Anticonvulsant Drug

1. Barbiturates- excellent anticonvulsant drugs

- mainly used in all types of partial seizures and in the control of tonic clonic seizures
MOA: increase the inhibitory effects of the inhibitory neurotransmitter gamma-aminobutyric acid
(GABA)
Example: phenobarbital and mephobarbital

2. Hydantoins - used in all types of partial seizures and for tonic clonic generalized seizures.
Phenytoin (dilantin) - the very potent and most important antiepileptic drug available of this class.
Advantage: produces little sedation
MOA: involves an effect in sodium ions. In epilepsy, appears to be disturbance in the distribution of
ions that are involved in the electrical activity of the brain
Side effects: dizziness, visual disturbances, and postural imbalance
Adverse effects: skin rashes, hirautism, gingival hyperplasia.
Example : ethotoin (peganone) and fosphenytoin ( cerebyx)

3. Carbamazepine - structurally related in the tricyclic antidepressants

- possesses analgesic properties
MOA: similar to phenytoin and involves and action to block sodium ions channels
Side effects: nausea, vomiting, drowsiness, and dizziness
Adverse effects: jaundice and bone marrow depression

4. Valproic acid (Depakine) - one of the few drugs used in all types of epilepsy
Advantage: little effect on causing sedation
MOA: ability to increase levels of GABA
Side effects : nausea, vomiting, diarrhea and tremor
Adverse effects : liver toxicity

5. Benzodiazepines
MOA: increase inhibitory effect of GABA
- intravenously
-usually used in grand mal type of seizures only
Example: diazepam (valium) , clonazepam (klonolin) , lorazepam (ativan)

TYPES OF SEIZURE
[] Generalized Seizures -originate in and involve both cerebral hemispheres.
Classified as:
> Tonic Clonic
> Myoclonic
> Absence Seizures

1. Tonic Clonic Seizures

- referred also as GRANDMAL
- produces full body motor convulsions
- an attack usually last 1-2 minutes
- individuals experience confusion, fatigue, or muscle soreness

• Tonic- convulsive spasms characterized by sustained muscular contractions

 • Clonic- convulsive spasms in which rigidity and relaxation alternate in rapid succession
• Status Epilepticus - series of grand mal seizure without cessation.

2. Myoclonic seizures- produce motor convulsions that are usually brief and oftern confined to one part
of the body.
3. Absence Seizures- also known as PETIT MAL
- generalized seizures that are usually confined to a brief impairment of consciousness.
- may involve form of staring or rapid eye blinking that last anywhere from 10 seconds to 2 minites

[] Partial Seizures – seizure originating in one area of the brain that may spread to other areas
Classified as:
> Simple
> Complex

1. Simple Partial Seizures- may be sensory or motor in nature.

- usually involve a limited area of the brain and are often manifested by a sensory change
(numbness) or muscular twitch that is confined to one body part

2. Complex Partial Seizures- involves loss of consciousness, usually not longer than 2 minutes.
- "purposeless"
-psychomotor
- individual usually has no memory

Anticonvulsant Drug
1. Barbiturates- excellent anticonvulsant drugs
- mainly used in all types of partial seizures and in the control of tonic clonic seizures
MOA: increase the inhibitory effects of the inhibitory neurotransmitter gamma-aminobutyric acid
(GABA)
Example: phenobarbital and mephobarbital

2. Hydantoins - used in all types of partial seizures and for tonic clonic generalized seizures.
Phenytoin (dilantin) - the very potent and most important antiepileptic drug available of this class.
Advantage: produces little sedation
MOA: involves an effect in sodium ions. In epilepsy, appears to be disturbance in the distribution of
ions that are involved in the electrical activity of the brain
Side effects: dizziness, visual disturbances, and postural imbalance
Adverse effects: skin rashes, hirautism, gingival hyperplasia.
Example : ethotoin (peganone) and fosphenytoin ( cerebyx)

3. Carbamazepine - structurally related in the tricyclic antidepressants

- possesses analgesic properties
MOA: similar to phenytoin and involves and action to block sodium ions channels
Side effects: nausea, vomiting, drowsiness, and dizziness
Adverse effects: jaundice and bone marrow depression

4. Valproic acid (Depakine) - one of the few drugs used in all types of epilepsy
Advantage: little effect on causing sedation
 MOA: ability to increase levels of GABA
Side effects : nausea, vomiting, diarrhea and tremor
Adverse effects : liver toxicity

5. Benzodiazepines
MOA: increase inhibitory effect of GABA
- intravenously
-usually used in grand mal type of seizures only
Example: diazepam (valium) , clonazepam (klonolin) , lorazepam (ativan)

Newer antiepileptic drugs

1. Felbamate (felbatol)
•treatment for partial seizures
•liver failure/ aplastic anemia
MOA: ability to interfere with sodium ions
2. Gabapentin (neurontin)
• used in patients over 12 years old
• treatment for partial seizures
MOA: not fully understood
Side effects: sleepiness, ataxia, fatigue, nausea, dizziness.
3. Levitiracetam (keppra)
•main indication is adjunctive therapy
• used in partial seizures in adults
• drug may take without regard to meals
MOA: not fully understood
Side effects: sleepiness, headache, nervousness, dizziness.

In sudden discontinuation of drugs can produce convulsion. Therefore, when withdrawal is desired a
patient's dose should be gradually reduces over the course of 1-2 weeks.

Anticonvulsant- a substance or procedure that prevent or reduces the severity of epileptic or other
convulsive seizures.
Autoinduction- a metabolic process that occurs when drug increases its own metabolism overtime,
leading to lower than expected drug concentration.
Seizure - excessive stimulation of neurons in the brain and characterized by the spasmodic contraction
of voluntary muscles.
Convulsions - a type of seizure involving excessive stimulation of neurons in the brain and characterized
by the spasmodic contraction of voluntary muscles.