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Pharmacology of Anti-epileptics for Nurses
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PHARMACOLOGICAL MANAGEMENT OF EPILEPSY
EPILEPSY VERSUS SEIZURE
A seizure is symptom caused by abnormal electrical discharges in the brain
Epilepsy is a disorder characterized by recurring seizures
A seizure is a symptom of epilepsy
EPILEPSY-CLASSIFICATIONFocal seizures account for 80% of adult epilepsies
Generalized seizures
Unclassified seizures
INCIDENCE OF EPILEPSY BY AGE
CAUSES OF EPILEPSY
POST-TRAUMATIC EPILEPSYEpilepsy arising as a result of head trauma
Head trauma may be subtle or severe
Extent & location of injury may increase likelihood of developing seizures 2 types of seizures -early/acute & delayed onset
Early treatment with anti-epileptic drugs (AEDs) may not affect the development of seizures later on
MORTALITYRisk of death higher in people with epilepsy
Mortality rate associated with seizures lasting > 30 minutes may be as high as 19%
Vast majority of deaths occur in people with seizure in the context of an acute brain insult, hypoxia, trauma, etc.
Sudden Death in Epilepsy (SUDEP)
A Spectrum of SeverityUncomplicated epilepsySeizures refractory to treatmentIncrease risk of SUDEP
Case 01A 24 year old male with idiopathic generalized epilepsy, who has been defaulted treatment for 2 months, admitted with recurrent GTC seizures without regaining consciousness in between.
IV Benzodiazepines
Lorazepam4-8mgMaximum effect in 2 minLasting for 4-6hourDiazepam5-30mgAct early(10-20sec)Lasting only for 2 hourMidazolam2.5-10mgAct in < 1minCan be used as infusion
ComplicationsOver sedationHypotensionRespiratory depressionTolerance
IV Phenytoin
Dose20mg/kg
Case 2A, 30 year male with post-traumatic epilepsy presented with unsteady gait for one week and double vision for 3 days. He was on phenytoin and phenobarbitone since the time of RTA and his medication changed to carbamazepine 200mg tds recently.
Carbamazepine
Dose800 1200mg daily
Side effectsAtaxia/diplopiaSkin rash
Other usesTrigeminal neuralgiaBipolar disorderNeuropathic pain
Phenytoin
Dose150 400mg daily
Side effectsGum hypertrophyDose related toxicity
Other uses?Anti-arrhythmic
Phenobarbitone
Dose30 120 mg daily
Side effectsDepressionWithdrawal seizures
Other usesPreoperative sedation
Case 3A, 26 year old newly married female with Juvenile Myoclonic epilepsy who has been on Sodium valproate is being evaluated in the routine clinic.
Sodium valproate
Dose600mg - 3g
Side effectsHepatotoxicityHair loss
Other usesManiaMigraine
Levetiracetam
Dose1000mg 3g
Side effectsSedationBehavioral disturbances
Other usesMyoclonus
A, 64 year old male with post stroke epilepsy has developed painful loss of vision of the right eye. His medications include Topiramate, Lamotrigine and Oxcarbazepine.
Topiramate
Dose50 400mg daily
Side effectsWeight lossImpaired cognition
Other usesMigraine Diabetic neuropathy
Oxcarbazepine
Dose600-1200mg daily
Side effectsSkin rashvertigo
Other usesNeuropathic painBipolar disorder
Lamotrigine
Dose100 300mg daily
Side effectsSkin rashNausea
Other usesBipolar disorderTrigeminal neuralgia
SUMMARY Definition of seizure
Definition of epilepsy
Causes and burden of epilepsy
Management of status epilepticus
Pharmacology of antiepileptics
**Epilepsy affects individuals to varying degrees. The spectrum of disability it creates is broad, ranging from a very limited effect on the individual to a devastating impact on all aspects of life. For a majority (perhaps as high as 80%) of people with epilepsy, seizures can be substantially reduced or completely controlled and may have limited impact on quality of life although memory and attention may pose additional challenges. For the remaining 20%, epilepsy is truly disabling, marked by frequent seizures, and other impairments, and a dramatically reduced quality of life.
Children whose seizures are not well controlled often experience social, emotional, and academic problems that compromise various stages of development. These problems may extend into adult life, where the same issues become barriers to employment and independence.
Question: What are some of the social issues that you think are important to people with epilepsy?