Seizures Flashcards
Principles of therapy for seizures
- Select the most appropriate drug from seizure pattern from EEG
- Absence can be increased by CBZ, Oxcarb, PB, PRimidone, PHT, gabapentin, pregablin
- Optimize first drug then add second drug if control is unsatisfactory
- Awareness of comorbidities
- reinforce compliance
Tonic-clonic (Grand-mal)
- Unresponsive and falls at onset
- Tonic phase- muscle spasms/shrill cry
- Clonic - Bilateral jerking movements
- Postical
- Muscle flaccidity, responsiveness gradually returns, amnesia of seizures, incontinence
Warnings for seizure meds
-suicidal behavior and ideation Antiepileptic drugs
Who is effected by seizures?
Minority higher
What is the most common seizure type?
CPS
Complex Partial Seizures
- Responsiveness is impaired
- Focal discharge
- May present:
- No other features
- Similar to simple partial
- Automatisms
- Briefly postical
Subtypes of partial or focal seizures
- -Secondary generalized
- Start out as simple or complex but moves on to generalized.
- Simple
- Complex
Atonic (Drop attacks)
- Sudden loss of muscle tone - Head - Limb
Active metabolite of carbamazepine?
10,11 epoxide
Goal of treatment for seizures
- Control or reduce frequency (many pts can be controlled) - Manage meds SEs and d-d interactions - Provide best QOL for pts.
Simple Partial Seizures
- No impaired responsiveness
- Focal discharges
- Motor, sensory or psychic manifestation
- Motor
- Sensory symptoms
- Aura
Autoinduction resolves _____ but?
3-4 wks, But if you titrate you avoid it.
Epilepsy is classifies if someone has ___ or more epileptic seizures
>=2 unprovoked
Valproic Acid/ Divalproex NA
Indications
Half life
Formulations
- Broad: Absence, SPS, CPS, CTCS, Myoclonic and atonic seizures
- Depakene: VPA:TID
- Depakote BID
- SEs: N/V, weight gain, tremor, hematologic (dose dependent)
SEs of phenytoin
Dose related: Nystagmus, ataxia, cognitice impairment, lethargy - Nondose: Gingival hyperplasia, coarse face, osteoporosis, acne, hirsutism, deficiency in folate, rash
Alternate agents for Partial seizures?
Today Gabe Picked up a Zibra Phinally
- Topiramate, Zonisamide, Gabapentin, pregabalin, phenobarb
Ethosuximide Indications
SEs
- Absence seizures, not first line, sometimes may be added
What are the indications for Carbamazepine?
SPS, CPS, GTCS
Myoclonic
Muscular contraction of the face, trunk or extremities
Lamotrigine
Indications
Metabolism
SEs
- SPS, CPS, absence, myoclonic, GTCS
- Primarily hepatic
- Possibly life threatening rashes (steven-johns), ataxia, sedation, dizziness
- Broad spectrum
- Start low go slow
- Mood stabalizing
Phenytoin indication can loading dose
SPS, CPS, GTCS
Alternative for myoclonic?
- Levetiracetam, topirimate, clonazepam
First line for myoclonic
- valproic acid, lamotrigine
General dosing guidelines for phenytoin?
- If ss= <7 mcg/mL increase by 100mg/day
- ss- 7-12 mcg/mL increase 50-60 mg/day
- SS > 12 mcg/mL increase by 30 mcg/day
Alternatives for Tonic Clonic
Levetiracetam, Topiramate, Phenobarb
Phenobarbital indications?
SEs
Long half life
- SPS, CPS, GTCS
- Sedation, possible learning impairment, hyperactivity, osteoporosis
- Withdrawal associated
NOT WELL TOLERATED
Diagnosis of seizures?
Patient history: Frequency/duration of episodes, time of day, precipitating factors, Aura present?, Ictal activity, Postictal Evaluations: Physical, neurological, lab - EEG - Diagnostic imaging
First line agents for partial seizures?
Cats Pee for a Very Long time when Lunging at Orcids
- Carbamazepine, Phenytoin, Lamotrigine, Valproic acid, Levetiracetam, Oxcarb
Classification of Seizures 2 subtypes?
Partial or Focal Generalized
Once someone has a seizure they are?
More likely to have another
Topiramate
Adjunctive for partial seizures
Dose dependent CNS effects, sedation, ataxia, cognition
First line for tonic clonic
Phen finds Carbs VERY Offputting Lately
Phenytoin, carbamazepine, valpro, lamotrigine, Ox carb.
Phenytoin metabolism Range?
Michaelis menten elimination 10-20 mcg/ml
Precipitation of Seizures
- Sleep deprivation - Sensory stimuli - Emotional stress - Hormonal changes - Fever - Lack of food - Trauma - Drugs
Sub-types of generalized seizures
- Absence - Myclonic - Tonic-clonic- major seizure type - Tonic - Atonic
Underlying etiology with seizures?
- CNS disorder - Cerebral palsy - Mental retardation
Gabapentin Indications
Questionable efficacy mostly used for neuropathy rather than seizures
But for CPS and SPS
What are the major causes of seizures?
- Trauma-MVA, birth injury - Drug withdrawal, alcohol, barbs, BZDs, anticonvulsants, antidepressants (older) - Toxins- lead poisoning, arsenic, insecticides - Cerebrovascular: Stroke, Tumors - Infection- fever, AIDS, meningitis, encephalitis - Metabolic disturbances-hypoglycemia, electrolytes - Hereditary - Drugs- Antihistamines, antidepressants (TCAs), amphetamines, theophylline, tramadol, illicit drugs, imipenime
SEs of carbamazepine? Indicated for mood disorders, trigeminalmyalgia
Ataxia, blurred vision, lethargy, nausea - Leukopenia, thrombocytopenia, rash, fluid retention, osteoporosis - Aplastic anemia:monitor CBC can cause death.
Felbamate
restricted use because there were 16 deaths when first used
causes insomnia
Monitor for liver enzymes in the first year
General absence seizures first line and alternative
- Lamotrigine, Valproic acid - Ethosuximide
Titrate dose to achieve adequate response
- Start low and go slow - Assess patient according to seizure control and SEs - Use total and free blood concentrations as a guideline
Primidone Indications
Metabolism
- SPS, CPS, GTCS
- Hepatic conversion to phenobarbital
Tiagabine
Some pts it was increasing seizures
cognition
Shitty drug
