Anticonvulsant 1.1

Question 1

Epilepsy

Answer 1

• A sudden, recurrent and transient disturbance of mental
function or movements of the body that result from
excessive discharging of groups of brain cells.
• An epileptic seizure occurs when there is an imbalance
between inhibitory and excitatory neurotransmission.
• Disease of the cerebral cortex
• Seizures correlate with abnormal EEG activity
• Epilepsy affects 0.3 to 0.6% (3-6/1000) of the population

Question 2

Idiopathic Epilepsy

Answer 2

– No specific anatomic cause for seizure

– May be inherited

Question 3

Symptomatic Epilepsy

Answer 3

– Drug use
– Hypoglycemia
– Brain Injury
– Tumors

Question 4

Types of Seizures: Generalized

Answer 4

– Convulsive
– Absence
– Myoclonic
– Atonic
– Febrile
– Status epilepticus

Question 5

Types of Seizures: Partial

Answer 5

– Simple

– Complex

Question 6

Status Epilepticus

Answer 6

• Generalized tonic-clonic seizures so frequent that
another seizure occurs before the patient returns to
normal consciousness from the postictal state
• Medical emergency with a high mortality rate

HYPOXIA —> BRAIN DAMAGE

Question 7

Treatment of Status Epilepticus

Answer 7

I.V. BDZ (lorazepam / diazepam /midazolam)
Followed by I.V. Phenytoin / Fosphenytoin
• This is given even if seizure has stopped indication
is to prevent seizure from reoccurring
If refractory
• More phenytoin and more BDZ
Then if still refractory
• Phenobarbital / Pentobarbital / Midazolam / Propofol
– No consensus on best option

Question 8

3 parts of a Seizure

Answer 8

• AURA:
– Warning: sensation/mood may help to identify location
of seizure
– Present in:
• Convulsive / Partial
– Absent in:
• Absence, Myoclonic
• ICTUS:
– The seizure itself
• POSTICTUS:
– The period after the seizure
• Absent in absence

Question 9

Treatment

Answer 9

• It is estimated that 85% of patients with
uncomplicated tonic-clonic seizures can achieve
complete seizure control.
• Therapeutic Goals:
– Cessation of all seizures
– No alteration in
• Intellect or alertness
• Physical abilities
• Reproductive ability due to therapy

Important because
may be on therapy for rest of life

Question 10

Principals of Therapy

Answer 10

• Treat underlying causes of the seizures:
– Work at the source to prevent the pathological firing of the
neurons of the seizure foci.
– Prevent the spread of excitation from the source to
surrounding normal tissue.
• Proper drug selection for the individual patient:
– Factors influencing anticonvulsant selection:
• Drug’s potential effectiveness
• Drug’s potential for causing problems
• Convenience
• Cost
• Avoid unnecessary drug combinations

Question 11

Serum levels of drug vital

Answer 11

• Utilize serum levels of anticonvulsants
– They can help the physician avoid producing
unpleasant and unexpected consequences of
drug toxicity.
– They can help insure adequate dosages in
patients with persisting seizures
– They can help increase patient compliance

Question 12

Mechanisms of Antiepileptic Drugs

Answer 12

• Inhibition of the sodium or calcium influx
responsible for neuronal depolarization
• Augmentation of inhibitory GABA neurotransmission
• Inhibition of excitatory glutamate neurotransmission
• Unknown