Seizure Drugs

Physiology of Epilepsy is not completely understood

Electrical disturbance
Imbalance of GABA (inhibitory) & Glutamante (excitatory)
Tx is NOT curative, but meds suppress the symptoms
Goal of tx is monotherapy
Anti-convulsants drugs are teratogenic
Begin folic acid 6 mo prior to p-word
In NYS must be seizure free for 1 yr to drive (3 mo trial if aura or known cause)
Need medical justification yearly blood level
Choosing an anticonvulsant
3 Objectives:
Seizures to maximum extent possible
Avoid chronic drug-related adverse effects
Maintain nml psychosocial & vocational adjustment
Medication
Caramazepine
(Tegretol)
Oxycarbazepine
(Trileptal)
Eslicarbazepine
(Aptiom)

Refinamide (Banzel)
Phytoin (Dilantin)

Phenobarbital

Primidone (Mysoline)

Notes
-Not effective against absence szs
-Metabolized by carbamazepime-10
-Transiet rash 5% of people- can be life threatening
-ADJUNT only
-Less toxicity and no blood monitoring
-Indicated for partial onset seizures
risk SI & aggressive behavior
risk life-threatening rash
Monitor K and CL levels
-ADJUNT in Lennox Gastaut Syndrome only
-Not effective against absence szs
-Prime use is post-traumatic seizures (tx 3w then d/c)
-Also used in elderly
-SE- gingival hyperplasia
-GABA-mediated inhibition
-Indicated in febrile seizures
-Causes excessive drowsiness in adults & hyperactivity in kids
-Physical dependence is common with chronic use
-Teratogenic- difficult to wean an infant off phenobarb (resp
supp and HOTN)
Lead to Folate & Vit D

Trimethadione
(Tridione)
Valproic Acid
(Depakote)

Gabapentin
(Neurontin)

Pregabalin (Lyrica)

Ethosuximide
(Zarontin)
Lamotrigine
(Lomictal)

Ezogabine (Potiga)

Vigabatrin (Sabril)

Tiagabine (Gabitril)
Lacosamide
(Vimpat)
Topiramate
(Topamax)
Zonisamide
(Zonegran)
Leviteracetam
(Keppra)

Perampanel
(Fycompa)

-Effective for absence

-Broadest spectrum of antiepileptics
-Successful as monotherapy in 80% of patients
-Enhances GABA-ergic tones
-SE- sedation, n/v/d, elevated liver enzymes in >40%
-Related to GABA
-ADJUNT only
-less bioavailability w/ a single dose
-SEs- fatigue, edema, wt, vasodilation, somnolence,
dizziness, HA, benign leukopenia, confusion at higher doses
er potency than gaba
-For neuropathic pain
+ trigger point pain
-for absence seizures
-Combod with other kid while waiting for drug levels
-Adjunt therapy
-SEVERE LIFE-THREATENING RASH
-Interferes with folate mechanism
-Teratogenic
-ADJUNCT
-risk of retinal pigment dystrophy
Must have failed all other txs first
-ADJUNCT
-Significant, irreversible RF of vision loss
-Restricted distribution
-ADJUNCT
Monitor for SI
-Contra in hepatic insufficiency
-Cardiac, heptatic & psych warnings
-Wt
-Adjunct for seizures, neuropathic pain and migraine HAs
-Sulfa derivative
-EXTREMELY SAFE
-Indicated for partial onset (okay in infants), myoclonus
-Adjunct for generalized seizures
-potential for HA management
BBW- aggressive behavior & SI (need to monitor for 1 mo post
d/c)

Benzos- Tx of epilepsy, anxiety for sedation and sleep induction

Augment effects of GABA
Each Benzo acts more selectively @ certain sites for specific indications of
use
Lorazepam (Ativan)
Clonazepam
(Klonopin)
Diazepam (Valium)
Chlordiazepoxide
(Librium)
Clobazam (Onfi)

Tx status epilepticus
life 8-24h
Tx partial & absence seizures, panic d/o, neuropathic pain,
insomnia & chronic anxiety
Enhances GABA activity in CNS
Tx skeletal muscle relaxation, ED procedures, DTs, status
epilepticus, insomnia & amnesia
Short-term tx of anxiety & alcohol w/drawl
Tx epilepsy
Life threatening skin rxn xan occur in 1st 8w of tx