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GoT of AED Tx
- manage first seizure
- prevent recurrence
- minimize S/E
- optimize QoL
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Non-pharm considerations
- avoid sleep deprivation
- discuss safety
- discuss alcohol consumption
- avoid stimulants
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Classification of Epilepsy
- 1. Primary generalized
- a. tonic-clonic (grand mal): tonic muscle contractions-->crescendo rhythmic contractions-->subside
- b. absence (petit mal): no major convulsions, 3/sec spikes
- c. myoclonic: rapid, dramatic (ie. throwing hands up in the air)
- d. JME: tonic-clonic+absence+myoclonic that is more prevalent in low arousal states (ie. HS, early AM), 6/sec spikes
- 2. Partial (Focal)
- a. simple: still conscious
- b. complex: wide range of S/S (temporal lobe, automatism)= fumbling clothes, impaired consciousness
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Tx for JME
- VPA*
- LTG, TPM, PHT(low dose)
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Tx for Complex Partial (Adults)
- CBZ*
- PHT>VPA>GBP, LTG, OXC, PB, TPM
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Tx for Complex Partial (Elderly)
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Tx for Complex Partial (Children)
- OXC*
- CBZ, PB, PHT, TPM, VPA
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Tx for Primary Generalized Seizure
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OC INTX with AEDs
CBZ,PHT,PB,TPM (high)= increased OC clearance
OC= decrease LTG concentration
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Amount of AED in breast milk
LTG,GBP,TPM > CBZ,VPA,PHT
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Rash risk with AEDs
- high risk: LTG, CBZ, PHT
- mod risk: OXC, PB, CBM
- low risk: LEV, GBP, VPA, TPM
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Multipurpose AEDs
- Tx for migraine= VPA, TPM, GBP
- Tx for neuropathic pain= GBP, PGB, TPM
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S/E of VPA
Dose related S/E of VPA: tremor, thrombocytopenia
- rash (low risk)
- hepatotoxicity
- pancreatitis
- weight gain
- osteoporosis
- hail loss
- (nausea, sedation)
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S/E of LTG
Acute CNS S/E of LTG: increased JME
rash (high risk)= SJS increased risk in Asians HLA-B*1502 allele
- diplopia
- (nausea, dizziness, HA, sleep disturbances)
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S/E of CBZ
Acute CNS S/E of CBZ: increased absence, myoclonic, JME
Dose-related S/E of CBZ: arrythmia, hyponatremia, leukopenia
- rash (high risk)
- aplastic anemia
- osteoporosis
- weight gain
- (diplopia, dizziness, fatigue, SJS)
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S/E of TPM
- rash (low risk)
- metabolic acidosis
- psychological toxicity
- ophthalmologic effects
- weight loss
- kidney stones
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S/E of PHT
- rash (high risk)
- arrythmia
- leukopenia
- psychological toxicity
- osteoporosis
- hirsutism
- gingival hyperplasia
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S/E of OXC
- rash (moderate risk)
- hyponatremia
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S/E of PB
- rash (moderate risk)
- osteoporosis
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S/E of GBP
- rash (low risk)
- weight gain
- osteoporosis
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