Anticonvulsants

Question 1

What is epilepsy?

Answer 1

Seizure disorder of sudden discharge of cerebral neurons

• Caused by electrical activity in the brain; recorded with EEG
• “seizure” - episode of neurologic dysfunction, often accompanied by motor activity such as convulsions, and emotional/sensory change
• May include visual, auditory or olfactory hallucinations

Question 2

T or F, epilepsy is a multifactorial disease

Answer 2

True, etiologies may include: infection, trauma, neoplasms, fevers, genetic/birth influences, hereditary factors, etc.

Question 3

Majority of patients with epilepsy have what?

Answer 3

idiopatchi epilepsy = no known cause

Question 4

Drugs for epilepsy provide marked improvement in what percentage of patients?

Answer 4

70-80%

Question 5

2 broad groups of epilepsy:

Answer 5

1. Partial epilepsies (Most common type)

2. Generalized epilepsies

Question 6

Two subtypes of partial epilepsy

Answer 6

1. Simple partial

2. Complex partial

Question 7

Describe simple partial epilepsy

Answer 7

Seizures caused by a group of hyperactive neurons confined to a single locus in the brain

Question 8

Describe the 5 details regarding partial epilepsy

Answer 8

1. Electrical disorder does not spread
2. Seizure lasts for only a few seconds
3. Individual does not lose consciousness
4. Often exhibits abnormal activity of a single limb or muscle group
5. May occur at any age

Question 9

Describe what a complex partial epilepsy is

Answer 9

Seizures exhibit complex sensory hallucinations, mental distortion and loss of consciousness

Question 10

Describe the 2 details to complex partial epilepsy

Answer 10

1. Aura (seizure symptoms before it occurs); seizure lasts for 3 to 5 minutes
2. Full consciousness is slow to return

Question 11

Complex partial epilepsy is also known as what?

Answer 11

psychomotor or temporal lobe seizures

Question 12

80% of people with complex partial epilepsy experience initial seizure prior to what age?

Answer 12

prior to 20 years of age

Question 13

Name the two types of Generalized Epilepsies

Answer 13

Tonic-clonic (grand mal)

Absence (petit mal)

Question 14

Consciousness is lost with which type of Generalized Epilepsy?

Answer 14

Both types

Tonic-clonic (grand mal) & Absence (petit mal)

Question 15

What is the most dramatic form of epilepsy?

Answer 15

Tonic-clonic (grand mal)

Question 16

Sequence of events during a tonic-clonic

Answer 16

Seizures result in:

1. loss of consciousness
2. tonic
3. clonic (convulsive twitching)

Question 17

Define tonic and clonic

Answer 17

tonic: producing/restoring normal tone; continuous tension
clonic: contraction/relaxation of muscle

Question 18

Major motor activity during a tonic-clonic

Answer 18

fall to floor, tonic rigidity, chronic jerking of face and limbs

Question 19

Tonic-clonic seizure is followed by what?

Answer 19

a period of confusion and exhaustion

• Can become Comatose
• Consciousness returns with confusion, headache, drowsiness

Question 20

What is an aura?

Answer 20

Brief period of heightened sensory activity prior to the onset of the seizure
- Characterized by numbness, nausea, or unusual sensitivity to light, odor, sound

Question 21

Define an Absence (petit mal) epilepsy

Answer 21

seizures involve an abrupt and brief loss of consciousness (10-30 seconds)

Question 22

When does the onset of Absence (petit mal) epilepsies occur?

Answer 22

Onset occurs at 3 to 5 years old and lasts until puberty (disappears in middle adulthood)

CHILDREN!

Question 23

Describe the aura that occurs in Absence (petit mal) epilepsies

Answer 23

There is no aura; patient stares and has rapid eye blinking for 3 to 5 seconds; quickly returns to normal

Question 24

What is status epileptics?

Answer 24

Seizures are continuous or rapidly recurrent

- can be life-threatening

Question 25

What happens if you have a patient that has status epilepticus in the dental office?

Answer 25

give injection of diazepam (valium)

- May also use lorazepam (Ativan) and midazolam (Versed) PARENTERALLY

Question 26

What are the goals of drug therapy for epilepsy

Answer 26

1. to control seizures (frequency)

2. Minimize adverse reactions

Question 27

Mechanism of drug therapy for epilepsy

Answer 27

prevent the spread of abnormal electric discharges in the brain without causing excessive drowsiness
- CNS depressants

Question 28

T or F, Epilepsy drugs are usually taken for life

Answer 28

True: chronic toxicity becomes an important consideration when selecting an agent

Question 29

How big of a therapeutic index do anticonvulsants have?

Answer 29

Narrow therapeutic index

- titrate dose carefully; monitor blood levels

Question 30

When dosing, need to consider that most anticonvulsants stimulate what?

Answer 30

liver microsomal enzymes (inducers)

- when adding additional anticonvulsants, changes the metabolism of all anticonvulsants

Question 31

At low doses, how are metabolized anticonvulsants eliminated? Are they always eliminated this way?

Answer 31

FIRST ORDER elimination (drug can be removed from body after metabolism).

-No, After saturation of liver enzymes, metabolism converts to ZERO ORDER KINETICS = blood level increases abruptly

Question 32

3 common side effects with anticonvulsants

Answer 32

1. CNS depression
2. CNS depression is addictive with other CNS depressants
   
   • Opioids in dentistry; alochol
3. GI effects (can be minimized by taking drug with food)
   
   • prescribe agents that can irritate the GI tract cautiously in patients taking anticonvulsants (NSAIDS)