AEDs

• common neurological disorder
• unprovoked seizures or abnormal electrical storms in the brain
• commonly occurs in children

• generalized: involves entire brain
• focal/partial: one part and may or may not spread
• NEVER DC meds abruptly due to seizure risk

• 1st line 
•       Carbamazepine
•       Lamotrigine
•       Levetiracetam
•       Oxcarbazepine
• 2nd line
•       Ezogabine, gabapentin, phenytoin, pregabalin, topiramate, valproate, zonisamide

• 1st line
•      Ethosuximide
•      Valproate
• 2nd line
•      Clonazepam, levetiracetam, zonisamide

• 1st line
•      Lamotrigine
•      Levetiracetam
•      Valproate
• 2nd line
•      Clonazepam, felbamate, topiramate, zonisamide

• 1st line 
•     Lamotrigine
•     Levetiracetam
•     Valproate
• 2nd line
•     carbamazepine, oxcarbazepine, phenytoin, topiramate, zonisamide

• DOSE: 100 mg TID (Max 600 mg/day)
• Tx Range: 10-20 mcg/ml
• AE: Sedation, Cognitive Impairment

• NOTE: Mix Injection in NS ONLY
• Max Infusion Rate: 50mg/min
• Faster Infusion Rate can LEAD to: Severe Bradycardia, Hypotension
• IV to Oral Ratio is 1:1
• Phenytoin ER caps contain 8% less drug than chewable & suspension
• Enteral Feeding MAY DECREASE dose; must separate

• Ataxia/slurred speech
• Nystagmus(wobbly eye balls)
• Blurred vision, diplopia
• Lethargy, drowsiness, headache

• Skin thickening of facial features
• Lupus-like syndrome
• Connective tissue disorders, gingival hyperplasia
• Hirsutism
• Peripheral neuropathies
• Osteomalacia, osteoporosis
• Vitamin D, calcium deficiency-causes bone loss, folate deficiency-can cause anemia: consider supplementation of each

• PHT correction=
• PHT measured/((0.2 x alb) + 0.1)

Indication: DOC for Partial Seizure; ALT Generalized Tonic Clonic, Trigeminal Neuralgia

• Initial Dose: 100-200 mg BID, or daily if XR
• Maintenance Dose: 400-1600 mg/day
• Tx Range: 4-12 mcg/ml
• SE: N, dizziness, drowsiness, HA, Fatigue, Blurred vision, diplopia
• Black Box Warning: Serious skin rxns(SJS, TENS)
• If Asian ancestry MUST be tested HLA-B1502; if POSITIVE DO NOT USE DRUG; Aplastic Anemia & Agranulocytosis
• Monitor: LFTS, CBC & platelets
• Potent CYP 450 Inducer & Autoinducer
• Occasional/Rare SE:
• Hepatotoxicity, check LFTs, Lupus Like Syndrome, SIADH/Low Na level

• Indication: Partial Seizures
• Dose: 300-600 mg BID
• Renal Dosing: CrCl <30 ml/min reduce dose(start 300 mg daily)
• SE: Sedation, GI effects, diplopia, ataxia
• Serious Skin Reactions: SJS TENS
• **If rash with carbamazepine 20-30% chance with oxcarbazepine)
• Hyponatremia: Monitor serum Na levels esp during first 3 mos, signs of CNS depression and seizure frequency
• Potent 3A4 Inducer

• Indicated: DOC for Absence(petit-mal), Atypical, Myoclonic, Atonic & Generalized Tonic Clonic. ALT: Partial  Formulation: solution or liquid filled capsules
• Initial Dose: 125-250 mg BID
• Maintenance Dose: 15-45 mg/kg/day
• Tx Range: 50-100 mcg/ml
• SE: GI upset, alopecia(treat with selenium and zinc), sedation, tremor and weight gain
• Adverse Reaction: Thrombocytopenia
• Black Box Warnings (3)
•        1. Hepatic Failure-LFTs must be checked prior to start, frequently during the 1st 6 months, and periodically thereafter
•        2. Teratogenicity-including neural tube defects(spina bifida)
•        3. Pancreatitis-Fatal in children and adults

MONITOR: LFTs, CBC, platelets

Indication: Adjucnt Tx for Partial seizures, or conversion to primary therapy from older drugs

• Dose: Wk 1 and 2: 50 mg/day
•          Wk 3 and 4: 100 mg/day
•          Wk 5: 200 mg/day
•          Wk 6: can increase by 100 mg every 1-2 wks, max 400 mg/day

• ** Divide BID, unless using XR***
• SE: N, diploplia, sedation, ataxia, HA
• Black Box Warning: Serious Skin Rxns(SJS, TENS); Chances INCREASED if used with VALPROIC ACID(increase levels of Lamotrigine 2 FOLD)

INCREASE risk of ASEPTIC MENINGITIS(FDA 2010)

PREGNANCY CATEGORY: C

• Indication: DOC for Absence Seizures
• Dose: Start 200-500 mg/d
• SE: Blood dyscrasias, SLE, effects on renal and hepatic function

• TOPAMAX
• Indication: adjunct for partial seizures
• dose: Wk 1 - 25mg BID
•          Wk 2 - 50mg BID
•          Wk 3 - 75mg BID
•          Wk 4 - 100mg BID
•          Wk 5 - 150mg BID
•          Wk 6 - 200mg BID
• S/E: oligohydrosis/hyperthermia (mainly kids-limit sun;hydrate), Nephrolithiasis (hydrate); paresthesias, memory problems, attention deficit, weight loss
• Decreases HCO₃
• acute myopia & secondary narrow-angle glaucoma
• Pregnancy D: oral clefts if mother takes while pregnant

• KLONOPIN - Benzodiazepine (BZD) C IV
• Use: Alt for absence, myoclonic, atonic
• dose: 0.5mg BID-TID (max dose: 20mg/d)
• S/E: somnolence, ataxia, cognitive impairment, depression, mood changes, dependence
• Do NOT discontinue abruptly - seizures can result 
• Panic attacks can occur if dosing interval missed

• KEPPRA, KEPPRA XR
• Use: adjunct for partial, atypical absence, myoclonic, atonic, tonic clonic
• Use: alt for absence
• dose: 500-1500mg BID
• S/E: somnolence, behavior changes, vomiting, weight loss, hematologic/hepatotoxicity (rare)
• No significant DDIs

• ZONEGRAN
• Use: adjunct for partial
• dose: 100-600mg/d
• S/E: HA, confusion, anorexia, weight loss, somnolence, serious skin rxns (SJS, TEN) oligohydrosis/hyperthermia (mainly kids-limit sun;hydrate); nephrolithiasis; aplastic anemia, metabolic acidosis
• Do NOT use if SULFA allergy