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15 Cards in this Set

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Simple Partial Seizure
focal seizure
consciousness preserved
Complex Partial Seizure
altered consciousness; bilateral cerebral involvement
Secondarily Generalized Seizure
tonic/clonic seizures
partial seizures that orginate in cortical structure -> thalamus and brainstem
Phenytoin
Mechanism: binds to inactivation particle in Na channel, delays recovery from inactivation

Pharmacokinetics: water insoluble at neutral pH, so i.v. is highly alkaline -> muscle necrosis is extravasates; hepatic metabloism is non-linear, clearance declines as conc. increases

Clinical Use: simple partial, complex partial, and and primary secondary generalized tonic-clonic seizures and primarily generalized tonic clonic seizures

Side Effects: ataxia, nystagmus, lethargy, rash, teratogenic 2-3x risk
Carbamazepine
Mechanism: same as phytoin

Pharmacokinetics: slowly titrated, orally absorbed

Clinical Use: First line drug for Partial Seizure esp in children, can worsen abscence seizure; CN V and IX neuralgia; bipolar disorder

Side Effects: well tolerated
chronic - leukopenia, aplastic anemia
Lamotrigine
Mechanism: similar to phenytoin, additional action at K channel (hyperpolarization), oral only

Clinical Use: Broad Spectrum, refractory tonic, atonic and absence; Partial seizures and seizure assoc. Lennox-Gastaut syndrome; bipolar disorder

Side Effects: toxic CNS similar to phenytoin, rash
Topiramate
Mechanism: blocks glutamate receptor

Clinical Use: broad spectrum anticonvulsant, second line partial seizure and assoc with Lennox-Gastaut

Side Effects: anxuety, memory and conc. difficulty
Levetiracetam
add-on therapy for partial seizures in refractory patients and those with hepatic dysfunction (renal metabolism)
Lorazepam
Diazepam
Tiagabine
Gabapentin
enhance GABA inhibitory potential
Effective for partial seizures
Tigabine NOT to be used in generalized epilepsy
Gabapentin only effective with another anticonvulsant
Phenobarbital
Primidone
Barbiturates are the cheapest anticonvulsant available; third-line drugs
Generalized Seizures
Absence- young children, staring out in space
Myoclonic- 12-20 yo
Tonic- brief stiffening of arms
Atonic- fall over, risk of head injury
Tonic-Clonic
Ethosuximide
Mechanism: blocks T-type Ca channel, long T1/2 (30-50 hrs)

Clinical Use: Pure Absence seizures

Side Effects: very safe, anxiety or other behavioral
Valproic Acid
Mechanism: like phenytoin, inhibits Na currents, also smaller effect on T-type Ca channel and increases GABA

Clinical Use: broad specturm against abscence, myoclonic, tonic, and tonic clonc and partial seizures; bipolar and migraine

Side Effects: tremor, sedation fetal malformation, fulminating hepatitis
Felbamate
Not really used

Clinical Use: refractory tonic, atonic and absence and partial seizures

Side Effects: aplastic anemia, hepatotoxicity
Clonazepam
Clorazepate
Diazepam
Lorazepam
Benzodiazepines with broad anticonvulsant properties.
Long term treatment: Clonazepam and Clorazepate
Status Epilectus: Lorazepam (superior) and Diazepam -> follow with fosphenytoin or if ineffective use pentobarbital or propofol