyptian National Drug Formulary - Nervous System Disorders 2025, levetiracetam monograph (chapter PDF p63) Why Broad spectrum, few interactions, and the option of first choice in a woman who might become pregnant. The formulary gives it as monotherapy for partial-onset seizures from one month of age. Caution Diagnosis and the choice of drug are the neurologist's. This entry is for continuing therapy already started, and for the questions that arise between visits. Never stop an antiepileptic abruptly - withdrawal can precipitate status epilepticus. Behavioural change, irritability and low mood are the common reason it is stopped; ask about them. Egypt KEPILEPSY 500MG 10 F.C.TAB. CHEMIPHARM 34.00 EGP (3.40/unit) LEVNOSEIZ 500 MG 30 F.C.TABS. GYPTO PHARMA 120.00 EGP (4.00/unit) TRINOVUME 500MG 10 F.C. TABS. SIGMA > HOCHS... 40.00 EGP (4.00/unit) SUNSEIZ 500 MG 30 F.C.TABS. SUN PHARMA EG... 171.00 EGP (5.70/unit) LIPTITAM XR 500 MG 20 F.C.TABS. ORGANOPHARMA ... 148.00 EGP (7.40/unit) TIRATAM 500 MG 30 F.C.TABS. ANDALOUS PHARMA 222.00 EGP (7.40/unit) SPRIALYPSY 500 MG 30 ORAL DISINTEGRATING TABS. MASH PREMIERE > SAS PHARMA 138.00 EGP KEPRADIL XR 500MG 30 EXTENDED F.C. TABS. HIKMA PHARMA 201.00 EGP KEPILEPSY 10GM/100ML ORAL SOLN. 120 ML CHEMIPHARM 48.00 EGP -> ? strength differs, ? different route - not oral solid LEVEPEX 100MG/ML SYRUP 100ML APEX PHARMA 50.00 EGP -> ? strength differs, ? different route - not oral solid 2. CARBAMAZEPINE [1st line] Adult Initial 100-200 mg once or twice daily, increased gradually at weekly intervals to the optimal response - Long term, specialist-directed Peds Paediatric dosing is specialist-set and is not reproduced here. The formulary's own instruction is a low starting dose with gradual increase to suit the patient. Source Egyptian National Drug Formulary - Nervous System Disorders 2025, carbamazepine monograph (chapter PDF p27) Why The formulary indicates it for partial seizures with complex symptomatology and for generalized tonic-clonic seizures. Caution Diagnosis and the choice of drug are the neurologist's. This entry is for continuing therapy already started, and for the questions that arise between visits. The formulary states it is NOT for absence seizures or myoclonic seizures - it can make both worse. A strong enzyme inducer: it lowers the effect of combined oral contraceptives, warfarin and many other drugs. Never stop an antiepileptic abruptly - withdrawal can precipitate status epilepticus. Egypt CARBAMAZEPIN 200MG 10 TAB.U.S.P.33 SEDICO 3.00 EGP (0.30/unit) CARBAMAZEPINE 200MG XR 10 TAB. SIGMA 4.00 EGP (0.40/unit) TONOCLONE 200MG 30 TAB. UP PHARMA 13.50 EGP (0.45/unit) CARBATOL 200 MG 20 TABS. AMOUN 37.00 EGP (1.85/unit) MAZEMAL 200 MG 20 TABS. UNIPHARMA 52.00 EGP (2.60/unit) CARBAPEX 200 MG CR 30 TABS. MULTI-APEX 81.00 EGP (2.70/unit) TEGRETOL CR 200MG 20 F.C. DIVITAB. NOVARTIS 61.00 EGP TEGRAL 200 MG 50 SCORED TABS. CID 140.00 EGP ALEXTOL 100MG/5ML ORAL SUSP. 100ML ALEXANDRIA 7.50 EGP -> ? strength differs, ? different route - not oral solid ARBATEG 2% SUSP. 100 ML MEDIZEN PHARM... 35.00 EGP -> ? strength differs, ? different route - not oral solid 3. LAMOTRIGINE [2nd line] Adult 13 years and older, monotherapy: 25 mg once daily for 2 weeks, then 50 mg once daily for 2 weeks, then a usual maintenance of 100-200 mg daily. Maximum 500 mg daily - Long term, specialist-directed Peds Adjunctive from 2 years, monotherapy from 13, and the titration differs by what else the child is taking. Specialist-set; not reproduced here. Source Egyptian National Drug Formulary - Nervous System Disorders 2025, lamotrigine monograph (chapter PDF p40) Why The formulary gives it for partial and generalized seizures including tonic-clonic, as monotherapy from 13 years. Caution Diagnosis and the choice of drug are the neurologist's. This entry is for continuing therapy already started, and for the questions that arise between visits. The slow titration is not optional - it is what prevents Stevens-Johnson syndrome. Any new rash means stop and seek advice the same day. With valproate the starting dose HALVES to 12.5 mg/day (25 mg on alternate days); valproate raises lamotrigine levels. Never stop an antiepileptic abruptly - withdrawal can precipitate status epilepticus. Egypt LAMOTROTIC 50 MG 30 TAB. ARAB DRUG COM... 27.60 EGP (0.92/unit) LABILENO 50MG 30 TAB. SEDICO 31.50 EGP (1.05/unit) CONTROLEPSY 50MG 30 TAB. GLOBAL NAPI P... 78.00 EGP (2.60/unit) LAMOTRINE 50MG 30 TAB. MULTI-APEX 78.00 EGP (2.60/unit) LAMICTAL 50MG 30 TAB. GLAXO SMITHKLINE 143.00 EGP (4.77/unit) SUNLAMOTRI 50 MG 30 DISP./CHEW. TABS. SUN PHARMACEUTICAL INDUSTRIES LTD. 93.00 EGP 4. VALPROIC ACID [3rd line] Adult Initial 600 mg daily (10-15 mg/kg/day), increased by 5-10 mg/kg at weekly intervals. Maintenance 1000-2000 mg daily, up to 2500 mg. Maximum 60 mg/kg/day - Long term, specialist-directed Peds 10-15 mg/kg/day (The formulary doses this PER DAY, not per dose. Initial 10-15 mg/kg/day, or 400 mg daily for a child. Maintenance 20-30 mg/kg/day. Maximum 60 mg/kg/day - the formulary gives no absolute mg ceiling for children. Any total daily dose above 250 mg must be split into 2-4 doses. Children under 2 years are at higher risk of fatal liver injury.) 3kg -> 30-45 mg/day 4kg -> 40-60 mg/day 5kg -> 50-75 mg/day 6kg -> 60-90 mg/day 7kg -> 70-105 mg/day 8kg -> 80-120 mg/day 9kg -> 90-135 mg/day 10kg -> 100-150 mg/day 11kg -> 110-165 mg/day 12kg -> 120-180 mg/day 13kg -> 130-195 mg/day 14kg -> 140-210 mg/day 15kg -> 150-225 mg/day 16kg -> 160-240 mg/day 17kg -> 170-255 mg/day 18kg -> 180-270 mg/day 19kg -> 190-285 mg/day 20kg -> 200-300 mg/day 21kg -> 210-315 mg/day 22kg -> 220-330 mg/day 23kg -> 230-345 mg/day 24kg -> 240-360 mg/day 25kg -> 250-375 mg/day 26kg -> 260-390 mg/day 27kg -> 270-405 mg/day 28kg -> 280-420 mg/day 29kg -> 290-435 mg/day 30kg -> 300-450 mg/day 31kg -> 310-465 mg/day 32kg -> 320-480 mg/day 33kg -> 330-495 mg/day 34kg -> 340-510 mg/day 35kg -> 350-525 mg/day 36kg -> 360-540 mg/day 37kg -> 370-555 mg/day 38kg -> 380-570 mg/day 39kg -> 390-585 mg/day 40kg -> 400-600 mg/day 41kg -> 410-615 mg/day 42kg -> 420-630 mg/day 43kg -> 430-645 mg/day 44kg -> 440-660 mg/day 45kg -> 450-675 mg/day 46kg -> 460-690 mg/day 47kg -> 470-705 mg/day 48kg -> 480-720 mg/day 49kg -> 490-735 mg/day 50kg -> 500-750 mg/day Source Egyptian National Drug Formulary - Nervous System Disorders 2025, valproic acid monograph (chapter PDF p83) Why The formulary indicates it for generalized, partial and other epilepsy. It is ranked below the others here for one reason only: the formulary lists Pregnancy among its contraindications, and this is an entry read while repeating a prescription. Caution If the response is inadequate, measure plasma valproate level; acceptable range 50-100 mcg/ml. Contraindicated in pregnancy, active liver disease, and personal or family history of severe hepatic dysfunction. CONTRAINDICATED IN PREGNANCY (Egyptian National Drug Formulary). It causes neural tube defects and developmental disorders. Before prescribing to anyone who could become pregnant: check pregnancy status and ensure reliable contraception - the formulary requires both. In a woman of childbearing potential, levetiracetam or lamotrigine are the alternatives to discuss with the neurologist. Diagnosis and the choice of drug are the neurologist's. This entry is for continuing therapy already started, and for the questions that arise between visits. Also contraindicated in active liver disease, a family history of severe hepatic dysfunction, porphyria and urea cycle disorders. Children under 2 years are at higher risk of fatal hepatotoxicity. Never stop an antiepileptic abruptly - withdrawal can precipitate status epilepticus. Egypt DAVIKEN 500MG SR 30 F.C.TAB. AMOUN 42.00 EGP (1.40/unit) VALPROEX CR 500 MG 30 F.C.TABS. MUP 48.00 EGP (1.60/unit) DEPACOM 500MG 30 EXTENDED RELEASE F.C.TAB. CHEMIPHARM > GENESIS PHARMAC... 36.00 EGP MENTAVERS 250MG/5ML SYRUP 100ML SIGMA 10.50 EGP -> ? strength differs, ? different route - not oral solid XOPLICT 250MG/5ML SYRUP 100ML MEDIZEN PHARM... 12.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)