Epilepsy Dr. Thomason Flashcards
When is a patient considered to have epilepsy?
Must have at least one seizure or one with a high predictor to have another one
Which test may be performed to confirm/deny epilepsy?
EEG
-CBC: elevated WBC could indicate an infection such as meningitis or enephalitis
CMP: sodium (hyponatremia can cause seizures), Ca2+ (hypocalcemia)
-urine drug screen: to check for substances
How indicative are EEG test for seizures?
Not so much, over 50% of patients with seizure disorder have a normal EEG, especially when they are currently not having a seizure
What are the triggers for seizures?
-sleep deprivation
-stress
-alcohol (decreases the seizure threshold)
-elicit substances (meth, cocaine, Adderall)
-> ask for benzodiazepines (from the street) -> Withdrawal of benzos can cause seizures
When do we usually see alcohol associated seizures?
occurs when the patient undergoes withdrawal
-after the blood alcohol goes to 0
-hours after the first drink
Questions to ask the patient?
-How often and and how much do you trink alcohol?
-any neurosurgical procedures
-any concussions
-have you had a seizure before and what characteristics of the seizure (movements during seizure, feelings before the seizure)
What are the risk factors for having seizures?
-abnormal EEG
-symptomatic neurological event (concussion, lost consciousness)
Which side effect is on the BBW for antiseizure medications?
Suicidal thoughts
Antiseizure drugs causing Hyponatremia, bone marrow suppression
Carbamezapine
Oxcarbazepine
Phenytoin
Which of the anitseizure drugs may cause SJS?
Carbamaezpine
Oxcarbazepine
Phenytoin
Fosphenytoin
Lamotrigine: severe rash -> can evolve to SJS
Zonisamide
Which antiseizure drugs cause PR prolongation?
Lacosamide -> also slowed cardiac conduction
Pregabalin
Which one causes aplastic anemia and liver failure?
Felbamate
-only used when all other options failed
Anitseizure drugs causing euphoria
-Pregabalin (C-V)
-Perampanel (C-III)
-Lacosamide (Vimpat)
Which have DDI with contraceptives?
Topiramate (high dose)
Valproic acid
Phenytoin
Fosphenytoin
Carbamazepine
Oxcarbazepine
Lamotrigine - OC reduces levels of Lamotrigine -> seizure risk
How is Lamotrigine dosing titrated?
25 mg daily - two weeks
50 mg daily - two week
100 mg daily - one week
200 mg - target dose
to prevent side effect of rash
When does Lamotrigine need to be retitrated?
If a patients discontinues Lamotrigine for 5 days
Dosing titration of Lamotrigine when the patient is also on Carbamazepine
50 mg daily x two weeks
100 mg daily x two weeks
200 mg daily x one week
300 or 400 mg daily - target dose
Carbamazepine speeds up the metabolism of Lamotrigine (CYP incucer)
How do Valproic acid and Depakote affect Lamotrigine?
Valproic acid is a CYP inhibitor
-> dose Lamotrigine
25 mg every other day x 2 weeks
25 mg every day x 2 weeks
50 mg daily x 1 week
100 mg daily - target dose
Therapeutic range of Valproic acid
50-100
Brand name for Carbamazepine?
Tegretol
Brand name for Ethosuxumide?
Zarontin
Brand name for Felbamate?
Felbatol
Brand name for Gabapentin?
Neurontin
Brand name for Lacosamide?
Vimpat
Brand name for Lamotrigine?
Lamictal
Brand name for Levetiracetam?
Keppra
Brand name for Oxcarbazepine?
Trileptal
Brand name for Perampanel?
Fycompa
Brand name for Phenytoin and Fosphenytoin?
Dilantin
Cerebyx
Brand name for Pregabalin?
Lyrica
Brand name for Valproic acid?
Depakene
Brand name for Topiramate?
Topamax
“Stupid max” - brain fog
ADE: Hypohidrosis (little or no sweat, cognitive impairment, bad taste)
Brand name for Divalproex?
Depakote
Brand name for Zonisamide?
Zonegran
