Drugs for Seizures

1
Drugs for Seizures

• Chapter 11

2
Introduction

• Epilepsy is a common disorder of the CNS
  characterized by symptoms of blackout, fainting
  spells, apparent clumsiness, temporary loss of
  memory, and/or irregular seizure activity.

3
Introduction

• Over two million Americans have epilepsy, and
  except for when these symptoms are expressed,
  most of the time it appears that their health is
  not challenged.

4
Seizures Convulsions are Symptoms of Epilepsy

• Seizuresabnormal or uncontrollable neuronal
  discharges within the brain.
• May cause a blank stare, a loss of consciousness,
  jerking body movements, or a period of general
  confusion for the client.

5
Seizures Convulsions

• The terms convulsion and seizure are not the
  same.
• Convulsions specifically refer to involuntary,
  violent spasms of the large skeletal muscles of
  the face, neck, arms, and legs.

6
Seizures Convulsions

• All convulsions are seizures, but not all
  seizures are convulsions.
• Although some types of seizures do indeed involve
  convulsions, other seizures do not.
• Thus antiseizure meds rather than
  anticonvulsants.

7
Causes

• Neuronal damage or injury
• Head trauma
• Extreme fever
• Heat exhaustion
• Brain tumor
• Infections
• Stroke

• Lowered blood glucose
• High protein levels
• Mood disorder, anti-psychotic, and local
  anesthetic meds
• Drug abusecocaine
• Alcohol withdrawal
• Withdrawal from sedative-hypnotics

8
Types of Seizures

• Partial seizures
• Simple
• Complex
• Generalized seizures
• Absence (petit mal)
• Atonic seizure (drop attacks)
• Myoclonic seizure
• Tonic-clonic (grand mal)

9
Status Epilepticus

• Status epilepticus is a medical emergency brought
  on by repeated generalized seizures and
  convulsions.
• Muscle spasms may block the airway, depriving the
  brain of oxygen.

10
Seizure Management

• Effective seizure management involves strict
  adherence to drug therapy.
• Choice of drug depends on the type of seizures,
  medical history, diagnostic studies, and the
  pathological processes causing the seizures.

11
Seizure Management

• Because seizures are likely to occur with abrupt
  withdrawal, antiseizure medications is withdrawn
  over a period of 6 to 12 weeks.
• In most cases, a single drug effectively manages
  seizures.
• Once seizures are controlled, patients are
  continued indefinitely on the antiseizure drug

12
Seizure Management

• Withdrawal should only be attempted after at
  least 3 years of being seizure free, and only
  under the close observation and direction of the
  healthcare team.

13
Seizure Management

• Goal of antiseizure drug therapy is to suppress
  neuronal activity just enough to prevent abnormal
  or repetitive firing.

14
Drugs with GABA Action

• Drugs with GABA action are drugs with the ability
  to mimic effects of the inhibitory
  neurotransmitter GABA.
• Ex. Benzodiazepines, barbiturates, and
  miscellaneous drugs
• DP-phenobarbital (luminal) pg. 182.

15
Phenytoin and Pheytoin-Like Drugs (Hydantoins)

• Delay influx of sodium ions across neuronal
  membrane.
• Ex.hydantoins, carbamazepine (Tegretol),
  divalproex (Depakote), valoproic acid (Depakene)
• DP for phenytoinDilantin pg. 185
• DP for valoproic acid (Depakene) pg. 185

16
Succinimides

• Succinimides delay entry of calcium ions into
  neuronincreases electrical threshold no impulse
  transmitted
• DPethosuximide (Zarontin) pg. 186.

17
Some Controlled by a Preferred Group of Drugs

• Drugs do not cure epilepsy just reduce number of
  seizures.
• Same seizures do not respond to same drug.