Epilepsycomprises a group of chronic syndromes that involve recurrent seizures. Approximately 1% of
the world’s population hasepilepsy; the
second most common neurologic disorder after stroke. Although standard
therapy permits control of seizures in 80% of these patients,
there are an estimated 500,000 people in the United States who suffer
from uncontrolled epilepsy.
Seizures are finite episodes of brain dysfunction resulting from abnormal transient discharge of cerebral
neurons. The causes of seizures are many. They include the full
range of neurologic diseases, such as tumor, head trauma, and stroke.
In some patients, the cause of seizures may be less obvious or unknown,
such as a congenital abnormality or genetic factor. In other patients,
seizures may be caused by an underlying acute toxic or systemic
metabolic disorder (e.g., infections, hypoglycemia, hypoxia, poisoning),
in which case appropriate therapy is usually directed toward the
specific abnormality. Classification of seizure types with clinical
descriptions are listed in Table 14–1.
Table 14–1. Seizure
Classification |Favorite Table|Download (.pdf)
Table 14–1. Seizure
|Partial seizures, simple||Consciousness preserved; manifested variously as convulsive jerking,
paresthesias, psychic symptoms (altered sensory perception, illusions, hallucinations,
affect changes), and autonomic dysfunction|
|Partial seizures, complex||Impaired consciousness that is preceded, accompanied, or
followed by psychologic symptoms|
|Tonic-clonic seizures, generalized||Tonic phase (less than 1 min) involves abrupt loss of consciousness, muscle rigidity,
and respiratory arrest; clonic phase (2–3 min) involves jerking
of body muscles, with lip or tongue biting, and fecal and urinary incontinence;
formerly called grand mal|
|Absence seizures, generalized ||Impaired consciousness (often abrupt onset and brief), sometimes with
automatisms, loss of postural tone, or enuresis; begin in childhood (formerly called
petit mal) and usually cease by age 20 years|
|Myoclonic seizures||Single or multiple myoclonic jerks|
|Status epilepticus||A series of seizures (usually tonic-clonic) without recovery
of consciousness between attacks; it is a life-threatening emergency|
Effective antiseizure drugs have, to varying degrees, selective
depressant actions on the abnormal neuronal discharge. However,
they vary in their mechanisms of action and in their effectiveness in
specific seizure disorders. In most seizure disorders, however,
the choice of medication depends on the empiric seizure classification.
In this chapter, we will discuss the various drugs used to treat
seizures based on their drug class and mechanism of action (Table
14–2) and adverse effects (Table 14–3). We will
then discuss their clinical uses in treating epilepsy, based on empiric
seizure classification (Figure 14–1).
Table 14–2. Drug
Classification and Mechanism of Action of Common Antiseizure Drugs |Favorite Table|Download (.pdf)
Table 14–2. Drug
Classification and Mechanism of Action of Common Antiseizure Drugs
|Drug Class or Drug Name||Proposed Mechanism of Action|
|Barbiturates||Facilitate the inhibitory effects of GABA; increase
the duration of the GABA-gated chloride channel openings. At high concentrations,
may also be GABAmimetic|
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