Antiseizure

Question 1

Classification of Seizures

Answer 1

Focal: one hemisphere
-Impaired awareness: automatic movements
-Normal awareness: dif manifestations

Generalized: both hemispheres
-Tonic clonic: loss of consciousness, contractions of muscles
-Absence: children, no motor sx, brief loss of consciousness
-Other motor

Question 2

General mechanisms of antiseizure drugs

Restore the balance of excitation and inhibition by:

Answer 2

1. Prolongation of the inactivated state of Na-channels
2. Inhibition of excitatory neurotransmission
3. Enhancement of inhibitory neurotransmission
4. Ca-channel blockade (mainly T-Type)

Question 3

Drugs that target prolongation of the inactivated state of Na-channels

Answer 3

CL is PG TV

-Gabapentin
-Phenytoin
-Carbamazepine
-Lamotrigine
-Topiramate
-Valproic acid

Question 4

Drugs that target at the excitatory glutamatergic synapse

Answer 4

PLLTv (pretty little liars Tv)

-Topiramate
-Perampanel
-Lamotrigine
-Levetiracetam

Question 5

Drugs that target at the inhibitory GABAergic synapse

Answer 5

BB TVT

-Barbiturates
-Benzodiazepines
-Topiramate
-Valproic acid
-Tiagabine

Question 6

Drugs that cause blockade of T-type Ca-channels

Answer 6

LEVon

Used in absence seizures (ONLY these for absence seizures)

-Valproic acid
-Ethosuximide
-Lamotrigine

Question 7

General considerations of seizure treatment

Answer 7

– Social problems
– Impact on driving license
– Impact on career
– Avoid trigger factors (light, sleep deprivation, noise)
– Long-term treatment (counseling side effects!)

Question 8

Phenytoin

Answer 8

USE: any seizure, esp. focal and generalized onset tonic-clonic seizures

AE: F CHHEG CPT
-CNS (nystagmus, ataxia, diplopia, sedation)
-Endocrine (osteomalacia + hypocalcemia)
-Hematologic (megaloblastic anemia, folate deficiency)
-Gingival hyperplasia
-Facial coarsening
-Hirsutism

DI: CYP, high protein binding drugs

CI: teratogenicity, cleft lip

Question 9

Carbamazepine

Answer 9

USE: any seizure (focal/tonic), trigeminal neuralgia, BP

AE: EHCH CT
-CNS (diplopia, ataxia, drowsy)
-Hypersensitivity (rash, SJS)
-Hematologic (leukopenia/anemia)
-Endocrine (hyponatremia)

DI: CYP induction

CI: Teratogenicity: cleft lip and palate and spina bifida

Question 10

Ethosuximide

Answer 10

USE: absence seizure

AE:
-GI (anorexia, NV) NAV
-CNS (sed/diz/ataxia) SAD

Question 11

Valproic acid

Answer 11

USE: any seizure, migraine, BP

AE: CAGL CLCP
-Liver and GI (NV, weight gain, hepatoxic)
-CNS (tremor, diz, sed)
-Alopecia

DI: CYP inhibition

CI:
-Liver disease
-Children
-Pregnancy and contraception REQUIRED

Question 12

Lamotrigine

Answer 12

I HHAD a lambo

USE: any seizure, BP

AE:
-CNS (diplopia, HA, ataxia) HAD
-Hypersensitivity (rash, SJS)

Question 13

Topiramate

Answer 13

USE: any seizure

AE: CWCT
-CNS (cognitive, HA, fat, diz)
-Weight loss (+phentermine)

DI: induce CYP3A and inhibits CYP2C19

CI: Teratogenicity (cleft lip)

Question 14

Gabapentin

Answer 14

USE: focal seizure to tonic seizure

AE:
-CNS (sed/diz/ataxia)
-Weight gain

Question 15

Tiagabine

Answer 15

USE: focal seizure

AE: CNS (sed/diz)

Question 16

Status Epilepticus TX

Answer 16

Prolonged/repeated seizures without recovery of consciousness

1. IV Lorazepam (or Diazepam/Midazolam)
2. Wait 1 min. No response = more lorazepam
3. Even if sz stops, administer nonbenzodiazepine (Fosphenytoin)

Question 17

Levetiracetam, Brivaracetam

Answer 17

USE: any seizure

AE: Minor, CNS (sed/depression)

Question 18

Perampanel

Answer 18

USE: any seizure

AE: DSN
-CNS (diz/somnolence)
-Neuropsychiatric (BBW)