Neurology
Summary
Antiepileptic medications, or AEDs, are employed both for patients at risk of recurrent seizures and as a preventive measure before invasive neurosurgical procedures. These drugs function by disrupting neuronal hyperactivity, particularly affecting the packaging and transmission of neurotransmitters, leading to a reduction in action potentials. One widespread side effect noted with AEDs is fatigue, coupled with drowsiness and somnolence. For acute seizure episodes, benzodiazepines like lorazepam, diazepam, and midazolam are often prescribed, as they serve as GABA agonists that hyperpolarize the neuron, extending its refractory period. Focal seizures might be managed using lacosamide, oxcarbazepine, or carbamazepineÑall of which are Na channel blockers. Note that oxacarbazepine and carbamazepine may cause SJS/TENS.
For generalized epilepsy, options include lamotrigine, topiramate, and levetiracetam. Lamotrigine, which is effective for both generalized and focal epilepsy, can result in complications like SJS/TENS and cardiac arrhythmias, while topiramate's side effects range from weight loss to paresthesias. On the other hand, levetiracetam can lead to agitation in some patients. Pregnancy is a critical factor when prescribing AEDs, as certain antiepileptics, such as valproic acid and phenytoin, are known teratogens. Notably, phenytoin is a Na channel blocker and P450 inducer, associated with complications like cardiac arrhythmias and SJS/TENS. After two years without seizures and exhibiting a normal EEG, it may be feasible to discuss the withdrawal of antiepileptic medication. For refractory epilepsy cases, a neurosurgical evaluation becomes necessary, and solutions might entail resecting the seizure nidus or implanting a neurostimulator device.
Lesson Outline
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FAQs
Antiepileptic medications are drugs designed to prevent, reduce, or stop seizures. They are typically indicated in patients with risk factors for recurrent seizures and are used prophylactically for invasive neurosurgical procedures.
The common side effects of antiepileptic drugs (AEDs) include fatigue, drowsiness, and somnolence. Side effects related to individual drugs can vary. For instance, lamotrigine can cause SJS/TENS and cardiac arrhythmia, topiramate can cause weight loss, nephrolithiasis, brain fog, and paresthesias, and levetiracetam can cause agitation.
Treatment for focal seizures typically includes medications such as lacosamide, oxcarbazepine, or carbamazepine. Generalized epilepsy, on the other hand, can be treated with lamotrigine, topiramate, or levetiracetam. It's important to note that lamotrigine, oxcarbazepine, and carbamazepine have a risk of causing SJS/TENS.
Some antiepileptic medications can cause severe fetal harm and are considered teratogens. Valproic acid and phenytoin, for instance, are known to be unsafe during pregnancy. Therefore, it's critical to discuss potential risks and benefits with a healthcare provider to ensure the safest possible treatment course if seizure control is necessary during pregnancy.
If epilepsy is refractory or resistant to medication, a neurosurgical evaluation should be considered. Treatments may include resection of the seizure nidus or implantation of a neurostimulator device. These options can offer an alternative path to seizure control for patients who do not respond to antiepileptic medications.
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