Epilepsy Flashcards
Partial Seizures
Seizures that begin at discrete and relatively limited focus
Simple partial seizures
- limited spread
- uncomplicated
- affects only limited aspects of neural function
- consciousness and memory undisturbed
Complex partial seizure
- alteration of consciousness follows initial simple seizure
- typically appear confused and preoccupied
- automatisms (purposeless and automatic behaviors: lip smacking, sucking, fumbling with clothing)
- seizures are stereotypic
Generalized seizures
cannot be linked to single foci, involves entire cerebrum
- Absence seizures (petit mal)
- simple absence seizure (an epilepsy of childhood and adolescence)
Tonic-clonic seizures
- Grand Mal
- maximal seizure response of brain in which all systems can be recruited into paroxysmal discharge
3 phases of tonic-clonic seizures
1.) initial tonic phase (10-20s)
2.) clonic phase (1/2-2min)
3.) terminal phase (5min)
Levetiracetam use
most seizure types
Levetiracetam dosing
IR: 500mg BID -> inc Q2weeks by 500mg/dose -> max dose 1.5g BID
ER: 1g QD -> inc Q2weeks by 1 g/dose -> max 3 g
Levetiracetam ADE
generally well tolerated
some weight gain
Oxcarbamazepine use
adjunctive therapy in treatment of partial seizures in kids 6 and older
Oxcarbamazepine dose
- 5 mg/kg/day
- inc weekly by 5 mg/kg/day
- target 30-50 mg/kg/day
- BID dosing
Oxcarbamazepine ADE
CNS
- drowsiness
- h/a
- dizziness
GI
-N/V
Rash
Oxcarbamazepine monitoring parameters
sodium
hepatic function
Lamotrigine use
partial onset seizures
absence seizures
GTC
juvenile myoclonic epilepsy
Lennox-Gastaut Syndrome
Lamotrigine dose
children 2-12 yo:
- start 0.5 mg/kg/day div BID x 2 weeks
- inc by 1 mg/kg/day x 2 weeks
-typical maintenance 5-15 mg/kg/day
-max 400mg/day
Lamotrigine ADE
SJS
Gabapentin use
partial seizures
monotherapy or addon
useful for co-morbid neuropathic pain / bipolar disorder
Gabapentin dose
start 30 mg/kg/d
max 1800 mg/d
TID dosing
Gabapentin ADE
drowsiness
dizziness
ataxia (involuntary movement)
weight gain
Phenytoin use
generalized seizures
Phenytoin dose
200-400 mg/d
Phenytoin concentration dependent ADE
nystagmus (rapid eye movement)
double vision
blurred vision
incoordination
drowsiness/dizziness
h/a
Phenytoin idiosyncratic ADE
aplastic anemia
granulocytopenia
hepatotoxicity
rash
exfoliative dermatitis
SJS
lupus-like rxn
Phenytoin chronic ADE
gum hypertrophy
acne
hirsutism
peripheral neuropathy
chronic cerebellar damage
megaloblastic anemia
osteoporosis
fetal vitamin K depletion
Valproate dose
15 mg/kg/d in 2-3 div doses ->
increase in 5-10 mg/kg/day increments weekly
max 60 mg/kg/d
Valproate ADE
N/V/D + abdominal cramps (minimized by slow titration)
inc LFTs
drowsiness
ataxia
hair loss
weight gain
asymptomatic hyperammonemia
liver failure
Carbamazepine use
partial seizures
secondary generalized seizures
Carbamazepine ADE
dizziness/drowsiness
h/a
double vision
N/V
hyponatremia
transient leukopenia
Carbamazepine monitoring
baseline CBC
LFTs
serum levels weekly during 1st month