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ANTICONVULSANTS
Joy N Bautista, RN, MPH, DRDM
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Review of Seizures
Seizures brief periods of abnormal electrical brain activity
Causes fever, head injury, brain tumor, meningitis,
hypoglycemia, drug overdose, withdrawal, poisoning
Epilepsy chronic and recurrent seizure episodes; sudden
discharge of electrical energy
Generalized both hemispheres of the brain with loss of
consciousness
Tonic-clonic (Grand mal)
Atonic or akinetic
Myoclonic
Partial begin in a localized area in 1 brain hemisphere
Simple
Complex


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Review of Seizures
Grand-mal seizures
Tonic phase sudden intense muscular contractions fall, loss
of consciousness, rigidity; lasts 20-60 seconds
Clonic phase bilateral symmetric jerking movements alternate
with relaxation of the extremities; lasts about 60 seconds
Post-ictal phase resting, recovery phase of flaccid paralysis and
sleep (2-3 hours)
Status epilepticus rapidly recurring generalized seizures
Atonic or akinetic seizures - sudden loss of muscle tone; drop attack
Myoclonic seizures lightning-like, repetitive contractions of the
voluntary muscles
Petit mal (absence) seizures non-convulsive seizure
Jacksonian partial simple motor seizure; localized convulsions of
voluntary muscles
Psychomotor seizures partial complex seizures; like petit-mal


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Anticonvulsants
Focus of therapy identification and management of
causative factors
Goals of therapy
Reduce frequency of seizure activity
Minimize adverse effects of anticonvulsants
Actions
Increase seizure threshhold
Regulate neuronal firing through inhibition of excitatory
processes or enhancement of inhibitory processes
Prevent seizure spread to adjacent neurons
Stabilization of neuronal membrane
Decrease release of excitatory neurotransmitters
Enhancement of GABA inhibitory effect
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Anticonvulsants
Barbiturates
Increased seizure threshold
Prevent spread of seizure by GABA enhancement
Examples: phenobarbital, mephobarbital
Benzodiazepines
Enhancement of GABA inhibition of neurotransmission
Diazepam, clonazepam, clorazepate
Hydantoins
Phenytoin, ethotoin, fosphenytoin, mephenytoin
For generalized tonic-clonic and partial seizures
Succinimides
Ethosuximide, methsuximide, phensuximide
For petit mal seizures
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Anticonvulsants
Carbamazepine
Blocks reuptake of NE, decreases release of NE, and decreases
rate of dopamine and GABA turnover
Tonic-clonic and partial seizures in combination with other
anticonvulsants, TGN, bipolar disorders
Gabapentin
Partial seizures in combination with other anticonvulsants
Lamotrigine
Blocks voltage-sensitive Na channels in neuron membranes for
stability
Inhibits release of excitatory neurotransmitters such as
glutamate
Partial and generalized seizures in combination with other
anticonvulsants
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Anticonvulsants
Primidone
Metabolized into phenobarbital and phenylethylmalonamide
(PEMA)
Partial and tonic-clonic seizures in combination with other
anticonvulsants
Tiagabine
Prevents reuptake of GABA for partial seizure control
Topiramate
Prolonged blockade of Na channels in the neuron membrane
Potentiation of GABA action
Antagonism of receptors for excitatory neurotransmitters
Valproic acid
Supports GABA activity