Understanding Seizures & Drugs Used to Control Them
Erin Romo-Vera

Understanding Seizures:
Partial seizures begin in a specific part of the brain. These include:
  • Simple Partial—
    • A seizure that does not alter consciousness. May produce abnormal sensations, such as an unpleasant smell, or a motor movement, such as jerking of the arm
  • Complex Partial—
    • Seizure that alters consciousness causing confusion
  • Complex Partial With Secondary Generalization—
    • Seizure that starts as complex partial but becomes a generalized seizure affecting both sides of the brain

Generalized seizures affect both hemispheres of the brain. These include:
  • Absence:
    • Previously known as petit mal, triggers a short lapse in consciousness. Most often seen in children
  • Atonic:
    • Previously known as a drop attack, causes a complete loss of muscle control and results in collapse
  • Myoclonic:
    • Triggers sudden jerking in the muscles, often in the arms and legs
  • Tonic-clonic:
    • Triggers a fall to the ground (tonic phase) followed by jerking movements (clonic phase)
Other types of seizures:
  • Febrile seizures:
    • Caused by high fever in young children; does not always lead to epilepsy
  • Status epilepticus:
    • Severe, life-threatening, nonstop seizures; can be either partial or generalized




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Seizure Log:
https://www.seizuretracker.com/supportdocs/cover.doc

Date:_ Time:_ Length: min. sec.
Type: o Simple Partial o Complex Partial o Secondary Generalized o Atonic
o Tonic o Clonic o Tonic-Clonic o Myoclonic oAtypical Absence
o Absence o Infantile Spasms (cluster) o Unknown
Mood: o Good o Normal o Bad
OTC Medications
Possible Triggers:
o Changes in Medication (including late or missed)
o Overtired or irregular sleep o Alcohol or drug use o Irregular Diet
o Bright or flashing lights o Fever or overheated o Emotional Stress
o Hormonal fluctuations o Sick – Describe
o Other

Trigger notes:_
Description:
o Change in awareness o Loss of urine or bowel control
o Loss of ability to communicate
o Automatic repeated movements
o Muscle stiffness in
o Aura
o Muscle twitch in_
o Other_
Description notes:
Post event:
o Unable to communicate o Remembers event
o Sleepy
o Muscle weakness
o Sleepy
Post event notes:___



Classification: Antiepileptic Agents

phenobarbital (Solfoton)

pheonobarbital (Solfoton) is indicated for use in treating status epilepticus and also for seizure prophylaxis. Side effects for this drug include: drowsiness, dizziness, lethargy, paradoxical restlessness, rash and urticaria. Be sure to take this drug at the same time everyday. Take this drug with meals to lessen GI upset. Be sure not to crush, chew, or open extended release forms as this can alter the effectiveness of this medication. Driving may be impaired until the drug levels are stabilized. Solfoton is used for therapy and should not be seen as a cure for seizures. Those with seizure disorders should wear a medical-alert tag at all times.

Nursing Implications:

Solfoton has a narrow therapeutic window of 15-40 mcg/ml (upper end may show signs of toxicity while the lower end may indicate increased seizure activity). Patient may report flat affect.

phenytonin (Dilantin)

phenytonin (Dilantin) is a first line anti-epileptic drug indicated for treatment of tonic-clonic and partial seizures. Side effects of this drug include: lethargy, abnormal movements, cognitive changes, and urine may appear pink, orange or red in color. With long-term therapy, Dilantin can cause gingival hyperplasia, acne, hirsuitism, dilantin facies and osteoporosis. Take this drug with meals to lessen GI upset. Be sure not to crush, chew, or open extended release forms as this can alter the effectiveness of this medication. Driving may be impaired until the drug levels are stabilized. Dilantin is used for therapy and should not be seen as a cure for seizures. Those with seizure disorders should wear a medical-alert tag at all times.

Nursing Implications:

Dilantin has a narrow therapeutic index of 10-20 mcg/ml, toxic levels can be reached quickly and should be frequently monitored. When administering IV forms of Dilantin, use only with normal saline, IV forms are irritating. Monitor albumin levels as more free drug is present with low albumin levels, increasing risk of toxicity.

carbamazepine (Tegretol)

carbamazepine (Tegretol) is the first line treatment for simple, complex and generalized tonic seizures. Tegretol is also indicated to treat trigeminal neuralgia. Side effects of this drug include increases in metabolism over time (usually 2 months) requiring a higher concentration for drug effectiveness. It is important to take Tegretol at the same time everyday to ensure that therapeutic drug levels are maintained. Take this drug with meals to lessen GI upset. Be sure not to crush, chew, or open extended release forms as this can alter the effectiveness of this medication. Driving may be impaired until the drug levels are stabilized. Tegretol is used for therapy and should not be seen as a cure for seizures. Those with seizure disorders should wear a medical-alert tag at all times.

Nursing Implications:

Tegretol has a narrow therapeutic index of 3-14 mcg/ml, toxic levels can be reached quickly and should be frequently monitored.

valproic acid (Depakene, Depakote)

valporic acid (Depakene, Depakote) is used for treatment of multiple seizures, generalized seizures, and partial seizures. Side effects of this drug include pancreatitis, irregular menses, secondary amenorrhea, weight gain, and galactorrhea (which can occur even while not breastfeeding and infant). Take this drug at the same time every day to ensure therapeutic levels are maintained. Do not abruptly stop taking this medication before consulting your physician. Take this drug with meals to lessen GI upset. Be sure not to crush, chew, or open extended release forms as this can alter the effectiveness of this medication. Driving may be impaired until the drug levels are stabilized. Depakene and Depakote is used for therapy and should not be seen as a cure for seizures. Those with seizure disorders should wear a medical-alert tag at all times.

Nursing Implications:

There are many drug interactions with valproic acid as it is highly protein bound, increasing concentrations of other medications, causing potentially toxic effects. Depakene and Depakote have a narrow therapeutic window of 50-100 mcg/ml, toxic levels can be reached quickly and should be frequently monitored. Hepatotoxicity and pancreatitis can be fatal so be sure to obtain baseline liver function studies and CBC prior to beginning treatment.

gabapentin (Neurontin)

gabapentin (Neurontin) is indicated to treat neuropathic pain and is also an add-on drug for partial seizures. Side effects of Neurontin include: dizziness, somnolence, visual changes, and fatigue. Take this drug at the same time every day to ensure therapeutic levels are maintained. Do not abruptly stop taking this medication before consulting your physician. Take this drug with meals to lessen GI upset. Be sure not to crush, chew, or open extended release forms as this can alter the effectiveness of this medication. Driving may be impaired until the drug levels are stabilized. Neurontin is used for therapy and should not be seen as a cure for seizures. Those with seizure disorders should wear a medical-alert tag at all times.

Nursing Implications:

Neurontin has a narrow therapeutic window and toxic levels can be reached quickly and require frequent monitoring.


References:


Lane, L, Collins, S, Harington, S, Rainforth, S, & S., J. (2010). Pharmacology and the nursing process. Mosby Inc.

Petges, Nancy RN MSN. Pharmacology : Antiepileptic Agents, 2011.