Treatment Strategies – Anti-Seizure Medications

by Pravin Shukle, MD

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    So, these are the lists of the different antiseizure medications. Let's go through treatment strategies for each of the different type of seizure activity. You'll also cover this lecture in your neurology course in more detail. Today, we're just going to focus on the pharmacology of these drugs. Let's start off with valproic acid. So, you can see that it's used in multiple different treatment strategies, right from absence seizures or myoclonic seizures to partial and tonic-clonic seizures. Valproic acid has a number of side effects, and they can be quite frequent. And in some studies we've shown up to 35 % of patients experience some kind of side effect from valproate. Nausea, drowsiness and vomiting via the chemoreceptor trigger zone activation can be experienced with patients on valproic acid. It does have a black box warning. What a black box warning means is is that the regulatory agencies have put it and mandated that all people be aware of potential problems of these drugs. The first black box warning is hepatotoxicity. The second black box warning is pancreatitis. And the third black box warning are fetal abnormalities. It is a class D drug. So, we do not want to give this drug in pregnant patients. Valproate syndrome is where the fetus has a triangular shaped head. They often have a low IQ. They loss the philtrum which is the little piece of folded tissue above your lip and they have more medial eyebrows. The next drug that I would like to discuss is clonazepam. You can see it here being used in absence seizures and myoclonic seizures. Clonazepam has a specific activity, once again on the GABA channel, remember that a benzodiazepine will increase the frequency of opening of this channel, allowing chloride to pass through. It is often...

    About the Lecture

    The lecture Treatment Strategies – Anti-Seizure Medications by Pravin Shukle, MD is from the course CNS - Pharmacology. It contains the following chapters:

    • Absence Seizures
    • Clonazepam
    • Ehtosuxamide
    • Lamotrigine
    • Phenytoin
    • Phenobarbital
    • Status Epilepticus

    Included Quiz Questions

    1. Pregnancy in second trimester
    2. Well controlled HIV
    3. Alcoholism
    4. Well controlled chronic hepatitis C infection
    5. Recurrent gallbladder stones
    1. Ethosuximide: Calcium channel blocker
    2. Lithium: Phosphoinositol inhibitor
    3. Valproate: Sodium and calcium channel blocker
    4. Phenytoin: Sodium channel blocker
    5. Primidone: Sodium channel blocker
    1. Phenytoin, periodic blood draws to check drug level.
    2. Valproic acid, periodic pregnancy test
    3. Bupropion, seizure activity
    4. Varenicline, regular checks for suicidal ideation
    5. Amantadine, periodic HIV viral load
    1. Absence seizures
    2. Neonatal seizures
    3. Tonic-clonic seizures
    4. Partial seizures
    5. Myoclonic seizures
    1. Intravenous benzodiazepam
    2. Oral benzodiazepam
    3. Phenobarbital
    4. Oxygen
    5. Phenytoin

    Author of lecture Treatment Strategies – Anti-Seizure Medications

     Pravin Shukle, MD

    Pravin Shukle, MD

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