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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

Medical Therapeutics: Epilepsy

Mark Granner, MD

Department of Neurology

University of Iowa


Principles of treatment
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.


Properties of an ideal aed
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



Aed mechanisms of action

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




Drug interactions of standard aeds
Drug Interactions of Standard AEDs

+

+

+

-

+ Hepatic enzyme inducer

- Hepatic enzyme inhibitor





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