Seize the Land Broad Spectrum Anti-Epileptics

4.2 – “Seize the land”: Broad spectru spectrum m anti-ep -epileptics ileptics (valproate (valproate,, topiramate, lamotrigine, levetiracetam) Physiology • Epilepsy is a chronic disorder characterized by seizures (cerebral dysfunction caused by abnormal discharge of cerebral nn) (seizures = seizure, in this case of land). Can be from a variety of causes, but have characteristic patterns. • Focal: attack begins in a specific locus & typically involves only 1 part of the body (person dodging cannonball with one arm shaking). Multiple types, although treatments generally the same. o Simple: no LOC + clonic jerking of extremity or other sensory, psych, or motor symptom. o Complex: loss of consciousness; often associated with automatisms (e.g. lip smacking, swallowing) • Generalized involve both hemispheres at onset (trembling person falling off wall). Most common type is generalized tonic-clonic (historically grand mal)characterized with diffuse muscle contraction, rhythmic jerking, often have post-ictal state. • Partial seizures may also become generalized and turn into tonic-clonic • Juvenile myoclonic epilepsy is a type of generalized seizure disorder (kid making chicken wings) • Absence seizure • Others Manageme Management nt • Valproate (Festival) o Effective for all seizure types discussed above. One of the go-to agents o Binds VG Na channels, preventing sustained high-frequency firing and sustaining inactivation phase of neurons (open basket of sodium peanuts, with open lid “gates”) o Also affects other channels, ions, and neurotransmitters, notably elevating levels of inhibitory neurotransmitter GABA (taxicab colored palanquin elevated in the air) o Metabolized by CYP450 (ship with CYP 450 nameplate). o Adverse effects: ▪ GI adverse effects (ill emperor Atahualpa) ▪ Increased appetite & wight gain (Emperor’s girth) ▪ Tremor (trembling weapon) ▪ Rare but potentially fatal hepatotoxicity (cow with liver spot) ▪ Pancreatitis (pancreas sponge) ▪ Teratogen: causes neural tube defects and increases risk of spina bifida (tarantula shields; mother playing on pipe flute) • Topiramate (toupee) o Effective in many of the seizure types discussed above; not as effective as valproate or lamotrigine o Binds VG Na channels, preventing sustained high-frequency firing and sustaining inactivation phase of neurons (open basket of sodium peanuts, with open lid “gates”) o Allosterically binds to the GABA-A receptor (directly binding hands) o Metabolized by CYP450 (ship with CYP 450 nameplate). o Adverse effects ▪ Dose related somnolence & fatigue (tired soldiers) ▪ Confusion & cognitive slowing (soldier scratching head) ▪ Wight loss (cachectic soldier) ▪ Urolithiasis (kidney shaped wheel and cannonballs) ▪ Acute myopia & angle-closure glaucoma (closing angle on high-pressure tea-kettle). Must stop medication immediately. • Lamotrigine (llama) o Effective against many seizure types, including absence. o Binds VG Na channels, preventing sustained high-frequency firing and sustaining inactivation phase of neurons (open basket of sodium peanuts, with open lid “gates”) o Metabolized by CYP450 (ship with CYP 450 nameplate). o Adverse events ▪ Skin rash in up to 10%. ▪ 1%, especially children, may have SJS/TEN (red mask) ▪ Diplopia (cross-eyed llama) • Levetiracetam (Keflex) (elevator) o Effective against many seizure types; not used much against absence o Metabolized by CYP450 (ship with CYP 450 nameplate). o Adverse effects: ▪ Somnolence (sleeping person on elevator)