Epilepsy

• consciousness NOT impaired
• motor, somatosensory, autonomic, psychic symptoms
• Duration - 90 secs
• Postictal symptoms - transient weakness or loss of sensation
• unilateral

• consciousness impaired
• may have aura
• motor, somatosensory, autonomic, psychic symptoms
• automatisms (abnormal behavior where pt has no recollection; lip smacking, picking at clothes, fumbling, confusion)
• Duration - 1-2 mins
• Postictal symptoms - amnesia during seziure, confusion, sleepy
• unilateral

simple or complex onset evolving to generalized tonic-clonic

• loss of consciousness w/o warning or preceded by myclonic jerks
• cry
• fall
• tonicity
• clonicity
• cyanosis (blue/purple skin)
• Duration - 1-2 mins
• Postictal - amnesia during seziure, confusion, sleepy
• bilateral

• rapid seizure onset, period of unresposiveness, rapid recovery
• stare
• eyes fluttering
• automatisms (abnormal behavior w/ no recollection)prolonged
• Duration - 2-15 secs
• Postictal - amnesia during seizure, NO confusion, promptly resumes activity

• childhood epileptic encephalopathy
• occurs in childs first 7 years of life
• have many seizures/day including drop attacks (atonic seizures)

rapid brief muscle contractions or jerks occurring to bilateral face, trunk, or extremities

• sudden loss of muscle tone can result in head drop or dropping of limbs, collapse or loss of posture, or slumping to ground
• can occur without warning

• occur in neonats and infants
• also known as infantile spasms

• impaired cognition (late)
• seizure aggravation (late)
• depression (late)
• aplastic anemia (late)
• leukopenia (late)
• megaloblastic anemia (late)
• thrombocyopenia (late)
• rash (early)
• Gi discomfort (early)
• liver failure (early)
• pancreatitis (early)
• hyyponatremia
• weight gain/loss

leukopenia (late)

Gi discomfort (early)

aplastic anemia (late) - bone marrow does not produce sufficient RBC

hyponatremia

weight gain

impaired cognition (late)

thrombocytopenia (late)

• enhancement of inhibitory neurotransmission (GABAergic)
• inhibition of excitatory neurotransmission (usually counteracting the effects of glutamate)
• modification of ion conduction involved in neuron action potential generation (usually affecting voltage gated sodium or calcium channels)

• improved adverse effect profile
• little to no need for theraputic drug moitoring (TDM)
• less risk for pharmacokinetic drug-drug interactions

• somnolence and difficulty concentrating occurring after initial dose and gradually improves over weeks
• dose-related ataxia (lack of muscle coordination), diplopia (double vision), and dizziness
• hypersensitivity (may lead to Stevens Johnson syndrome/toxic epidermal necrolysis); begins as rash then leads into hypersensitivity

• prolongs the fast-inactivated state of sodium channels, delaying repolarization of VGSCs
• reduces T-type calcium currents, providing a reason for its efficacy in management of absence seizures
• has a GABAergic effect, suggesting VPA enhances synthesis of GABA and inhibit the breakdown of GABA that is catalyzed by GABA-transaminase

• gingival hyperplasia
• hirsutism (unusual hair growth for women)
• nystagmus (involuntary eye movement)
• blood conc > 20: ataxia, nystagmus, diplopia, vertigo
• blood conc >30: cardiovascular collapse and death
• teratogenic (pregnancy category D)

CBZ, LTG, OXC, PHT, TPM, VPA, ZNS

ETS, LTG, VPA, ZNS

FBM, PHB (diminishes glutamate activity), VPA

TGB

TPM

• adjunctive treatment for LGS
• MOA: not really known, maybe prlong inactivated VGSC

• ONLY effective for absence seizures
• MOA: reduces low-threshold T-type calcium currents in thalamus

• adjunctive therapy for refractory partial seizures
• contains a sulfonamide: black box warning for allergy to sulfa
• MOA: prolongs inactivated state by blocking VGSC, and reduces threshold of T-type calcium currents

• adjunctive therapy for refractory seizures
• MOA: Enhances transition from fact-activated to slow-activated state of the VGSC

• First line treatment for newly diagonsed and refractory partial, and generalized tonic-clonic
• MOA: 1) prolongs fast-inactivated VGSC, 2) enahnces postsynaptic GABA receptor currents, 3) limits activation of glutamate receptors

• last line of therapy
• MOA: enhances GABA activity and inhibits glutamate activity (both uknownmechanisms)

• adjunctive therapy for refractory partial seizures
• MOA: modifies synaptic release of GABA and/or glutamate interaction with SV2A

• adjunctive therapy for partial seizures
• MOA: mostly unkown, may increase brain GABA and inhibit glutamate activity

• normalized PHT levels = Measured PHT levels / (X *Albumin) + 0.1
• X =
• 0.1 for severe renal impairment CrCl ≤10 mL/min with hypoalbuminemi
• 0.2 for hypoalbuminemia
• 0.25 for elderly nursing home patients or critically ill trauma patients with hypoalbuminemia

• First line: CBZ, OXC, GBP, PGN (PGB), TPM, VPA, LTG
• Second line: LTG, OXC, TPM

• First line: LTG, ETS, VPA
• Second line: LTG

• First line: TPM, VPA
• Second line: LTG, TPM

• First line: VPA
• Second line: LEV, TPM, ZNS

• First line: LTG, TPM, VPA
• Second line: FBM, RFM

• 2-3yrs of age: have decresed renal elminiation and heaptic activity therefore should get lower dose
• 3yrs or older: should increse dose due to incresed hepatic activity
• febrile seizures: treat with rectal diazepam

• Oral contraceptives: Inducing AEDs (CBZ, PHB, PHT) causing less effective birth control
• Congenital malformation: VPA, CPZ, PHB, LTG (LTG lowest risk but highest in cleft defects)

Avoid these drugs b/c they can contribute to depression: PHT, PHB

• Keotgenic diet: an intial fasting state followed by high fat and low carb used to treat LGS patients
• Surgery: temporal lobectomy
• Vagal nerve stimulation: pacemaker-device disperses energy to wide areas of the brain

• seizure lasting more than 5 mins or recurrent seizures without regaining consciousness
• occurs to pts <1 or >60yrs
• causes: febrile seizures, viral or CNS infection, pyridoxine defiency, acute encephalopathy, metabolic disorders

• IV route only
• First line: Lorazepam perferred (diazepam or midazolam) and Phenytoin or fosphenytoin (hydantoins)
• IV lorazepam 4mg for adulta
• IV phenytoin 20-30mg/kg for 50mg/min for adults