Antiseizure Drugs

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Seizure

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Self-limited episode of brain dysfunction.

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Partial seizure

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Result as focal areas of dysfunction in the cortex. Often occur due to brain tumors, AV malformations, trauma or stroke.

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Simple partial seizure

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Seizure with no loss of consiousness. Cna be motor or sensory. Last less than 1 min.

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Complex partial seizure

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Impaired or loss of conciousness. Usually less than 2min.

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Generalized seizures.

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Grand Mal seizures. Global neocortical discharges in the thalamus.

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Absence seizure

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Form of generalized seizure. Abrupt onset of impaired consciousness. Lasts less than 30 sec.

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Myoclonic seizure.

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Shocklike contraction of muscles. May be generalized or localized.

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Tonic-clonic

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From of seizure not preceded by a partial seizure.

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How do most anti-seizure agents work?

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They act by stabilizing the inhibitory peptide that blocks Na channels.

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Phenytoin

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Anti-seizure medication. Partially closes voltage-gated Na channels. Effective in partial and generalized tonic-clonic seizures.

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In what type of seizures should phenytoin not be used?

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They may exacerbate absence seizures and should not be used in these types of seizures.

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What occular symptoms does phenytoin casue?

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Nystagmus and diplopia.

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Facial side effects of phenytoin.

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Hirsutism, gingival hyperplasia, facial coarsening- due to collagen deposition.

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Fetal hydantoin syndrome

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Teratogenic effect of phenytoin characterized by mental retardation, flat nasal ridge, epicanthal folds, mild hypertelorism, prominent upper lip, hypoplastic distal phalanges.

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Carbamazepine

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Anti-seizure medication. Has effects on Na channels and potentiates GABA-a receptors. Used for partial seizures, tonic-clonic and bipolar disease. Also used to treat CN-V neuralgia.

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What are the toxic side effects of carbamazepine?

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Can cause diplopia and ataxia.
Can cause hematological effects from mild leukopenia to apalstic anemia.

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Valproate

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Triple effect anti-seizure medication. Blocks Na channels, increases GABA, and inhibits Ca voltage gated channels in the thalamus. Used to treat generalized seizures.

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What are the toxic side-effects of valproate?

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Nausea, epigastric distress and hepatotoxicity. Can also inhibit the metabolism of pheytoin.

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Topiramate

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Anti-seizure medication. Blocks Na channels and potentiates GABA receptors. Used for partial seizures

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What are the side effects of topiramate?

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Fatigue, decreased mental acuity, anxiety , confusion. Paresthesias are common. Glaucoma and vision changes are rare.

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Lamotrigine

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Anti-seizure medication. Blocks Na channels and Ca channels in the thalamus. Used for partial and generalized tonic-clonic seizures.

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What are the side effects of lamotrigine?

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Skin rashes are common they may progress to Stevens-Johnson syndrome. Occurs mostly in children.

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Zonisamide

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Anti-seizure medication. Inhibits Na and Ca channels. Used for adjunct and refractory partial seizures.

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What are the side effects of zonisamide.

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Somnolence, fatigue, depression, psychosis, skin rashes and renal calculi.

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Why is phenobarbital also used as an anti-seizure medication.

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It enhances GABA chloride flux hyperpolarizing the postsynaptic membrane.

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Primidone

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Drug that is metabolized to phenobarbital. Used as an anti-seizure medication.

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Tigabine

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Anti-seizure medication. Inhibits GABA reuptake. Used in partial seizures.

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What are the toxic effects of tigabine

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Tremors, anxiety depression, psychosis.

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Gabapentin

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Anti-seizure drug. Increases concentration of presynaptic GABA. GABA analog but does not work ont he same receptor.

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Ethosuximide

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First line drug for absence seizures. Acts primarily by blocking voltage-gated channels in the thalamus.

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Levetiracetam

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Used for partial seizures- unknown mechanism. Causes sedation and dizziness.

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Felbamate

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Third line drug for partial seizures-unknown mechanism. May cause aplastic anemia and hepatitis.

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What is the current treatment for status epilepticus?

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IV diazepam to stop the seizure followed by IV phenytoin.

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Why is IV phenytoin dangerous?

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Propylene glycol in the IV formula may cause renal and cardiac toxicity.

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What are the three conventional drugs used for simple partial seizures? 3

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Carbamazepine, Phenytoin, Valproate.

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What are the conventional drugs used for complex partial seizures? 3

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Carbamazepine, Phenytoin, Valproate.

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What are the conventional drugs used to treat partail with secondary generalized seizures? 4

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Gabapentin, Phenytoin, Valproate, Phenobarbital.

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What are the conventional drugs used to treat absence seizures? 2

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Ethosuximide, Valpraote

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What is the conventional drug used to treat myoclonic seizures? 1

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Valproate

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What are the conventional drugs used to treat tonic-clonic seizures? 5

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Carbamazipine, Phenobarbital, Phenytoin, Primidone, Valproate.