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Medical Therapeutics: Epilepsy

Medical Therapeutics: Epilepsy. Mark Granner, MD Department of Neurology University of Iowa. Principles of Treatment. Pick the medication most appropriate for the seizure type(s) Use one medication at a time. If the first fails, convert over to a second agent and withdraw the first.

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Medical Therapeutics: Epilepsy

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  1. Medical Therapeutics: Epilepsy Mark Granner, MD Department of Neurology University of Iowa

  2. Principles of Treatment • Pick the medication most appropriate for the seizure type(s) • Use one medication at a time. If the first fails, convert over to a second agent and withdraw the first. • Use medication plasma concentrations (“blood levels”) as a guideline, but don’t base dose changes solely on the level. • Beware of certain populations of patients (pregnant women, elderly) where pharmacokinetics are altered. • Consider medication withdrawal if seizure-free for at least 2 years.

  3. Properties of an Ideal AED • Oral and IV formulations • Readily absorbed • Effective • No side effects • Long half-life • No drug-drug interactions • No protein binding • No hepatic enzyme effects • Inexpensive

  4. AED History

  5. Reduce excitation Inhibit voltage-gated sodium channels Inhibit glutamate channels Inhibit calcium channels Promote inhibition Enhance GABA activity Increase GABA levels Activate GABA receptors AED Mechanisms of Action

  6. AED Mechanisms of Action

  7. Standard AED Properties

  8. Drug Interactions of Standard AEDs + + + - + Hepatic enzyme inducer - Hepatic enzyme inhibitor

  9. Selected Properties of Newer AEDs

  10. Selected Properties of Newer AEDs

  11. AED Choice

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