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Medical Therapeutics: Epilepsy

This document outlines essential principles for treating epilepsy, emphasizing the importance of selecting the most appropriate medication for specific seizure types and the clinical strategy of using one medication at a time. It highlights the significance of plasma concentration monitoring while cautioning against making dose changes solely based on these levels. Special considerations for vulnerable populations, such as pregnant women and the elderly, are discussed. The properties of an ideal antiepileptic drug (AED) and the mechanisms of action are also detailed, along with the historical evolution of AEDs.

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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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