We’re Here for You - Jon Manocchio's Professional...
Transcript of We’re Here for You - Jon Manocchio's Professional...
Absence Epilepsy: Presentation, Diagnosis,
and Treatment
Prepared and Presented by
Jon Manocchio, Pharm D
Blanchard Valley Hospital
September 2011
Introduction
•Many different forms of Epilepsy
•Can affect a variety of patients
•Presentation will differ based on the
type of epilepsy
•Diagnosis is usually based on
sympomatology
•Treatment is very patient specific
Definitions
•Seizure
–Abnormal, excessive, hypersynchronous discharge from an aggregate of CNS neurons
–Various manifestations will produce different seizure types
•Epilepsy
–A person who has recurrent seizures due to a chronic underlying process
–Two or more unprovoked seizures
Classification •Partial Seizures
–Simple Partial
–Complex Partial
–Partial Seizures with Secondary Generalization
•Generalized Seizures
–Tonic-Clonic
–Myoclonic
–Atonic
–Absence*
•Epileptic Complications
Various Causes of Epilepsy
• Alcohol
• Hypoglycemia
• Hyperglycemia
• Renal Failure
• Hepatic Failure
• Fever
• CNS Lesion
• Idiopathic
• Trauma
• Certain Medications
• Congenital
Abnormality
• Illicit Drug Use
• Infection
Simple Partial Seizures
•Presentation
–Motor, sensory, autonomic, or psychic
symptoms
–No altered level of consciousness
–“Jacksonian March” phenomenon
–Possible localized paralysis
–Epilepsia partialis continua
–20-60 seconds in duration
Simple Partial Seizures
•Diagnosis
–Based on presentation of symptoms
–EEG recordings may be altered depending on
area of the brain affected
•Treatment
–Many
Complex Partial Seizures
•Presentation
–Frequently begin with an aura
–Motionless stare
–Involuntary autonomic movements
–Post-ictal confusion
–Anterograde amnesia
–30 seconds to 2 minutes in duration
Complex Partial Seizures
•Diagnosis
–Based on presentation of symptoms
–EEG may show brief spikes in between
seizures
•Treatment
–Many
Partial Seizures with Secondary
Generalization
•Presentation
–Presents like a partial seizure
–Spreads to produce a generalized seizure
–Difficult to distinguish
–1-2 minutes in duration
Partial Seizures with Secondary
Generalization
•Diagnosis
–Based on presentation of symptoms
–Careful patient history
•Treatment
–Many
Tonic-Clonic Seizures
•Presentation
–Begins abruptly without warning
–Initially the tonic phase
•10-20 seconds in duration
–Evolves into the clonic phase
•Can last up to a minute in duration
–The post-ictal phase
•Slow to regain baseline functioning
Tonic-Clonic Seizures
•Diagnosis
–Based on presentation of symptoms
–EEG will show different patterns based on the
phase that the patient is experiencing
•Treatment
–Many
Myoclonic Seizures
•Presentation
–Sudden and brief muscle contraction
–Usually coexist with generalized seizures
–1-5 seconds in duration
•Diagnosis
–Based on presentation of symptoms
–EEG may show spike and wave discharges
•Treatment
–Valproic Acid, Levetiracetam
Atonic Seizures
•Presentation
–Sudden loss of postural muscle tone
•Sharp head nod
•Drop attack
–Brief loss of consciousness
–No post-ictal confusion
Atonic Seizures
•Diagnosis
–Based on presentation of symptoms
–EEG will show a generalized spike and wave
discharge followed by slow waves
•Treatment
–Treat underlying syndrome
Absence Seizures
•Presentation
–Main seizure type in children
–Sudden, brief lapses of consciousness
–Maintains postural control
–Associated with subtle motor signs
–No post-ictal confusion
–Manual seizure induction
–Less than 30 seconds in duration
Absence Seizures
•Diagnosis
–Based on presentation of symptoms
–EEG has a characteristic 3 Hz spike
•Treatment
–Ethosuximide, Valproic Acid, Lamotrigine
–Journal club article
Selected Epileptic Complications
•Status Epilepticus
•Juvenile Myoclonic Epilepsy
•Lennox-Gastaut Syndrome
•Reflex Epilepsy
•Temporal Lobe Epilepsy
Conclusion
•Main forms of epileptic seizures
•Pharmacotherapeutic management
•Patient specific treatments
•Quality of life
•Compliance
Anti-Epileptic Drugs (AEDS): Therapies for the Treatment of
Absence Epilepsy
Prepared and Presented by
Jon Manocchio, Pharm D
Blanchard Valley Hospital
September 2011
Introduction
•Compliance
•Mechanisms of AED’s
–Inhibit voltage-gated Na+ channels
–Potentiate GABA-mediated inhibition
•Enhanced flux of Cl-
–Inhibit voltage-gated Ca++ channels
•Localize genetic causes
AED’s in General •Topiramate
•Felbamate
•Zonisamide
•Lacosamide
•Rufinamide
•Vigabatrin
•Ethosuximide
•Primidone
•Phenytoin
•Phenobarbital
•Carbamazepine
•Oxcarbazepine
•Valproic Acid
•Gabapentin
•Lamotrigine
•Levetiracetam
•Tiagabine
Ethosuximide (Zarontin®)
•Indication
–Treatment of absence seizures
•Normal Dose
–750mg - 1250mg per day
–Given daily or BID
•Pharmacokinetics
Ethosuximide (Zarontin®)
•Adverse Effects
–Ataxia
–Lethargy
–Headache
–GI Irritation
–Skin rash
–Bone marrow suppression
Lamotrigine (Lamictal®)
•Indication
–Lennox-Gastatut (adj), primary generalized tonic-
clonic seizures (adj), partial seizures (adj), bipolar
disorder
•Normal Dose
–150mg-500mg per day
–Given BID
–Complex dosing regimens based on biweekly tapers
•Pharmacokinetics
Lamotrigine (Lamictal®)
•Adverse Effects
–Dizziness
–Diplopia
–Sedation
–Ataxia
–Headache
–Skin rash
–BBW
•Steven-Johnson Syndrome
Valproic Acid (Depakene®)
•Indication
–Seizures, Mania, and Migraine prophylaxis
(status epilepticus and diabetic neuropathy
are unlabeled uses)
•Normal Dose
–750mg - 2000mg per day
–Dosed BID to QID
•Pharmacokinetics
Valproic Acid (Depakene®)
•Adverse Reactions
–Ataxia
–Sedation
–Tremor
–Weight gain
–Alopecia
–BBW
•Hepatic Failure, Pancreatitis, Teratogenicity
Discontinuation of Therapy
•Potential to remain seizure free
•After two years of therapy
•Slow taper
•Risk of recurrence
–Avoid risky behavior
Conclusion
•General seizure control
•Multiple medications
•Risks vs. Benefits
•Non-pharmacological assistance
•Compliance