online pharmacy:	minimal price:	best buy:	shipping:	payment method:	delivery to:
GenericMed	- -	- -	14/free		most countries
Tl-Pharmacy	- - -	- - -	10-21 days/free		every country
MedRx-One	- - -	- -	10 days/free		most countries
LeadMedic	- - -	- -	14-21days/$10 5-7 days/$25		every country
Pharma-Doc	- - -	- -	FedEx next day/$24		USA only
Med-Pen	- - -	- -	14-20 days/$10 7-14 days/$20		most countries
OurPharmacyRx	- - -	- -	14-21 days/$15 5-12 days/$30		most countries
RxPharms	- - -	- - -	14-24 days/free		worldwide
RxMedShop	- - -	- - -	8-16 days/$20 5-9 days/$30 3-6 days/$40		most countries

THE TREATMENT OF EPILEPSY
There are a number of general principles about the management of epilepsy which we will discuss at the beginning of this chapter. These include:
The fact that about 70-75% of people with epilepsy will achieve good seizure control with medical treatment using anticonvulsants. About 25% of people will not respond very well to anticonvulsants and a very small percentage may be helped by surgical means. Partial seizures, especially temporal lobe epilepsy, respond less well to medication than do generalised seizures.
The observation that 60-80% of epileptics who can be controlled with anticonvulsant medication (anti-epileptic drugs), need only one medication. This is called monotherapy (treatment with one medication only).
Naturally there are some epileptics who will need more than one drug, but rarely more than two. As a matter of principle, when someone first starts on anticonvulsant medication, the dose should be increased relative to the frequency of the fits. There should be no need for the addition of another medication unless the fits are not controlled (assuming that the patient is really taking the medication) or side effects from the drug arise. It is really only in these two situations that the addition of another drug is to be recommended. Frequency of dosage: the majority of anticonvulsants need to be taken only twice daily. Certain drugs – for example, phenytoin – can often be taken once a day. There may be occasions when it is necessary to administer anticonvulsant medication three times a day, but this is uncommon.
Compliance with medication: the term ‘compliance’ means the adherence by the patient to the doctor’s instructions. Patients who do not take their medication regularly are called ‘non-compliant’. The incidence of non-compliance probably varies from 30-50 per cent. The traditional medical interpretation of this phenomenon is that these patients are ‘naughty’ and are ‘irreverently’ ignoring medical advice. An alternative viewpoint, which I personally hold, is that non-compliant patients are telling their doctor that they do not agree with the proposed treatment or that they see it as inappropriate or unnecessary. There are many reasons for this form of behaviour such as the presence of drug side effects, which from the patient’s point of view are worse than having seizures, forgetfulness or boredom with taking medication. Other people may have very infrequent fits and decide that it is not worth taking medication for months on end, to prevent perhaps an annual fit. Whatever the cause of noncompliance, it should be detected and respected by the doctor. In general, patients should be encouraged to be compliant, but if they are not, the reasons for this should be sought. There is, of course, especially in certain circumstances, a social responsibility for epileptics to take their medication. Thus epileptics with driving licences have a responsibility to others not to have a seizure if at all possible and this means taking medication regularly.
The question of whether all seizures should be treated or eradicated. Epilepsy is a condition which, above all others, requires individualised treatment. As we have discussed previously, it is inappropriate to use the term epilepsy as an all-encompassing word. There are a number of different forms of epilepsy, all of which differ in origin, seizure type, seizure frequency, and disruption of lifestyle and outlook. It is very tempting to try to eradicate all seizures in every epileptic, but the reality is that in some people this may be extremely difficult and the price paid for eradicating seizures may be greater in terms of drug side effects than it is worth. It is essential that a consensus be achieved between doctor and patient as to the degree of seizure control desired by the patient – not that necessarily desired by the doctor. When such a proposal is put to patients, their response is often very positive, depending on their degree of self-confidence, the nature of their seizures and the drugs that they are taking. It is the patient’s right to decide on the degree of seizure control he or she wants and it is not the prerogative of the doctor to insist on the complete eradication of seizures. The management of epilepsy should be decided in cooperation with the patient or parents.
These comments do not imply a laissez faire attitude by doctors, but serve to emphasise the very important role of the patient in making these decisions.
*11/192/2*

Responses are currently closed, but you can trackback from your own site.