Agents Used to Treat Seizures and Epilepsy

Chapter 31

Epilepsy

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An electrical disorder of the brain that sometimes leads to seizures

DefinitionsSeizure: a brief episode of abnormal electrical activity in the nerve cells

Convulsion: spasmodic contractions of involuntary muscles

Symptoms of Epilepsy

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Abnormal motor functionLoss of consciousnessAltered sensory awareness

Psychic changes

Status Epilepticus

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Series of tonic-clonic seizuresNo return to consciousness between seizures

Prompt treatment in hospital necessary

Life support equipment

Anticonvulsant Therapy

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Prevent and control seizuresAct by decreasing CNS stimulation

Drug depends on type of seizure, therapeutic goal, and adverse effects

Patient compliance is vitalNeed to monitor serum levels

Drug Agents Used to Prevent Seizures

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BarbituratesHydantoinsSuccinimidesBenzodiazepines

Drug Agents Used to Prevent Seizures

(cont’d)

Other agentsValproic acidCarbamazepine (Tegretol)

Clients often on these medications for life

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Barbiturates

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Nonspecific CNS depressants

Interferes with impulse transmission in the cortex of the brain

Nonselective

BarbituratesUsed alone or in combination with other drugs

Safe and effectiveMay cause - sedation - hypnosis - respiratory depression

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Hydantoins

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Dilantin – oral Fosphenytoin – IV usePreventing and treating partial and generalized tonic-clonic seizures

Reduces spontaneous electrical impulses in the brain

Hydantoins

(cont’d)Selective action on hyperactive synapses

Does not cause sedation or hypnosis

Narrow therapeutic rangeContraindicated in patients with bradycardia, third degree heart block, or sinoatrial block

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Hydantoins Adverse effects

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HypotensionDysrhythmiasCardiovascular collapse

Heart blockDrowsinessWeakness Insomnia

ConfusionIrritabilityDepressionHeadachePsychosis If serum too high – coma can result

Succinimides

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Ethosuximide (Zarontin) – safest in group

Used for absence seizuresRisk for hematological, hepatic, and renal dysfunction

Benzodiazepines

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CNS depressantsMultiple actionsLimits spread of seizure electrical discharges

Potential for dependence

Benzodiazepines

Examples: - Valium - KlonopinAdverse effects with abrupt withdrawal

- convulsions - vomiting - tremor - sweating

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Anticonvulsants

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TreatmentStart with one drug and add others as needed

Check serum drug concentrations as required

Goal of Anticonvulsants

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Prevent the generation and spread of excessive electrical discharges in the brain Protect the normal cells

Anticonvulsants: Therapeutic Effects

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Stabilize nerve cells and prevent hyperexcitabilityPrevent the generation of

hyperactive neuronsPrevent abnormal

impulses from spreading

Anticonvulsants: Side Effects

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Carbamazepine (Tegretol)Blood dyscrasias

Phenytoin (Dilantin)Gum hyperplasia

Diazepam (Valium)Respiratory depression and drowsiness

Pediatric Considerations

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Barbiturates require lower dosages

Excessive sedation, confusion, lethargy, or decreased movement

Paradoxical reactionsValproic acid (Depakene): do not give with milk

Wear a MedicAlert® bracelet

Nursing Considerations

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Encourage patient to carry medical alert item

Educate patients and families about seizure precautions and importance of following drug regime

Educate patients regarding drug interactions

Educate patients regarding side effects and when to report to provider

Monitor appropriate lab valuesMonitor effectiveness of therapy

To be Covered in Mental Health

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Sedatives and hypnoticsAntianxiety drugsAntidepressantsAntipsychoticsSubstance abuse