Antiepileptic Drugs AED

SE

Lamotrigine

Insomnia (adv) , Rash

Topiramate

Cognitive problems, weight

loss, headache, kidney stones,
fingers & toes parathesias

Clobazam

Irritabity, depression &

Tolerance

Vigabatrin

depression, psychosis, irrev.

Visual field problems

gabapentin

phenobarbital
primidone

sedation, dec libido,

depression, Rash

Enz. Inducers
DI

Enteric coated tabs

not to be chewed

. av in all forms,
.
by Folic a' . inexpensive,
easy to dose

.Saturation Kinetics
complicates dose
.Good Oral hygeine
dec SE

. CI in allergies
to TCA

. Av in Oral & CR

. Worsens Absence &

Myoclonus siezure

1st Choice in
Absence only

by Valproic

dec eff of OC

Alert pt.

Slow dose
titration

GI upset

1st Choice (expt

Partial)
Broad Spectrum

Add-on therapies

Ethusiximide

Safe, No enz. Induction, Few DI

Neutopenia, rarely aplastic

anemia, low serum Na+,
Rash

Potent Enz.
Ind many DI

Carbamazepine

Disadv

Only oral form

Expensive

Expensive

rapid onset

. Worsens Absence &

Myoclonus .Expensive

safe, not
metabolized &
used in liver dys

expensive

by Valproic

.Long t1/2.'.OD .
av in all forms .
inexpensive,

Slow dose
titration

Phenytoin

Encephalopathy,
hairsutism, Nystagmus,
gum hyperplasia, Ataxia,
Rash
n sr level=10-20 mcg
>20
SE >40
coma

. Many DI
.Only one that
doesn't OC

Adv

Broad Spectrum

weight gain, Edema, hair

loss, menstrual irreg,
teratogenicity, tremors

Bld Dysc

Valpoic a'

No
Enz.Ind

DI

many

D'

Declinning use

Epilepsy in Women:
1. OC > 35mcg Estradiol (due to risk of failure in pts taking enzyme enhancing AED)
2. Preg Plans: - dec AED to min.---> Control Seizures
- cont. Folate suppl. (Valproic & phenytoin-->dec Folic & to dec risk of teratogenicity)
- Valproic is CI in history of neural tube closure
3. Preg: - oral Vit K: in the 9th month
- Follow up baby malformations & AED level (dec in preg)
4. PostPartum:
- Breast feeding is OK (Barb--> sedation, Barb in preg, if stopped pp-->with. Symp)
- Follow up AED level (inc PP)
Status Epilepticus:
0-5 min---> O2, intubation, Bld invest, ECG, pulse & BP
5-10 min---> IV saline, dextrose, Lorazepam or Diazepam & IM Thiamine
10-30min--->IV Phenytoin or phenobarbital
30-60min---> ICU, EEG, IV Phenytoin <-->Phenobarbital
Epilepsy in General

1. Base line CBC & liver enz 2. BID dose is generally recommended
3. Sudden stop---> Status Eilepticus 4. ttt not necessrily life long
5. Pre surgery: Vit K & Bld coagulation mnitoring is necssary.