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SE
Lamotrigine
Topiramate
Clobazam
Vigabatrin
gabapentin
phenobarbital
primidone
Enz. Inducers
DI
. av in all forms,
.
by Folic a' . inexpensive,
easy to dose
.Saturation Kinetics
complicates dose
.Good Oral hygeine
dec SE
. CI in allergies
to TCA
. Av in Oral & CR
1st Choice in
Absence only
by Valproic
dec eff of OC
Alert pt.
Slow dose
titration
GI upset
Add-on therapies
Ethusiximide
Potent Enz.
Ind many DI
Carbamazepine
Disadv
Expensive
rapid onset
safe, not
metabolized &
used in liver dys
expensive
by Valproic
.Long t1/2.'.OD .
av in all forms .
inexpensive,
Slow dose
titration
Phenytoin
Encephalopathy,
hairsutism, Nystagmus,
gum hyperplasia, Ataxia,
Rash
n sr level=10-20 mcg
>20
SE >40
coma
. Many DI
.Only one that
doesn't OC
Adv
Broad Spectrum
Bld Dysc
Valpoic a'
No
Enz.Ind
DI
many
D'
Declinning use
Epilepsy in Women:
1. OC > 35mcg Estradiol (due to risk of failure in pts taking enzyme enhancing AED)
2. Preg Plans: - dec AED to min.---> Control Seizures
- cont. Folate suppl. (Valproic & phenytoin-->dec Folic & to dec risk of teratogenicity)
- Valproic is CI in history of neural tube closure
3. Preg: - oral Vit K: in the 9th month
- Follow up baby malformations & AED level (dec in preg)
4. PostPartum:
- Breast feeding is OK (Barb--> sedation, Barb in preg, if stopped pp-->with. Symp)
- Follow up AED level (inc PP)
Status Epilepticus:
0-5 min---> O2, intubation, Bld invest, ECG, pulse & BP
5-10 min---> IV saline, dextrose, Lorazepam or Diazepam & IM Thiamine
10-30min--->IV Phenytoin or phenobarbital
30-60min---> ICU, EEG, IV Phenytoin <-->Phenobarbital
Epilepsy in General
1. Base line CBC & liver enz 2. BID dose is generally recommended
3. Sudden stop---> Status Eilepticus 4. ttt not necessrily life long
5. Pre surgery: Vit K & Bld coagulation mnitoring is necssary.