SEIZURE DISORDERS

Question 1

what are the partial seizures?

Answer 1

simple partial
complex partial seizures
partial seizures, secondarily generalized

Question 2

• Onset age 4-12
• Brief impairment of consciousness (<30 s)
• Stares vacantly
• No memory of episode
• Multiple episodes daily
• Infrequent GTC seizures
• Generalized 3/s spike-wave discharges

Answer 2

Absence

Question 3

• Brief, sudden shocklike muscle contractions
• Associated with polyspike pattern on EEG
• Generalized or focal
• Patients may drop objects, spill food, or be propelled out of chairs/beds

Answer 3

Myoclonic

Question 4

• Either tonic or clonic seizure may be seen separately in a generalized seizure
disorder

Answer 4

Tonic-Clonic

Question 5

• Tonic seizures are brief, lasting 10-30 seconds

– Occur most frequently in patients with multiple seizure types

Answer 5

Tonic

Question 6

• Onset age 2-5
• Seen most frequently in developmentally disabled patients
• Legs lose tone, patient falls to ground
• Usually brief, may last up to one minute
• If frequent, head protection may be required

Answer 6

Atonic

Question 7

Indication: Simple/complex partial, generalized tonic/clonic seizures

Does not work for myoclonic, atonic, absence

Sodium channel antagonist

Answer 7

Phenytoin/Fosphenytoin

Question 8

Tegretol, Carbatrol

Indication: simple/complex partial, generalized tonic-clonic

Sodium channel antagonist

Answer 8

Carbamazepine

Question 9

Indicated for myoclonic, atonic, absence, simple/complex partial, and generalized
seizures

Treatment of choice for idiopathic epilepsies

Enhances GABA-mediated inhibitory activity and is also a sodium channel antagonist

Answer 9

Valproic Acid

Question 10

Indication: partial and
generalized seizures

Increases amount of time in open state of GABA-mediated chloride channels, reduces
effect of glutamate, and reduces presynaptic Ca channel effect, blocking neurotransmission

Answer 10

Phenobarbital/Primidone

Question 11

Indication: Complex partial seizures (adjunct)

Structurally related to GABA (g-amino butyric acid)

Mechanism of action is not known. Suspected to be another sodium channel
antagonist

Answer 11

Gabapentin

Question 12

Triazine derivative. Indication: Adjunct for complex partial seizures (though can be
used as monotherapy. Also used for generalized seizures.

Sodium channel antagonist, inhibits glutamate release

Answer 12

Lamotrigine

Question 13

Indication: Complex partial epilepsy. May exacerbate generalized seizures!

Inhibits GABA intake at the axonal terminal, increasing level in synapse

Answer 13

Tiagabine

Question 14

Indication: Partial and generalized seizures, Lennox-Gastaut (drop attacks)

Sodium and calcium channel antagonist, increases GABA-mediated antagonism, weak
carbonic anhydrase inhibitor

Answer 14

Topiramate

Question 15

Indication: Complex partial seizures

Sodium channel antagonist
Pharmacokinetics
– Advantage over carbamazepine: Not autoinducing
– Oxcarbazepine is a prodrug, metabolized to active metabolite–
monohydroxycarbamazepine

Answer 15

Oxcarbazepine

Question 16

Indication: Partial and generalized seizures

Mechanism of action unknown–does not affect known receptor sites. Med has its own
receptor site

Answer 16

Levetiracetam