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Flashcards in Seizures Deck (44):
1

Principles of therapy for seizures

  •  Select the most appropriate drug from seizure pattern from EEG
    • Absence can be increased by CBZ, Oxcarb, PB, PRimidone, PHT, gabapentin, pregablin
    • Optimize first drug then add second drug if control is unsatisfactory
    •  Awareness of comorbidities
    •  reinforce compliance

2

Tonic-clonic (Grand-mal)

  • Unresponsive and falls at onset
  • Tonic phase- muscle spasms/shrill cry 
  • Clonic - Bilateral jerking movements 
  • Postical
    • Muscle flaccidity, responsiveness gradually returns, amnesia of seizures, incontinence

3

Warnings for seizure meds

-suicidal behavior and ideation Antiepileptic drugs

4

Who is effected by seizures?

Minority higher

5

What is the most common seizure type?

CPS

6

Complex Partial Seizures

  •  Responsiveness is impaired
  • Focal discharge
  • May present:
    • No other features
    • Similar to simple partial
    • Automatisms
  • Briefly postical

7

Subtypes of partial or focal seizures

  • -Secondary generalized
  • - Start out as simple or complex but moves on to generalized.
  • - Simple
  • - Complex

8

Atonic (Drop attacks)

- Sudden loss of muscle tone - Head - Limb

9

Active metabolite of carbamazepine?

10,11 epoxide

10

Goal of treatment for seizures

- Control or reduce frequency (many pts can be controlled) - Manage meds SEs and d-d interactions - Provide best QOL for pts.

11

Simple Partial Seizures

  •  No impaired responsiveness  
  • Focal discharges
  • Motor, sensory or psychic manifestation
    •  Motor
    •  Sensory symptoms  
  • Aura

12

Autoinduction resolves _____ but?

3-4 wks, But if you titrate you avoid it.

13

Epilepsy is classifies if someone has ___ or more epileptic seizures

>=2 unprovoked

14

Valproic Acid/ Divalproex NA 

Indications

Half life 

Formulations 

  • Broad: Absence, SPS, CPS, CTCS, Myoclonic and atonic seizures 
  • Depakene: VPA:TID
  • Depakote BID
  • SEs: N/V, weight gain, tremor, hematologic (dose dependent) 

15

SEs of phenytoin

Dose related: Nystagmus, ataxia, cognitice impairment, lethargy - Nondose: Gingival hyperplasia, coarse face, osteoporosis, acne, hirsutism, deficiency in folate, rash

16

Alternate agents for Partial seizures?

Today Gabe Picked up a Zibra Phinally 

- Topiramate, Zonisamide, Gabapentin, pregabalin, phenobarb

17

Ethosuximide Indications 

SEs

  • Absence seizures, not first line, sometimes may be added 

18

What are the indications for Carbamazepine?

SPS, CPS, GTCS

19

Myoclonic

Muscular contraction of the face, trunk or extremities

20

Lamotrigine 

Indications 

Metabolism 

SEs

 

  • SPS, CPS, absence, myoclonic, GTCS
  • Primarily hepatic 
  • Possibly life threatening rashes (steven-johns), ataxia, sedation, dizziness
  • Broad spectrum 
  • Start low go slow
  • Mood stabalizing 

21

Phenytoin indication can loading dose

SPS, CPS, GTCS

 

22

Alternative for myoclonic?

- Levetiracetam, topirimate, clonazepam

23

First line for myoclonic

- valproic acid, lamotrigine

24

General dosing guidelines for phenytoin?

  • If ss= <7 mcg/mL increase by 100mg/day
  • ss- 7-12 mcg/mL increase 50-60 mg/day
  • SS > 12 mcg/mL increase by 30 mcg/day

25

Alternatives for Tonic Clonic

Levetiracetam, Topiramate, Phenobarb

26

Phenobarbital indications?

 

SEs

Long half life 

 

  • SPS, CPS, GTCS
  • Sedation, possible learning impairment, hyperactivity, osteoporosis
  • Withdrawal associated 

NOT WELL TOLERATED 

27

Diagnosis of seizures?

Patient history: Frequency/duration of episodes, time of day, precipitating factors, Aura present?, Ictal activity, Postictal Evaluations: Physical, neurological, lab - EEG - Diagnostic imaging

28

First line agents for partial seizures?

Cats Pee for a Very Long time when Lunging at Orcids 

- Carbamazepine, Phenytoin, Lamotrigine, Valproic acid, Levetiracetam, Oxcarb

29

Classification of Seizures 2 subtypes?

Partial or Focal Generalized

30

Once someone has a seizure they are?

More likely to have another

31

Topiramate

 

Adjunctive for partial seizures

Dose dependent CNS effects, sedation, ataxia, cognition 

32

First line for tonic clonic

Phen finds Carbs VERY Offputting Lately 

Phenytoin, carbamazepine, valpro, lamotrigine, Ox carb.

33

Phenytoin metabolism Range?

Michaelis menten elimination 10-20 mcg/ml

34

Precipitation of Seizures

- Sleep deprivation - Sensory stimuli - Emotional stress - Hormonal changes - Fever - Lack of food - Trauma - Drugs

35

Sub-types of generalized seizures

- Absence - Myclonic - Tonic-clonic- major seizure type - Tonic - Atonic

36

Underlying etiology with seizures?

- CNS disorder - Cerebral palsy - Mental retardation

37

Gabapentin Indications 

 

Questionable efficacy mostly used for neuropathy rather than seizures

But for CPS and SPS 

38

What are the major causes of seizures?

- Trauma-MVA, birth injury - Drug withdrawal, alcohol, barbs, BZDs, anticonvulsants, antidepressants (older) - Toxins- lead poisoning, arsenic, insecticides - Cerebrovascular: Stroke, Tumors - Infection- fever, AIDS, meningitis, encephalitis - Metabolic disturbances-hypoglycemia, electrolytes - Hereditary - Drugs- Antihistamines, antidepressants (TCAs), amphetamines, theophylline, tramadol, illicit drugs, imipenime

39

SEs of carbamazepine? Indicated for mood disorders, trigeminalmyalgia

Ataxia, blurred vision, lethargy, nausea - Leukopenia, thrombocytopenia, rash, fluid retention, osteoporosis - Aplastic anemia:monitor CBC can cause death.

40

Felbamate 

restricted use because there were 16 deaths when first used 

causes insomnia 

Monitor for liver enzymes in the first year 

41

General absence seizures first line and alternative

- Lamotrigine, Valproic acid - Ethosuximide

42

Titrate dose to achieve adequate response

- Start low and go slow - Assess patient according to seizure control and SEs - Use total and free blood concentrations as a guideline

43

Primidone Indications 

 

Metabolism 

  • SPS, CPS, GTCS
  • Hepatic conversion to phenobarbital 

44

Tiagabine

Some pts it was increasing seizures 

cognition 

Shitty drug