-
Phenobarbital -- moa
- enhances GABA mediated Cl influx
- also blocks glutamate AMPA receptors
- may worsen absence
-
Phenobarbital -- A/E
- sedation
- diplopia, ataxia, nystagmus
- skin rxns
-
Primidone (Mysoline)
- active metabolites -- Pb and PEMA
- may worsen absence
- A/E -- sedation, N/V, blood dyscrasis
-
Phenytoin (Dilantin)
- block VSSCs
- Gingival hyperplasia, hirsutism, skin rxns, osteomalacia, blood dyscrasias
-
Fosphenytoin (Cerebyx)
- prodrug of phenytoin
- DOC in status epilepticus
-
Ethosuximide (Zarontin)
- Absence; may worsen grand mal
- decreases low threshold T-type Ca current
- sedation, HA, hiccough, photophobia
-
Trimethadione (Tridione)
- absence in pts refractory to ethosuximide
- sedation, blood dyscrasias -- neutropenia (20%), SLE
-
Carbamazepine (Tegretol) also TCA
- DOC in simple and complex partial seizures
- blockade of VSSC
- induces microsomal enzymes
- SJS -- 10x more common in asians with HLA-B 1502 allele
-
Valproic Acid (Depakene)
- broad spectrum drug, absence and mixed types with absence
- blockade of VSSC and T-type Ca channels, also increases GABA
- Hyperammonemic encephalopathy, hepatotoxicity, alopecia and blood dycrasias
-
Lamotrigine (Lamictal)
- blockade of VSSC and T-type Ca channels
- may make myclonus worse
- N/V, blood dyscrasias, skin rash can progress to SJS
-
Felbamate (Felbatol)
- block VSSC and may increase GABA may also block NMDA
- treating refractory seizures -- reserved drug
- aplastic anemia, acture liver failure
-
Gabapentin (Neurontin)
- increase of GABA and alter GABA transporters
- partial seizures
- somnolence, dizziness, ataxia, fatigue
-
Tiagabine (Gabitril)
- adjunct. therapy in pts >12 yo with partial seizures
- inhibits GABA uptake in neurons and glia
- nervousness, dizziness, tremor, psychosis
-
Topiramate (Topamax)
- blocks VSSC, also potentiates GABA, blocks glutamate AMPA receptors, also T-type Ca channels
- fatigue, dizziness, drowsiness, acute myopia, glaucoma, urolithiasis
- no wt gain
-
Levetiracetam (Keppra)
- partial and generalized tonic clonic
- increase in GABA, block Na, K, Ca, channels and modulates SV2A
- weakness, dizziness and somnolence
-
Diazepam (Valium)
- status epilepticus
- tolerance develops quickly
-
Clonazepam (Klonopin)
absence and akinetic and myoclonic seizures
-
Clorazepate (Tranxene)
adjunct in complex partial seizures
-
Lorazepam (Ativan)
status epilepticus
-
Zonisamide (Zonegran)
- partial but has broad spectrum
- blocks VSSC and T-type Ca channels
- sulfonamide
- does not interact with other AED
-
Vigabatrin (Sabril)
- partial seizures, infantile spasms
- irreversible inhibitor of GABA transaminase
- visual field loss in 1/3 of pts, wt gain
-
Pregabalin (Lyrica)
- partial seizures
- same as gabapentin
- somnolence, ataxia, dizziness
-
Lacosamide (Vimpat)
- add-on with partial seizures
- slow inactivation of Na channels
- HA, N, diplopia
-
Rufinamide (Banzel)
- Lennox-Gastaut syndrome, difficult to treat syndromes
- inactivation of Na channels
- QT shortening, HA, N, somnolence
-
Ezogabine (Potiga)
- adjunct in partial seizures
- facilitator of K channels
- bladder dysfunction (8-9%), confusion, somnolence, blurred vision
-
PerAMPAnel (Fycompa)
- adjunct in partial seizures
- antagonist of AMPA gluatamate receptor
- drowsiness, dizziness
- wt gain, mood changes, N, visual disturbances
-
Stiripentol (Diacomit)
- orphan drug in tx of severe myclonic epilepsy in infancy
- unique GABA-a receptor agonist
-
Acetazolamide (Diamox)
- adjunct in petit mal
- CA inhibitor in the seiure focal area
- sulfonamide
-
DOC in Partial, including secondarily generalized seizures
- Lamotrigine
- Carbamazepine
- Levetracetam
- Oxcarbazepine
-
DOC in Primary generalized tonic-clonic
- Valproate
- Lamotrigine
- Levetracetam
-
-
DOC atypical seizures
- Valproate
- Lamotrigine
- Levetracetam
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