AntiepilepticsMark Tuttle, 2011

Group/MechDrugsAdverse Effects

Sodium channel Blockers Prevent repetitive AP propagation

Stabilizes inactive state General side effects: Due to inhibiting high-frequency neurons Nystagmus

Diplopia

Ataxia

Somnolence

Cognitive slowingPhenytoin (DilantinTM) Fosphenytoin (CerebyxTM) P450, not autoinduced

1st order ( zero-order * Gingival hyperplasia

Vitamin D deficiency - Osteopenia: Ca2+

Hepatotoxic

Cardiac conduction defect Peripheral neuropathy Blood: Anemia (megaloblastic)

Teratogenic

Purple glove syndrome (Phenytoin only)

Carbamazepine (TegretolTM)Oxcarbazepine (TrileptalTM) P450, autoinduced Dizziness

Sedation

Diplopia

Cardiac conduction defect Hyponatremia

Osteoporosis Rash: Stevens Johnson Syndrome

Blood: Neutropenia, thrombocytopenia, aplastic anemia

Valproic Acid (DepakoteTM) Hepatic excretion Fat, shaky, bald, yellow Weight gain, tremor, alopecia, hepatotoxicity

Nausea / vomiting Pancreatitis Polycystic ovarian syndrome

Osteopenia

Blood: thrombocytopenia

Teratogenic: Neural tube defects

Lamotrigine (LamictalTM) Hepatic excretion Rash: Stevens-Johnson Asceptic meningitis Dizziness, sedation Pediatric: ADHD worse

Topiramate(TopamaxTM) Renal excretion Confusion/psychosis Kidney stones Weight loss Metabolic acidosis Glaucoma

Paresthesias Headache

Zonisamide (ZonegranTM) Long t: once-daily dosing Kidney stones*

Hepatotoxic

Weight loss Rash: Stevens-Johnson Syndrome Blood: dyscrasias Sulfonamide (allergies)

GABA transmission

chan: BZs, Barbs, Topiramate

synthesis: Gabapentin

GABA metab: Valproaic ac.Somnolence

Confusion,Memory probsBenzodiazepines:Clonazepam (Klonopin)Diazepam (Valium)

Lorazepam (Ativan) Sedation

Ataxia

Psychosis Tolerance

Barbiturates: P450Phenobarbital Sedation: Cognitive slowing, respiratory Pediatric: Hyperactivity (paradoxical)

T-type Ca channel agents

Stabilize inactive state Prevent rhythmic firingEthosuximide (ZarontinTM) Hepatic excretion Nausea / vomiting Hiccups

Aggressiveness Headache

concentration

Blood: Leukopenia, agranulocytosis

Inhibition of excitatory amino acid synaptic releaseGabapentin (NeurontinTM) Renal excretion Dizziness Weight gain Pedal edema

Pediatrics: aggressive behavior

Pregabalin (LyricaTM) Sedation, cognitive impairment

Blurred vision Weight gain Dry mouth

Peripheral edema

Blood: Thrombocytopenia

Levatiracetam (KeppraTM) Renal excretion Sedation, dizziness

Ataxia Psychosis Blood: anemia, neutropenia

Slow inact. of Na+ chan.Lacosamide (VimpatTM)

Stab. inactive Na+ chan.Rufinamide (BanzelTM) Lennoux Gastaut (MR, multiple seizure types)

Side effects (by effect): Rash: Stevens-Johnson Syndrome

Phenytoin (DilantinTM), Carbamazepine (TegretolTM), Oxcarbazepine (TrileptalTM), Zonisamide (ZonegranTM) Blood problems

Phenytoin (DilantinTM), Carbamazepine (TegretolTM), Oxcarbazepine (TrileptalTM), Zonisamide (ZonegranTM),

Valproic Acid (DepakoteTM), Ethosuximide (ZarontinTM), Pregabalin (LyricaTM), Levatiracetam (KeppraTM) Hepatotoxicity

Phenytoin (DilantinTM), Valproic Acid (DepakoteTM), Zonisamide (ZonegranTM) Pediatric problems

Phenobarbital, Gabapentin (NeurontinTM), Lamotrigine (LamictalTM) Kidney stones

Topiramate(TopamaxTM), Zonisamide (ZonegranTM) Osteopenia

Carbamazepine (TegretolTM), Oxcarbazepine (TrileptalTM), Valproic Acid (DepakoteTM) Weight gain

Valproic Acid (DepakoteTM), Gabapentin (NeurontinTM), Pregabalin (LyricaTM) Weight loss

Topiramate(TopamaxTM), Zonisamide (ZonegranTM)IndicationsSide Effects

Antiepileptics

PartialGeneralizedAbsenceRashCardiac conductionBloodHepatotoxicityPediatric problemsKidney StonesOsteopeniaWeight gainWeight loss

Phenytoin (DilantinTM)Fosphenytoin (CerebyxTM)1st2ndXXXX

Carbamazepine (TegretolTM)Oxcarbazepine (TrileptalTM)1st2ndXXXX

Valproic Acid (DepakoteTM)1st1stXXXX

Lamotrigine (LamictalTM)1st1st2ndX

Topiramate(TopamaxTM)1stX

Zonisamide (ZonegranTM)2nd2ndXXXX

Clonazepam (KlonopinTM)

Diazepam (ValiumTM)

Lorazepam (AtivanTM)2nd

Phenobarbital2nd2ndX

Ethosuximide (ZarontinTM)1stX

Gabapentin (NeurontinTM)XX

Pregabalin (LyricaTM)XX

Levatiracetam (KeppraTM)2ndX

Determine if antiepileptic medication is indicated: Recurrent seizures of unknown etiology

Known cause that cannot be reversed

Present with status epilepticus

Family history of seizures

Abnormal interictal EEG

Job depends on no seizures (ex. driver)

Selection of antiepileptic drugs Begin with monotherapy. Add a second drug with a different mechanism of action if poorly controlled Surgery is an option in focal epilepsy with poor control on medications.