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Chapter 52

Drug Therapy for Seizure


Disorders and Spasticity

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Seizure Disorders

Seizure: brief episode of abnormal electrical activity in


the brains nerve cells
May occur as single events
May occur in a chronic, recurrent pattern
Disorder known as epilepsy

Convulsion: tonicclonic type of seizure characterized by


spasmodic contractions of involuntary muscles
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Question

Is the following statement True or False?

Seizure and convulsion are different terms for the same


disorder.

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Answer

False

Rationale: A seizure is a brief episode of abnormal


electrical activity in the brains nerve cells. A convulsion
is a tonicclonic type of seizure characterized by
spasmodic contractions of involuntary muscles.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Epilepsy

Usually requires long-term therapy


Characterized by sudden, abnormal, hypersynchronous
firing of neurons
Diagnosed by
Clinical signs and symptoms of seizure activity
Presence of abnormal brain wave patterns on EEG

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Epilepsy (cont.)
Classifications
Idiopathic
Attributable to secondary cause
Developmental defects
Metabolic disease, birth injury
Fever, acquired neurologic disorder
Alcohol or other drug effects
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Question

Is the following statement True or False?

Epilepsy can be classified as either idiopathic or


attributable to secondary causes.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Answer

True

Rationale: Epilepsy can be classified as either idiopathic


or attributable to secondary causes.

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Seizure Classifications
Partial seizures
Begin in a specific area of the brain
Often indicate a localized brain lesion
Birth injury
Trauma
Stroke
Tumor
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Seizure Classifications (cont.)

Partial seizures (cont.)


Symptoms range from
Simple motor and sensory effects
To
More complex abnormal movements and bizarre
behavior

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Seizure Classifications (cont.)
Partial seizures (cont.)
Movements are usually
Automatic
Repetitive
Inappropriate to the situation
Chewing, swallowing
Aversive movements
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Seizure Classifications (cont.)

Partial seizures (cont.)


Simple partial seizures
Consciousness not impaired
Complex partial seizures
Level of consciousness is decreased.

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Question

Is the following statement True or False?

Partial seizures have no discernible origin in the brain.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Answer

False

Rationale: Generalized seizures have no discernible origin


in the brain. Partial seizures begin in a specific area of
the brain.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Seizure Classifications (cont.)
Generalized seizures
Bilateral
Symmetric
No discernible point of origin in the brain
Most common type
Tonicclonic

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Seizure Classifications (cont.)
Generalized seizures (cont.)
Absence seizure
Alteration in consciousness that lasts only a few
seconds
Myoclonic
Contraction of muscle or group of muscles
Akinetic
Absence of movement
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Seizure Classifications (cont.)

Status epilepticus
Life-threatening emergency
Characteristics include
Generalized tonicclonic convulsions lasting for
several minutes
Generalized tonicclonic convulsions occurring at
close intervals during which consciousness is not
regained
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Seizure Classifications (cont.)

Status epilepticus (cont.)


Characteristics include (cont.)
Hypotension, hypoxia, and cardiac dysrhythmias
High risk of permanent brain damage and death
Unless prompt, appropriate treatment is
instituted

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Seizure Classifications (cont.)

Status epilepticus (cont.)


Causes
Abruptly stopping AEDs in diagnosed seizure
disorders
Brain trauma or tumors
Systemic or CNS infections
Alcohol withdrawal, drug overdose
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Generalized Characteristics of
Antiseizure Drugs
Usually control seizure activity
Do not cure underlying disorder
Difficulties
Trials of different drugs
Monotherapy versus combination therapy
Titrating dosage
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Generalized Characteristics of
Antiseizure Drugs (cont.)
Difficulties (cont.)
Lack of seizure control during drug selection and
titration
Social stigma
Adverse medication effects
Often leading to poor compliance
Undesirable drug interactions
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Phenobarbital

Depresses the CNS by inhibiting the conduction of


impulses in the ascending reticular activating system, thus
depressing the cerebral cortex and cerebellar function

Used as a sedative and antiepileptic agent in the


treatment of generalized tonicclonic and partial seizures

Parenteral form is used to control acute seizures.


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Adverse Effects

CNS depression
Cognitive impairment with sedation
Somnolence, agitation, confusion, vertigo, and
nightmares
Stevens-Johnson syndrome
Black box warning

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Benzodiazepines

Used as antidepressants, antiepileptics, or skeletal


muscle relaxants

Used for treatment of severe recurrent convulsive


seizures and status epilepticus

Contraindications include acute narrow-angle glaucoma,


shock, coma, acute alcohol intoxication, and pregnancy
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Neurontin

Used in treatment of partial seizures

It has the ability to inhibit postsynaptic responses and


block post-tetanic potentiation.

Patient teaching

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Dilantin

Oldest and most widely used antiepileptic

Stabilizes the neuronal membrane by delaying the influx


of sodium ions into the neurons and preventing the
excitability caused by excessive stimulation

Used to control tonicclonic seizures, psychomotor


seizures, and nonepileptic seizures
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Adverse Effects

Ataxia, drowsiness, lethargy


Nausea and vomiting
Gingival hyperplasia
Increased risk of osteoporosis
Patient teaching

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Monitoring Antiepileptic Drug Therapy

Periodic measurement of serum drug levels


Document blood levels and connections with
Drug dosages, seizure control, or adverse drug
effects
Assess
Therapeutic failures

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Monitoring Antiepileptic Drug Therapy
(cont.)
Assess (cont.)
Drug malabsorption
Patient noncompliance
Guide dosage adjustments.
Evaluate possible drug-related adverse effects.

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Drug Therapy Failure
Causes
Noncompliance, inadequate drug dosage
Incorrect diagnosis or medication for seizure type
Too frequent changes or premature withdrawal
Drug overdoses, use of alcohol or recreational drugs
Severe electrolyte imbalance

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Use in Special Populations

Children
Older adults
Patients with renal impairment
Patients with hepatic impairment
Patients with critical illness
Home care

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Definitions
Skeletal muscle relaxants are used to decrease muscle
spasms or spasticity that occurs within neurologic and
musculoskeletal disorders.
Muscle spasm: sudden, involuntary, painful muscle
contraction
May be clonic or tonic
Spasticity: increased muscle tone or contraction and
stiff, awkward movements

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Question

Is the following statement True or False?

Spasticity is a sudden, involuntary, painful muscle


contraction.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Answer

False

Rationale: Spasticity is increased muscle tone or


contraction and stiff, awkward movements. Muscle
spasm is a sudden, involuntary, painful muscle
contraction.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


General Characteristics of Skeletal Muscle
Relaxants
Mechanism of action
General depression of the CNS
Indications for use
Primarily as adjuncts to other treatments
Physical therapy
Spastic disorders

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General Characteristics of Skeletal Muscle
Relaxants (cont.)

Contraindications for use


Impaired renal or hepatic function
Respiratory depression
Patients who must be alert for activities of daily living

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Principles of Skeletal Muscle Relaxant
Therapy
Goal: relieve pain, muscle spasm, and muscle spasticity
without impairing the ability to perform self-care
activities

Drug selection
Medication used depends mainly on the disorder
being treated.

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Principles of Skeletal Muscle Relaxant
Therapy (cont.)

Use in special populations


Children
Older adults
Impaired renal or hepatic function
Home care

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