Phenytoin (Dilantin)

Antiepileptic

Traditional Drug

Used for partial and tonic-clonic seizures, not absence seizures

Selective inhibition of sodium channels

Very narrow therapeutic range (10-20 mcg/mL)

CNS toxicity can occur at levels above 20 mcg (Nystagmus, ataxia, sedation, diplopia)

Causes gingival hyperplasia in 20% of pts

Stop drug if rash develops

IV: should be injected slowly and in dilute solution

Carbamazepine (Tegretol)

Antiepileptic

Traditional Drug

Used for partial and tonic-clonic seizures

Often preferred over phenytoin b/c it's better tolerated

CBC's should be monitored: R/f leukopenia, anemia, and thrombocytopenia

Can provide symptomatic control in pts w/ bipolar

Visual disturbances, vertigo, unsteadiness, HA common during first few weeks of treatment. Tolerance usually develops

Avoid grapefruit juice

Valproic Acid (Depekote)

Antiepileptic

Traditional Drug

Broad-spectrum AED used for all seizure types

Blocks sodium channels, calcium channels, and may inhibit GABA

Approved for prophylaxis of migraines

GI effects (N/V, indigestion) are most common

Hepatotoxicity and pancreatitis are rare but serious

Don't use with pts with liver dysfunction

Phenobarbital

Antiepileptic

Traditional Drug

Barbituate

One of the oldest AED's available

Potentiates the effects of GABA

Able to suppress seizures w/out causing generalized CNS depression

S/E: lethargy, depression, learning impairment

Not used for absence seizures

Gabapentin (Neurontin)

Antiepileptic

Newer Drug

Monotherapy or adjunctive therapy for partial seizures

Well-suited for combined use with other AED's

S/E: somnolence, dizziness, ataxia, fatigue, peripheral edema

Doses should be reduced in pts with renal impairment

Topiramate (Topamax)

Antiepileptic

Newer Drug

Monotherapy or adjunctive therapy for partial or tonic-clonic seizures

Prophylaxis of migraines

S/E: dizziness, ataxia, nervousness, diplopia, nausea, anorexia, wt loss

Can cause metabolic acidosis

Dilantin and Tegretol can dec levels of topamax

Lamotrigine (Lamictal)

Antiepileptic

Newer Drug

Used for partial or tonic-clonic seizures

Blocks sodium and calcium channels

S/E: Can cause life threatening rashes. Using w/ valproic acid inc risk. Also: N/V, blurred vision, HA

Management of Status Epilepticus (SE)

Ideally, treatment should commence w/in 5 min of seizure onset

Goal: Maintain ventilation, correct hypoglycemia, terminate the seizure

IV benzodiazepine (Ativan or Valium). Ativan usually preferred b/c of its shorter duration

After seizure has stopped, dilantin or cerebyx (prodrug form of dilantin) may be given for long-term suppression

Diazepam (Valium)

Centrally acting agent

Benzodiazepine used for spasticity

Mimic the inhibitory actions of GABA in the CNS

S/E: Sedation is most common. Initial doses should be low to minimize sedation

Does not affect skeletal muscles directly

Baclofen (Lioresal)

Spasticity Agent

Acts w/in the spinal cord to suppress hyperactive reflexes involved in regulation of muscle movement

Used for spasticity involved in MS, spinal cord injury, and cerebral palsy, but NOT stroke

Does not directly affect skeletal muscle

S/E: Drowsiness, dizziness, weakness, fatigue. Diminish with continued drug use

Ropinirole (Requip)

Dopamine Agonist

Used for muscle spasms in Parkinson's Disease or Restless Leg Syndrome

Can be used as monotherapy (in early PD) or as an adjunct to levodopa (in advanced PD)

S/E: Nausea, dizziness, somnolence, hallucinations