Seizure Disorder Flashcards
What are the drug causes of Seizures?
-antidepressants (bupropion, SNRI, TCA)
-antipsychotics
-amphetamines
-theophylline
-illicit substances
-tramadol/tapentadol
-withdrawal from alcohol, anticonvulsants, benzos, baclofen
What are the seizure types?
-partial or focal seizures: abnormal electrical activity in one hemisphere
-generalized seizures: abnormal electrical activity in both hemispheres
Describe Simple Focal Onset Seizures
without dyscognitive features
-no loss of consciousness
-involuntary twitching or jerking in one extremity
-sweating, salivating, vomiting (autonomic symptoms)
-numbness, tingling, feeling of deja vu, visual disturbances, hallucinations, ringing/buzzing sounds
Describe Complex Focal Onset Seizures
with dyscognitive features
-loss of consciousness
-similar presentation to simple focal onset seizures, but may also not make sense while speaking, lip smacking, picking at clothes, staring off into space, extreme changes in behavior postictal state (post- seizure) common
Describe Absence Generalized Onset Seizures
-sudden interruption
-blank stare
-no aura (“warning”) or postictal state
-shorter than complex focal seizures (2-30 seconds)
-generally presents in children and adolescents
Describe Myoclonic Generalized Onset Seizures
-brief shock-like muscle contractions
-may be repetitive
-can be confined to small isolated muscle group or larger areas
Describe Clonic Generalized Onset Seizures
-bilateral, symmetrical, rhythmic jerk movements
-longer than myoclonic seizures
Describe Tonic Generalized Onset Seizures
-stiffness in the limbs
-bilateral increased tone
-seconds to a minute
Describe Tonic-Clonic Generalized Onset Seizures
-5 phase characterization: loss of consciousness, flexion, extension, tremor, clonic
-phase of tonic followed by clonic
-prodromal (“warning”) symptoms in some patients
Describe Atonic Generalized Onset Seizures
-sudden loss in muscle tone
-very brief
-often in patients with intellectual impairment
-protective hardware
-hallmark of Lennox-Gastaut
What is Lennox-Gastuat Syndrome?
-severe, refractory seizure disorder
-commonly identified in childhood
-includes a variety of seizure types
-often requires combination medication therapy
What are the symptoms of postictal?
-confusion
-frustration
-weakness
-fatigue
-memory loss/confusion
-embarrassment
-headache
-nausea
How is seizure type identified and diagnosed?
-history and clinical evaluation (pt may not be a reliable historian of details of their seizures)
-radiologic evaluation
-laboratory evaluation
-EEG (most useful DURING seizure)
What are the consequences of not treating seizures?
-uncontrolled seizures may impact quality of life, lead to development of new seizure types, altered response to anticonvulsants
-prolonged seizure activity may lead to neurological damage and could be life threatening
What are factors associated with successful pharmacological therapy withdrawal?
if the patient…
-single seizure type
-age of onset of seizure was age 2-35
-has been seizure free for 2 years+
-normal neurological exam, EEG, and IQ
-complete seizure control within 1 year of initiating treatment
-taper dose over 6 months (no more than 25% per 2 weeks)
What is the relapse rate of seizures once withdrawn from pharmacotherapy?
70%
What drugs are considered broad spectrum for seizures?
-lamotrigine
-levetiracetam
-topiramate
-valproic acid
-zonisamide
What is the Black Box Warning of Lamotrigine?
serious skin rash
What are the adverse effects of Lamotrigine?
ASEPTIC MENINGITIS
What are the drug interactions of Lamotrigine?
-oral contraceptives
-valproic acid
What are the advantages of Lamotrigine?
-multiple uses in seizure disorders (efficacy in focal onset and generalized)
-multiple dosage forms
-generally well tolerated
-use in bipolar disorder
-fewer cognitive effects in the elderly
What are the disadvantages of Lamotrigine?
-slow titration to avoid serious skin rash
-not for rapid control
What are the adverse effects of Levetiracetam?
mood changes
-irritability
-aggression/agitation
What are the drug interactions of Levetiracetam?
minimal
What are the monitoring parameters of Levetiracetam?
behavioral and renal function (dosing adjustment needed)
What are the advantages of using Levetiracetam?
-well tolerated
-no significant drug interactions
-can be loaded
What are the disadvantages of Levetiracetam?
behavioral problems can limit therapy in some patients
What are the adverse effects of Topiramate?
-word filling difficulty
-paresthesias
-psychomotor slowing
-nephrolithiasis
-oligohydrolysis
-metabolic acidosis
-weight loss
What are the drug interactions of Topiramate?
phenytoin and valproic acid
What is Topiramate place in therapy?
may be considered for comorbid conditions such as migraines (efficacy seen) or obesity (due to SE of weight loss)
What are the adverse effects of Valproic Acid?
-GI upset
-thrombocytopenia
-hepatotoxicity
-hyperammonemia
-pancreatitis
-alopecia
-PCOS
-weight gain
What are the drug interactions of Valproic Acid?
-lamotrigine
-carbapenems
-aspirin
What are the monitoring parameters of Valproic Acid?
CBC, LFT, levels 50-100
What is Valproic Acid place in therapy?
may be useful in comorbidities such as migraines and bipolar disorder
What are the adverse effects of Zonisamide?
-impaired concentration
-paresthesias
-nephrolithiasis
-oligohydrosis
-metabolic acidosis
-agitation/irritability
-skin rash (SJS)
What are the disadvantages of Zonisamide?
-cognitive impairment with rapid dose increase
-sulfa allergy cross reaction and renal stones
What is the Black Box Warning of Valproic Acid?
hepatoxicity, mitochondrial disease, fetal risk, pancreatitis
What are the adverse effects of Carbamazepine?
-diplopia
-dizziness
-unsteadiness
-lethargy
-nystagmus
-ataxia
-nausea
-leukopenia, anemia, and thrombocytopenia
-HYPOnatremia
-skin rash (SJS or TEN)
-decreased vitamin D and bone density
What are the drug interactions of Carbamazepine?
-CYP3A4 substrate
-CYP3A4 major inducer (autoinducer, induces its own metabolism)
What are the monitoring parameters of Carbamazepine?
-HLA-B *1502 allele
-renal
-CMP
-BMP
-levels (4-12)
