Epilepsy

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Author:
timothy.pdlt
ID:
211800
Filename:
Epilepsy
Updated:
2013-04-06 17:06:15
Tags:
AED epilepsy
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Description:
Therapeutics, Side-effects, Interactions
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  1. GoT of AED Tx
    • manage first seizure
    • prevent recurrence
    • minimize S/E
    • optimize QoL
  2. Non-pharm considerations
    • avoid sleep deprivation
    • discuss safety
    • discuss alcohol consumption
    • avoid stimulants
  3. Classification of Epilepsy
    • 1. Primary generalized
    • a. tonic-clonic (grand mal): tonic muscle contractions-->crescendo rhythmic contractions-->subside
    • b. absence (petit mal): no major convulsions, 3/sec spikes
    • c. myoclonic: rapid, dramatic (ie. throwing hands up in the air)
    • d. JME: tonic-clonic+absence+myoclonic that is more prevalent in low arousal states (ie. HS, early AM), 6/sec spikes
    • 2. Partial (Focal)
    • a. simple: still conscious
    • b. complex: wide range of S/S (temporal lobe, automatism)= fumbling clothes, impaired consciousness
  4. EEG of different seizure types
    • Partial seizure EEG
    • Tonic-clonic EEG
    • Absence seizure EEG
  5. Tx for JME
    • VPA*
    • LTG, TPM, PHT(low dose)
  6. Tx for Complex Partial (Adults)
    • CBZ*
    • PHT>VPA>GBP, LTG, OXC, PB, TPM
  7. Tx for Complex Partial (Elderly)
    • GBP*, LTG*
    • CBZ
  8. Tx for Complex Partial (Children)
    • OXC*
    • CBZ, PB, PHT, TPM, VPA
  9. Tx for Primary Generalized Seizure
    • VPA*
    • LTG, TPM
  10. OC INTX with AEDs
    CBZ,PHT,PB,TPM (high)= increased OC clearance

    OC= decrease LTG concentration
  11. Teratogenic AEDs
    • VPA
    • PB, PHT, CBZ, LTG
  12. Amount of AED in breast milk
    LTG,GBP,TPM > CBZ,VPA,PHT
  13. Rash risk with AEDs
    • high risk: LTG, CBZ, PHT
    • mod risk: OXC, PB, CBM
    • low risk: LEV, GBP, VPA, TPM
  14. Multipurpose AEDs
    • Tx for migraine= VPA, TPM, GBP
    • Tx for neuropathic pain= GBP, PGB, TPM
  15. S/E of VPA
    Dose related S/E of VPA: tremor, thrombocytopenia

    • rash (low risk)
    • hepatotoxicity
    • pancreatitis
    • weight gain
    • osteoporosis
    • hail loss
    • (nausea, sedation)
  16. S/E of LTG
    Acute CNS S/E of LTG: increased JME

    rash (high risk)= SJS increased risk in Asians HLA-B*1502 allele

    • diplopia
    • (nausea, dizziness, HA, sleep disturbances)
  17. S/E of CBZ
    Acute CNS S/E of CBZ: increased absence, myoclonic, JME

    Dose-related S/E of CBZ: arrythmia, hyponatremia, leukopenia

    • rash (high risk)
    • aplastic anemia
    • osteoporosis
    • weight gain
    • (diplopia, dizziness, fatigue, SJS)
  18. S/E of TPM
    • rash (low risk)
    • metabolic acidosis
    • psychological toxicity
    • ophthalmologic effects
    • weight loss
    • kidney stones
  19. S/E of PHT
    • rash (high risk)
    • arrythmia
    • leukopenia
    • psychological toxicity
    • osteoporosis
    • hirsutism
    • gingival hyperplasia
  20. S/E of OXC
    • rash (moderate risk)
    • hyponatremia
  21. S/E of PB
    • rash (moderate risk)
    • osteoporosis
  22. S/E of GBP
    • rash (low risk)
    • weight gain
    • osteoporosis

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