Basic Concepts

• Kindling Theory
• Treatment Goals
• Decrease excessive rate of neuronal discharge
• Prevent propagation of seizure
• Brand Specific Medications
• Therapeutic Drug Monitoring

• Absence Seizure
• Simple Parial Seizure
• Generalized Tonic Clonic
• Status Epilepticus

• Benzodiazepines
• Barbiturates
• Membrane Stabilizers
• GABA Enhancement

• Indications
• Severe Sz, Status Epilepticus
• Diazepam, Clonazepam
• Drowsiness, CNS depression, hepatoxicity
• Do Not Stop Abruptly
• Ongoing patient monitoring & teaching
• Clonazepam bld levels 0.02-0.08 ug/ml

• Acute Sz, Status Epilepticus, long term management of seizures
• SE’s
• Drowsiness, lethargy, fatigue, withdrawal syndromes
• Patient Care Issues
• Do not stop abruptly
• Induces drug metabolism
• Therapeutic Drug Monitoring levels 15-40 ug/ml

• Phenytoin
• Mechanism of Action - Sodium inhibition
• Indications
• Tonic Clonic Seizures
• SE’s
• Hepatoxicity, Bone marrow suppression, gingival hyperplasia, hirsutism, acne
• Ataxia and other CNS symptoms
• Patient Care Issues
• Brand Specific
• Therapeutic Drug Monitoring levels 10-20 ug/ml

• Mechanism of Action - Supporesion of Neuronal Discharge
• Suppress neuronal firing by inhibiting calcium movement
• Indications
• Absence Seizure
• SE’s
• Drowsiness, dizziness, lethargy, N/V, drug induced Lupus
• Patient Care Issues
• Therapeutic Drug levels 40-100 ug/ml

• Carbamazepine
• Potentiation of GABA
• SE’s
• CNS, Ataxia,
• Caution
• Bone Marrow Depression
• Induce drug metabolism
• Levels 4-12 ug/ml

• Valproic Acid
• Increase available GABA
• SE’s
• GI
• Caution
• Liver Toxicity
• Decrease drug metabolism
• Levels 50 –150 ug/ml

 
• Gabapentin
• Mechanism of Action - GABA enhancement
• Indication - Partial Seizures with or without generalization
• Not metabolized - excreted in urine
• Drug interaction - may increase phenytoin levels.
• Antacids reduce absorption
• SEs - somnolence, dizziness, fatigue, weight gain

Ó JPFrizzell2001

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