Epilepsy Drugs II

WVSOM Neuro: Schriefer 3/14/11

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Epilepsy Drugs II by Mind Map: Epilepsy Drugs II

1. Felbamate

1.1. Use

1.1.1. Partial seizures in adults Both of the are very serious seizures

1.1.2. Lennox-Gastaut Syndrome in kids

1.2. SE

1.2.1. High incidence of aplastic anemia and liver failure Only used on "compassionate use" basis

2. Vigabatrin

2.1. MOA

2.1.1. Inhibits GABA degradation (GABA transaminase) and reuptake Increases GABA-mediated inhibition

2.2. Use

2.2.1. DLR for infantile spasms and refractory complex partial seizures CP seizures are notoriously hard to control

2.3. SE

2.3.1. 30% of pts have vision loss

2.3.2. headache, somnolence fatigue, dizziness

3. Rufinamide

3.1. Use

3.1.1. Lennox-Gastaut syndrome

3.2. MOA

3.2.1. acts on Na channels

3.3. SE

3.3.1. somnolence, vomiting

4. Adjunct drugs (for parital seizures)

4.1. Lamotrigen

4.1.1. Use Partial seizures Neuropathic pain

4.1.2. MOA Slows recovery in Na channels Inhibits V-G Ca channels Inhibits Glutamate release

4.1.3. SE Most common: weakness, diplopia, ataxia, N, irritability, SJS Teratogen: increase risk of cleft palate DDI Inhibits carbarmazepine metab

4.2. Gabapentin

4.2.1. Use Partial seizures Neuropathic pain

4.2.2. MOA Acts as a subunit of V-G Ca channels to decrease depolarization-induce Ca influx decreases release of glutatmate (excitatory NT)

4.2.3. SE somnolence, dizziness, ataxia, fatigue, wt gain, nystagmus DDI No major problems!

4.3. Topiramate

4.3.1. Use Partial seizures Tremors Migraine prevention

4.3.2. MOA Blocks Na channels & AMPA/Kainate receptors

4.3.3. SE Difficulty concentrating, drowsiness, dizziness, ataxia Wt loss!!! Increased risk of kidney stones Inhibits carbonic anhydrase Measure serum bicarb before starting Metabolic acidosis may result

4.4. Pregabalin

4.4.1. SE somnolence, dry mouth, blurred vision, peripheral edeam, wt gain Euphoria - Schedule V

5. Practical aspects of Drug Tx

5.1. Status epilepticus

5.1.1. State of continuous seizure activity

5.1.2. Generalized T/C type is 10% fatal

5.1.3. Usually d/t sudden withdrawal of CNS depressants or drug poisoning

5.1.4. Tx Supportive care Electrolytes, cardiac arrhythmia, ABCs Drug 1) IV diazepam or lorazepam 2) Maintenance Tx of slow IV phenytoin of PBB infusion

5.2. Monotherapy

5.2.1. Multiple drug Tx only used if: >1 seizure type is present single drug fails to provide adequate control near toxic levels

5.2.2. Remember therapeutic concentration is close to toxic levels for most drugs watch for signs of toxicity

5.3. Pregnancy

5.3.1. Use lowest dose that will control seizures

5.3.2. Teratogenic, but uncontrolled seizure also unsafe for fetus

5.3.3. Supplement w/ Vit K and folic acid

6. Seizure Tx

6.1. Grand Mal (Primary generalized Tonic-clonic)

6.1.1. Valproate OR carbamazepine OR phenytoin

6.2. Partial (including secondarily generalized)

6.2.1. Valproate OR carbamazepine OR phenytoin

6.3. Absence (Petit mal)

6.3.1. Ethosuximide OR Valproate

6.4. Atypical absence, myoclonic, atonic

6.4.1. Valproate