Term
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Definition
| treat 1) epileptic seizures and 2) non-epileptic convulsions |
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Term
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Definition
| short term alteration in behavior due to disordered synchronous, rhythmic firing of brain neurons |
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Term
| Non-epileptic convulsions |
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Definition
| similar to epileptic seizures but caused by a variety of environmental stimuli such as electroshock therapy, chemicals, hypoglycemia, genetic disorders, & brain damage |
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Term
| Starting Treatment of Epilepsy |
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Definition
| usually, physicians start drug therapy after 2 unexplained seizures |
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Term
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Definition
| stroke, trauma, and genetic disorders |
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Term
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Definition
| seizure activity begins at a SINGLE site within cortex; one arm, leg, or body part is affected |
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Term
| simple partial (focal) seizure |
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Definition
| seizure that lasts 20-60 seconds and has preservation of consciousness; pt may have twitches or other weird responses but DOES NOT lose consciousness |
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Term
| complex partial (focal) seizure |
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Definition
| seizure that has gradual loss of consciousness; it lasts 30 secs to 2 min; may begin with a simple seizure, hallucinations, strong emotions followed by automatisms (lip smacking, hand wringing) |
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Term
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Definition
| shows only 1 or 2 electrodes displaying synchronous activity during a seizure |
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Term
| EEG of generalized seizures |
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Definition
| all 15-20 electrodes used will display synchronous activity during a seizure |
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Term
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Definition
| seizure activity that begins simultaneously in both hemispheres of brain |
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Term
| absence (petit mal) generalized seizure |
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Definition
| seizure that includes sudden loss of consciousness and lasts less than 30 seconds; characterized by staring & blinking (3 blinks per second) while the body may remain active (sitting, walking, biking, etc); more common in children |
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Term
| tonic-clonic (grand mal) seizures |
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Definition
| seizures that result in sudden loss of consciousness and lass 1.5 to 2.5 minutes; initial stage (tonic): 20 seconds of muscle rigidity; followed by: 1-2 min of rhythmic muscle contractions (clonic); most injuries due to falling during tonic stage; associated with loss of control of bowels |
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Term
| myoclonic generalized seizure |
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Definition
| single shock-like contraction wit duration of less than 1 second; whole body or one extremity may contract; more common in children |
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Term
| secondarily generalized seizures |
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Definition
| a combination of both partial and generalized seizures; seizure activity starts in one area (partial) with axonal fibers leaving seizure focus to excite a structure like the thalamus that begins rhythmic asynchronous firing in both hemispheres (generalized) |
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Term
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Definition
| experimental model of seizures using animal models; repeated low-intensity, brief, electrical stimulation to amygdale-hippocampus; model of partial & generalized seizures |
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Term
| Injection of excitatory neurotransmitters/chemoconvulsants |
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Definition
| experimental models of seizures that use animal models; this is a model for tonic-clonic seizures |
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Term
| Anticonvulsant drug mechanism of action (phenytoin, valproic acid, carbamazepine, oxycarbazepine) |
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Definition
| drugs that act to reduce neuronal activity by blocking voltage-gated sodium channels on neuronal axons |
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Term
| Anticonvulsant drug mechanism of action (ethosuximide & valproic acid) |
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Definition
| drugs that act to reduce neuronal activity by blocking T-type calcium channels located on post-synaptic membranes; used to treat absence seizures |
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Term
| Anticonvulsant drug mechanism of action (barbiturates: phenobarbital & primidone; benzodiazepines: clonazepam, diazepam; tiagapine) |
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Definition
| drugs that all act to reduce neuronal activity by enhancing the inhibitory effects of GABA |
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Term
| Bromides - sodium & potassium bromide |
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Definition
| drugs used at high doses that cause severe sedation resulting in fewer seizures; used in 1800's; side effects: severe sedation, severe skin rash and/or lesions |
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Term
| Lennox-Gustaut Syndrome (LGS) |
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Definition
| childhood-onset epilepsy with severe cognitive dysfunction; pts have multiple seizure types including atonic seizures; resistant to drug therapy and high mortality rate (3-7%); treat with ketogenic diet that is very low in carbs and high in protein and fat; also treated with felbamate (Felbatol) |
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Term
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Definition
| drug used as monotherapy & adjunctive therapy for Lennox-Gustaut Syndrome (LGS), partial, & generalized seizures in adults; inhibits Ca & Na channels as well as NMDA & AMPA-kainate receptors |
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Term
| Side Effects of felbamate (Felbatol) |
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Definition
| GI upsets, anorexia, insomnia, aplastic anemia, hepatotoxicity |
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Term
| phenobarbital (Luminal, 1912) |
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Definition
| first anti-seizure drug still used today because it is cheap & effective; Use: monotherapy for generalized tonic-clonic & partial seizures; MOA: enhances inhibitory effect of GABA on synaptic receptors; Pharmacokinetics: mainly metabolized by liver; SE: sedation (adults), irritability/hyperactivity (children), induction of CYP3A4 which leads to increased drug metabolism (oral contraceptives) |
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Term
| primidone (Mysoline, 1949) |
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Definition
| barbiturate metabolized to phenobarbital & PEMA; Use: monotherapy for generalized tonic-clonic, partial, & adolescent myoclonic seizures; less effective than phenobarbital; MOA: enhances inhibitory effects of GABA on synapse receptors; Pharmacokinetics: a lot of variation in absorptoin, distribution; Side Effects: sedation (adults), irritability/hyperactivity (children), dizziness, nausea, nystagmus, ataxia |
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Term
| phenytoin (Dilantin, Diphenylan) |
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Definition
| Use: monotherapy for generalized tonic-clonic & partial seizures; MOA: prolong rate of recovery of voltage-gated Na channels from inactivation; Kinetics: 90% protein bound, drug concentration increases disproportionately as dosage is increased, 95% metabolized in liver; Side Effects: drugs metabolized by CYP2C9/10/19 affected (warfarin), induction of CYP3A4 results in increased drug metabolism (oral contraceptives), minor rash, occasional Stevens-Johnson Syndrome (SJS) |
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Term
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Definition
| adverse, immune system-mediated drug reaction characterized by blistering of skin & mucous membranes; starts with flu-like symptoms with persistent fever progressing to blisters then sloughing of skin; Treatment: discontinuation of suspected drug (phenytoin) & possible immunosuppressives; Toxic Epidermal Necrolysis: a more severe form of SJS in which 30% of total skin surface area is covered in blisters with a higher mortality rate |
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Term
| carbamazepine (Tegretol, Carbatrol, 1974) |
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Definition
| Use: monotherapy for generalized tonic-clonic & partial seizures, also used in manic-depressive pts; MOA: prolonged rate of recovery of voltage-gated Na channels from inactivation; Kinetics: metabolized to epoxide that induces its own metabolism, must wait 3 wks for consistent plasma concentrations, metabolism increased by phenobarbital, phenytoin, valproic acid; Side Effects: Acute: stupor, coma, hyperirritability, convulsions; Chronic: drowsiness, vertigo, ataxia, blurred vision; induces CYP3A4 resulting in increased drug metabolism (oral contraceptives) |
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Term
| oxcarbazepine (Trileptal, 2000) |
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Definition
| structurally similar to carbamazepine; Use: monotherapy/adjunctive treatment of partial seizures; MOA: prolongs rate of recovery of voltage-gated Na channels from inactivation; Kinetics: acts as prodrug converted to active form in liver; Side effects: dizziness, nausea, somnolence, ataxia, induces CYP3A4 resulting in increased drug metabolism (oral contraceptives) |
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Term
| ethosuximide (Zarontin, 1960) |
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Definition
| Use: monotherapy of ABSENCE seizures; MOA: inhibits T-type Ca channels; Kinetics: unbound, mainly excreted by liver; SE: nausea, vomiting, anorexia, CNS drowsiness, lethargy, euphoria, SJS, aplastic anemia |
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Term
| valproic acid (Depakote, Depakene, 1978) |
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Definition
| Use: monotherapy of ABSENCE, MYOCLONIC, PARTIAL, and TONIC/CLONIC seizures; MOA: inhibits T-type Ca channels, prolongs inactivation of Na channels, increases GABA synthesis; Kinets: 90% protein bound; SEs: GI nausea, anorexia, CNS sedation, ataxia, tremor, increases hepatic blood enzymes, inhibits CYP2C9 resulting in increased concentrations of phenytoin, phenobarbital |
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Term
| benzodiazepines - clonazepam (Klonopin) & clorazepate (Tranxene-SD) |
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Definition
| Use: adjunctive therapy for ABSENCE seizures & juvenile myoclonic seizures; MOA: increases inhibitory effect of GABA by inhibiting synapses; Kinetics: good oral absorption, fast acting; SEs: drowsiness, lethargy, decrease with time; Children: aggression, hyperactivity, irritability |
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Term
| gabapentin (Neurontin, 1993) |
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Definition
| Use: adjunctive treatment for partial seizures with or without generalized secondary seizures, mostly used for neuropathic pain; MOA: not completely known, binds to L-type Ca channels but no change in Ca conductance, does not act like endogenous GABA; Kinetics: not metabolized, excreted unchanged in urine; SEs: fatigue, ataxia |
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Term
| lamotrigine (Lamictal, 1994) |
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Definition
| Uses: monotherapy & adjunctive therapy for partial & generalized tonic/clonic seizures, LGS; MOA: prolong rate of recovery of voltage-gated Na channels from inactivation, inhibits Ca to lesser extent; Kinetics: long half-life, reduced by phenytoin, carbamazepine, phenobarbital, & primidone; SEs: dizziness, ataxia, blurred vision, nausea |
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Term
| topiramate (Topamax, 1996) |
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Definition
| Use: adjunctive therapy for partial seizures with and without generalized tonic/clonic seizures, LGS; MOA: inhibits Na channels & AMPA-kainate receptors, enhances GABA receptors; Kinetics: excreted mostly unchanged in urine; SE: ataxia, fatigue, somnolence, weight loss |
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Term
| tiagabine (Gabitril, 1997) |
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Definition
| Use: adjunctive therapy for partial seizures with or without secondarily generalized tonic/clonic seizures; MOA: inhibits GABA reuptake at synapse, prolonging actions of GABA; Kinetics: shorter half-life; SEs: dizziness, somnolence, tremor |
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Term
| levetiracetam (Keppra, 1999) |
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Definition
| Use: adjunctive treatment for partial seizures in adults; MOA: prolong rate of recovery of voltage-gated Ca channels from inactivation, inhibits T-type Ca channels; Kinetics: 85% excreted in urine unchanged, minor liver metabolism; SEs: somnolence, dizziness, anorexia, fatigue |
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Term
| AEDs of choice for partial secondarily generalized seizures |
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Definition
| Drugs of Choice: 1) phenytoin, 2) carbamazepine; Alternatives: phenobarbital, primidone, valproic acid |
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Term
| AEDs of choice for generalized absence seizures |
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Definition
| Drug of Choice: ethosuximide, valproic acid; Alternatives: clonazepam, diazepam |
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Term
| AEDs of choice for generalized tonic/clonic seizures |
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Definition
| drugs of choice: phenytoin, carbamazepine, valproic acid; Alternatives: phenobarbital, primidone |
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Term
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Definition
| a series of seizures where full recovery from one seizure does not occur before onset of next seizure; medical emergency with 20% mortality rate; give IV diazepam for initial treatment, closely monitor pt avoid hypoventilation & hypotension, once seizures are controlled give fosphenytoin (Cerebryx) |
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Term
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Definition
| when taking both meds (AED + oral contraceptives), women have a 3x higher failure rate of contraceptive; also, a 2-3 fold increase in birth defects while taking AEDs during pregnancy (neural tube formation abnormalities, facial & cranial deformities) |
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Term
| Treatment of Pregnant Women on AEDs |
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Definition
| reduce adjunctive therapy to monotherapy; find minimum dose of drug to adequately control seizure activity; give patient folate (0.4 mg/day) throughout pregnancy; also give vitamin K (10 mg/day) during last month of gestation to help reduce newborn blood coagulation problems/vitamin K deficiencies |
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