Chapter 16: Drugs for the Treatment of Seizure Disorders

bleeding, increase in birth defects if taken during pregnancy, hepatotoxicity & hepatic failure, indigestion, nausea, hypersalivation

Side effects of valproate

aura

a brief period of heightened sensory activity that can occur before the onset of a seizure

True

True of false: reports have shown that growth and development of a fetus can be affected when antiepileptic drugs are taken during pregnancy

False

True or False: Gradual withdrawal of antiepileptic drugs is not necessary

Gingival enlargement or hyperplasia mostly around anterior teeth

What are the oral complications associated with phenytoin?

gingival enlargement and swelling of the tongue

What are the oral side effects of ethosuximide (Zarontin)

depressed CNS function; impaired cognitive abilities; hyperactivity or sedation

general adverse reactions of antiepileptic agents

Steven Johnson syndrome, rash, dermatitis, erythema mulitforme, systemic lupus erythematous

idiosyncratic reactions

ataxia

lack of muscle coordination

amblyopia

lazy eye

Phenobarbital (Luminal)

newer anticonvulsant medication; side effects include sedation or excitement and hyperactivity in children

complex partial attack

occurs when consciousness is impaired during a partial seizure

simple partial attack

occurs when consciousness is not impaired during a partial seizure

Vitamin D

osteomalacia can result from a deficiency of this vitamin as a result of a drug interaction with phenytoin

partial seizure

seizure involving only limited areas of the brain with localized symptoms

Generalized seizures

seizures that involve the entire brain; two groups (tonic-clonic & absence)

tonic-clonic seizure

stiffening-jerking; a major motor seizure involving all muscle groups for long periods of time; previously termed grand mal (big bad) seizure

status elipticus

type of seizure: lasting **>30 mins; emergency situation requiring rapid therapy; treated with benzodiazepines & diazepam (Valium)

CNS depression, GI problems, and fatal blood dyscrasias (aplatic anemia, agranulocytosis), rash, skin pigmentation,

Most common side effects of carbamazepine

xerostomia, glossitis, stomatitis

Oral side effects of carbamazepine

increased salivation, coated tongue, dry mouth, sore gums

Oral side effects of clonazepam

Valproate (Depakote)

Anticonvulsant used in the treatment of generalized tonic-clonic seizures; also commonly used to treat migraines and bipolar disorder

Absence seizures (petit mal)

10 to 30 sec loss of consciousness with eyelid fluttering, abruptly stop activity; typically seen in children

Lamotrigine (Lamictal)

Antiepileptic that inactivates sodium channels used to treat partial and tonic-clonic seizures; side effects include dizziness, headache, nausea, rash, and rarely Stevens-Johnson syndrome;

Phenytoin (Dilantin)

Anticonvulsant drug that works by blocking the repetitive firing of action potentials; used to treat both tonic-clonic and partial seizures; associated with gingival enlargement; used to be the number one drug of choice to treat epilepsy

Gabapentin (Neurontin)

Anticonvulsant that is used to treat neuropathic pain and fibromyalgia

Clobazam (Onfi)

Anticonvulsant used as an adjunctive to treat seizures in patients with Lennox-Gestaut syndrome; can cause amnesia, ataxia, somnolence, lethargy, drooling, and constipation

Clonazepam (Klonopin)

Benzodiazepine that is used to treat absence seizures in the event that ethosuximide does not work

mental confusion, slurred speech, blurred vision, diplopia, amblyopia, insomnia

CNS effects of phenytoin

anorexia, nausea, vomiting

GI effects of antiepileptic agents

Fetal hydantoin syndrome

What term is given to the congenital abnormality associated with maternal ingestion of phenytoin?

Partial (focal) seizures

affect single area of brain most commonly originate in temporal lobe often preceded by seizure aura can generalize 2 types: simple, complex

Carbamazepine (Tegretol)

antiepileptic drug used in the treatment of trigeminal neuralgia; simple partial seizures and bipolar disorder; blocks sodium channels thus stopping the propagation of nerve impulses

Levetiracetam (Keppra)

antiepileptic drug used to treat partial and generalized tonic-clonic, and absence seizures; side effects include dizziness; irritability; hallucinations, behavior changes, and psychosis

Oxcarbazepine (Trileptal)

antiepileptic drug used to treat partial seizures; side effects include dizziness, diplopia, somnolence; nausea; rarely Stevens-Johnson syndrome

Epilepsy

chronic brain disorder characterized by recurrent seizure activity

rash, exfoliative dermatitis, lupus erythematosus, Stevens-Johnson syndrome, hirsutism (excessive hairiness)

dermatological effects of phenytoin

decreases the effect of doxycycline, warfarin, theophylline, and oral contraceptives; increases effect when taking erythomycin & calcium channel blockers

drug interactions of carbamazepine

increased production of hepatic microsomal enzymes which lower the amount of the drug in the blood; older antiepileptic drugs have more interactions than newer drugs

drug interactions with antiepileptic agents

Ethosuximide

drug of choice for the treatment of absence seizures

valproate, lamotrigine, and levetiracetam

drugs of choice in treating tonic-clonic seizures