Anti-Seizure Drugs Flashcards
Who should be started on anti seizure drugs?
If a patient has had 2 or more unprovoked seizures
Name drugs that lower seizure threshold (5)
- Theophylline
- Alcohol
- Phenothiazines (high-dose)
- Antidepressants (ex. Bupropion)
- Street drugs
When to stop anti-seizure medications?
- Seizure free for 2-4 years
- Complete seizure control within 1 year
- Onset of seizures between 2-35
AND normal neuro exam + EEG
What are the 3 mechanisms of action for anti-seizure drugs?
- Enhance GABA (inhibitory)
- Turn down Glutamatergic (excitatory)
- Modify ion conductance
How do benzodiazepines (Diazepam, Lorazepam) work?
bind to single site on chloride-ion channel which facilitates opening
Flumazenil: MOA
reverses effects of the benzodiazepines
Which seizure is associated with a 3Hz spike and wave pattern on EEG?
Generalized Absence
Generalized Absence: Tx
- Ethosuximide***
- Lamotrigine
- Valproic acid
Ethosuximide: clinical application
Generalized absence only!
Ethosuximide: ADEs
- Headache
- Blood dyscrasias (unspecified blood abnormality)
- *Monitor CBC**
Ethosuximide: MOA
decreases glutamate
Lamotrigine: MOA
decreases glutamate
Lamotrigine: Clinical applications
- Generalized Absence
- Generalized Tonic-clonic
- Focal aware
- Focal/Generalized myoclonic
Lamotrigine: ADEs
- Serious skin rash (go low and slow)***
2. Diplopia
Valproate/Valproic acid: MOA
alters GABA
Valproate/Valproic acid: ADEs
- Hepatotoxicity*
- Teratogenic**
- Pancreatitis*
- Alopecia
Clonazepam: MOA
Enchance GABA
Clonazepam: clinical applications
- Generalized Absence
- Focal/Generalized myoclonic
- Infantile spasms***
Clonazepam: ADE
sedation
Topiramate: Clinical applications besides seizures
Migrane!
Topiramate: ADEs
cognitive slowing
confusion
Which medications should be avoided as they worsen absence seizures? (4)
- Carbamazepine
- Vigabatrin
- Gabapentin
- Tiagabin
(pheytoin, and phenobarbital are ineffective and old!)
According to US Guidelines, what is the drug of choice for tonic-clonic seizures?
Topiramate*
What are the 3 FDA approved medications for tonic-clonic seizures?
- Lamotrigine
- Levatriacetam
- Perampanel
Levetiracetam: ADE
- behavioral problems (aggression, irritable)
- Headache
Carbamazepine: ADE
Serious dermatologic reactions in Asians, and people with HLA-B (SJS and TEN)
- Aplastic anemia
- Agranulocytosis
- Ataxia
- Diplopia
- Hyponatremia
- Metabolic bone disease
What is interesting about Carbamazepine’s pharmacokinetics?
induces own metabolism
Lacosamide: MOA
blocks effect of neurotrophins
Lacosamide: ADEs
small increase in PR interval
Phenytoin (Dilantin): ADEs
- Cardiovascular risk associated with rapid infusion**
- Nystagmus (first sign of toxicity)
- Gingival hyperplasia
- Hirsuitism
- Folate deficiency
Phenobarbital: ADEs
- Sedation (can cause coma or death)**
- Intellectual blunting
- Behavioral changes (idiosyncratic - hyperactive)
Phenobarbital: pharmakokinetics
Long-half life and inducer of P450 (many reactions!!!)
What is the biggest worry you have for a patient taking Vigabatrin?
Permanent vision loss***
What is the biggest concern for taking Perampanel?
serious psychiatric and behavioral reactions
Tigabine: ADEs
- Concentration and attention difficulties
- Behavioral disturbance
- Increased appetite
What is the 1st line treatment for Myoclonic seizures?
Levetriacetam (Keppra)
Levetiracetam: ADEs/interactions
minimal and rare!
