Chapter 15: Drugs for Seizures Flashcards
What are seizures?
- clinically detectable sign of epilepsy
- abnormal or uncontrolled neuronal discharges in the brain
- symptom of an underlying disorder
- Affect
–> consciousness
–> Motor activity
–> Sensation
What is a convulsion?
- Involuntary violent spasm of large muscles of face, neck, arms, and legs
- not synonymous with seizures
What is the most common serious neurologic problem affecting children?
Seizures
What are the Etiologies of Seizures
- Fever
- Infectious disease
- Metabolic disorders
- Neoplastic disease
- Trauma
- Vascular diseases
- Medications
- High doses of local anesthetics
- Eclampsia
- Drug abuse
- withdraw symptoms from alcohol or sedative-hypnotic drugs
What is Epilepsy?
- seizures occurring chronically
- International Classification of Epileptic seizures
- will need pharmacologic management indefinitely
- can be broken down into Partial (focal), Generalized, and Special epileptic syndromes
how are seizures classified in Neonates, Infants, and children?
- Congenital abnormalities of CNS
- Perinatal brain injury
- Metabolic imbalances
What is the etiology of seizures in later childhood?
- CNS infections
- Neurological degenerative disorders
- Inherited epilepsies
What is the etiology of seizures in adults?
- Cerebral trauma
- Cerebrovascular disorders
- Neoplastic disease
What are the two types of Seizure Classifications
Partial and Generalized
How are Partial seizures further broken down?
Simple and Complex
How are Generalized seizures further broken down?
- Absence (petit mal)
- Atonic
- Tonic-clonic (gran mal)
Partial simple seizure
CNS S/S: Hallucinations, intense emotions
MSK S/S: twitching of arms, legs, face
Aura: No
Postictal: No
Partial Complex seizure
CNS S/S: No response to verbal stimuli
MSK S/S: Fumbling with or attempting to remove clothing
Aura: Yes
Postictal: Yes
Absence (petit mal) seizure
Length: seconds
CNS s/s: stares, no response to verbal stimuli
MSK s/s: Fluttering eyelids, jerking
Aura: No
Postictal: No
Other: seen most often in children, often misdiagnosed
Atonic seizures
Length: seconds
MSK s/s: Falling or stumbling
Aura: No
Postictal: No
Tonic-clonic (gran mal)
Length: Minutes
MSK s/s: Intense contraction (tonic) –> alternating contraction/relaxation (clonic)
Aura: Yes
Posticital: Yes
Other: Loss of bladder/bowel control, shallow breathing/apnea
What are the special syndromes seizure classifications?
- Febrile seizure
- Myoclonic seizure
- Status epilepticus
What is a Febrile seizure?
- tonic-clonic activity lasting 1-2 minutes
- rapid return to consciousness
- occurs in children usually
What is a Myoclonic seizure?
- Large jerking movements of major muscle group, such as an arm
- falling from a sitting position or dropping what is held
What is Status epilepticus?
- considered a medical emergency
- continuous seizure activity, which can lead to coma and death
What type of drugs potentiate GABA Action
- Barbiturates
- Benzodiazepines
- Miscellaneous GABA Agents
How to manage seizure medication once selected
- The patient placed on a low initial dose
- The is amount gradually increased
- if seizure activity remains –> different medication added in small increments
- newer antiseizure drugs have fewer adverse effects than older ddrugs
- most cases require only a single drug
what is the goal of antiseizure pharmacotherapy?
- to suppress neuronal activity enough to prevent abnormal or repetitive firing
- directed at controlling the movement of electrolytes across neuronal membranes
- affecting neurotransmitter balance
What is the target action of Barbiturates, Benzodiazepines, and Miscellaneous GABA agents
Acts by changing the action of gamma-aminobutyric acid (GABA), The primary inhibitory neurotransmitter in the brain
