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CNS – Antiepileptic Drugs. Compare and contrast the terms seizure, convulsion and epilepsy. Discuss the indications for antiepileptic therapy (AED). Compare and contrast the first line drugs of choice for AED.

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Cns antiepileptic drugs
CNS – Antiepileptic Drugs

  • Compare and contrast the terms seizure, convulsion and epilepsy.

  • Discuss the indications for antiepileptic therapy (AED).

  • Compare and contrast the first line drugs of choice for AED.

  • Discuss the nursing process related to the care of the patient receiving AEDs in acute and chronic situations.


Cns antiepileptic drugs international classification of seizures
CNS – Antiepileptic DrugsInternational Classification of Seizures

  • Partial Seizures – short alterations of consciousness; repetitive unusual movements (chewing or swallowing); psychologic changes; confusion

  • Simple Seizures – No impaired consciousness; motor symptoms of face, arm or legs; hallucinations of sight, hearing, or taste; tingling sensation; ANS changes; personality changes

  • Complex Seizures – Impaired consciousness; memory impairment; behavioral effects; purposeless behaviors; aura, unreal feelings, bizarre behavior

  • Generalized Seizures – Temporary lapses in consciousness; staring off into space; rhythmic movements of eyes, head, or hands; may have tonic, clonic, myoclonic, atonic, or tonic-clonic seizures; brief loss of consciousness without confusion; head drop or falling down symptoms


Cns antiepileptic drugs syndrome of cns dysfunction
CNS – Antiepileptic DrugsSyndrome of CNS Dysfunction

  • Convulsion – Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal and facial muscles. Postictal state

  • Seizures – Brief episode of abnormal electrical activity in the nerve cells of the brain -- detected on EEG

  • Epilepsy – Chronic, recurrent pattern of seizures


Cns antiepileptic drugs anticonvulsant drugs
CNS Antiepileptic Drugs /Anticonvulsant Drugs

Terms overlap and are used interchangeably to achieve the goal of maintaining a reasonable quality of life.

  • Antiepileptic Drugs: management of all types of epilepsy, not just convulsions (AED Therapy)

  • Anticonvulsant Drugs: used to prevent the seizures typically associated with epilepsy.


Cns antiepileptic drugs mechanism of action
CNS – Antiepileptic DrugsMechanism of Action

  • ION Theory – movement of K+, Na+, Ca+, Mg+:

    Stabilizes neurons:

    • from becoming hyperexcited

    • prevents excessive impulses to adjacent neurons

      1. Increase threshold of activity in the motor cortex

      Makes it more difficult to excite; reduces response

      2. Depress the seizure discharge from its origin

      Suppress transmission of impulsesfrom one nerve to the next

      3. Decrease the speed of nerve impulse conduction within a given neuron


Cns antiepileptic drugs indications
CNS – Antiepileptic DrugsIndications

  • Prevention or control of seizure activity

  • Long-term maintenance treatment of epilepsy

  • Acute treatment of convulsions and status epilepticus

    • Status epilepticus: common seizure disorder –

      • life-threatening emergency characterized by tonic-clonic convulsions that occur in succession.

      • Loss of consciousness, hypotension, hypoxia, cardiac dysrhythmias – brain damage and death may quickly result

      • Once controlled, long term therapy is begun to prevent future seizures

  • Brain Surgery - Head injuries = prophylactic AED Therapy


Cns antiepileptic drugs contraindications
CNS – Antiepileptic DrugsContraindications

  • Known drug allergy

  • Pregnancy – consider risks to mother & infant if untreated


Cns antiepileptic drugs drugs of first choice
CNS – Antiepileptic DrugsDrugs of First Choice



Cns antiepileptic drugs benzodiazepines
CNS – Antiepileptic DrugsBenzodiazepines

  • Actions

    • Not fully understood

    • May enhance the inhibitory effects of GABA in postsynaptic clefts between nerve cells

  • Uses

    • Diazepam (Valium), clonazepam (Klonopin),

      clorazepate (Tranxene), lorazepam (Ativan)

    • Diazepam - drug of choice for status epilepticus

      • must be given intravenously -- slowly

      • never mixed with any other medication

  • Therapeutic outcomes

    • Reduced frequency of seizures, reduced injuries

    • Minimal adverse effects from therapy


Cns antiepileptic drugs hydantoins
CNS – Antiepileptic DrugsHydantoins

  • Actions – mechanism unknown

    • phenytoin (Dilantin) – most commonly used

    • ethotoin (Peganone)

    • fosphenytoin (Cerebyx)

  • Uses

    • Anticonvulsants used to control tonic-clonic seizures

    • CAUTION:

      • Phenytoin must be administered slowly

      • Do not mix with other medications in the same syringe

      • Dilute only with 0.9% NaCl to avoid precipitation

      • Infuse slowly <150mg/min

    • CAUTION: toxicity may cause nystagmus

    • CAUTION: infiltration causes sloughing of tissue

  • Therapeutic outcomes

    • Reduced frequency of seizures, reduced injuries

    • Minimal adverse effects from therapy


Cns antiepileptic drugs carbamazepine
CNS – Antiepileptic DrugsCarbamazepine

  • Actions -- carbamazepine (Tegretol)

    • Blocks up the reuptake of norepinephrine

    • Decreases release of norepinephrine and rate of dopamine and GABA turnover

    • Mechanisms of action as anticonvulsant are unknown

  • Uses

    • Used in combination with other anticonvulsants to control tonic-clonic seizures

    • Not effective for myoclonic or absence seizures

    • Should not be given with grapefruit – increased levels of the AED

  • Therapeutic outcomes

    • Reduced frequency of seizures, reduced injuries

    • Minimal adverse effects from therapy


Cns antiepileptic drugs succinimides
CNS – Antiepileptic Drugs Succinimides

  • Actionsethosuximide (Zarontin),

    methsuximide (Celontin)

    • Mechanism of action unknown

  • Uses

    • To control absence (petit mal) seizures

  • Therapeutic outcomes

    • Reduced frequency of seizures, reduced injuries

    • Minimal adverse effects from therapy


Cns antiepileptic drugs topiramate
CNS – Antiepileptic DrugsTopiramate

  • Actions topiramate (Topomax)

    • Mechanisms of action are unknown

    • May prolong blockade of sodium channels, enhance activity of GABA, and antagonize certain neurotransmitter receptors

  • Uses

    • Used in combination with other anticonvulsants to control tonic-clonic seizures

    • Prevention of migraine headaches

  • Therapeutic outcomes

    • Reduced frequency of seizures and injuries

    • Minimal adverse effects from therapy


Cns antiepileptic drugs primidone
CNS – Antiepileptic DrugsPrimidone

  • Actionsprimidone (Mysoline)

    • Metabolized into phenobarbital and PEMA - both active anticonvulsants

    • Exact anticonvulsant mechanism of action is unknown

  • Uses

    • Used in combination with other anticonvulsants to treat tonic-clonic seizures

  • Therapeutic outcomes

    • Reduced frequency of seizures and injuries

    • Minimal adverse effects from therapy


Cns antiepileptic drugs gabapentin
CNS – Antiepileptic DrugsGabapentin

  • Actionsgabapentin (Neurontin)

    • Mechanisms of action are unknown

    • Does not appear to enhance GABA

  • Uses

    • Used in combination with other anticonvulsants to control partial seizures

  • Therapeutic outcomes

    • Reduced frequency of seizures

    • Minimal adverse effects from therapy

    • Also used for pain reduction – shingles, peripheral neuropathy – nerve pain


Cns antiepileptic drugs nursing implications
CNS – Antiepileptic DrugsNursing Implications

  • Nurses may play an important role in diagnosis and treatment

    • Comprehensive history – allergies/medication reconciliation

    • Describe seizures – precipitating events, duration/frequency, intensity of the seizure activity, postictal behavior – observe & record

    • Safety – positioning – assist pt during seizure, proper supplies

    • Medication administration guidelines – specific for IV meds

    • Lab values – check therapeutic blood levels on admission

    • Patient and family support: discuss lifestyle and feelings with patient


Cns antiepileptic drugs patient education
CNS – Antiepileptic DrugsPatient Education

  • Medication:

    • adherence to prescribe regimen

    • Do not Stop Abruptly – Life Time Treatment - Rebound Convulsions

    • Medic Alert Bracelet

    • Protective environment

    • Driving – physician prescription/State laws

    • Sedating effects of the drugs – may decrease with time

      • Avoid alcohol & cigarettes

    • Photosensitivity with certain AEDs – sunscreen & protective clothing

    • Avoid stimulants

    • Oral hygiene – hyperplasia


Cns antiepileptic drugs review
CNS – Antiepileptic DrugsReview

  • When caring for a patient with epilepsy who was hospitalized and successfully treated for status epilepticus, a precaution that the nurse institutes includes:

    • a. placing oxygen and suction equipment at the bedside.

    • b. assigning an assistant to stay with the patient at all times.

    • c. keeping an airway available to insert as needed.

    • d. instructing the patient to stay in bed and call for assistance

      to go to the bathroom.


Cns antiepileptic drugs review1
CNS – Antiepileptic DrugsReview

  • A nurse witnesses a patient with a seizure disorder as he suddenly jerks his arms and legs with tonic-clonic type movement, falls to the floor, temporary loss of consciousness, which he regains immediately. The type of seizure demonstrated by this patient and that the nurse documents is:

    • a. atonic seizure

    • b. myoclonic seizure

    • c. complex partial seizure with automatisms

    • d. generalized seizure


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