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epilepsy any disorder characterized by recurrent seizures; symptoms depend on the type of seizure and may include blackout, fainting spells, sensory disturbances, jerking body movements and temporary loss of memory seizure symptoms of epilepsy characterized by abnormal neuronal discharges within the brain electroencephalogram (EEG) a tool in measuring uncontrolled neuronal activity; useful in diagnosing seizure disorders convulsions involuntary, violent spasms of the large skeletal muscles of the face, neck, arms and legs.All convulsions are seizures, but not all seizures are convulsions Known causes of seizures infectious diseases, trauma, metabolic disorders, vascular diseases, pediatric disorders (febrile seizure) and neoplastic disease eclampsia a severe hypertensive disorder of pregnancy, characterized by seizures, coma and perinatal mortality. simple partial seizure olfactory, auditory and visual hallucinations intense emotions twitching of arms, face and legs complex partial (psychomotor) seizure aura (preceding) brief period of confusion or sleepiness afterward with no memory of seizure fumbling with or attempting to remove clothing no response to verbal commands absence (petit mal) seizure lasting a few seconds seen most often in children (fluttering eyelids, no response to verbal stimulation, jerking) misdiagnosed as ADD or daydreaming atonic (drop attacks) falling or stumbling for no reason lasting a few seconds tonic-clonic (grand mal) aura intense muscle contraction (tonic) followed by alternating contraction and relaxation of muscles (clonic) loss of bowel/bladder control; shallow breathing with periods of apnea disorientation and deep sleep after seizure (postictal state) febrile seizure tonic- clonic activity lasting 1-2 minutes rapid return to consciousness occurs in children usually between 3 months and 5 years of age myoclonic seizure large jerking movements of a major muscle group, such as an arm falling from a sitting position or dropping what is held status epilepticus considered a medical emergency continuous seizure activity, which can lead to coma and death 3 general mechanisms by which antiseizure drugs act 1. stimulating an influx of chloride ions, an effect associated with the neurotransmitter gamma-aminobutyric acid (GABA) 2. delaying an influx of sodium 3. delaying an influx of calcium ketogenic diet used when seizures cannot be controlled through pharmacotherapy or when there are unacceptable adverse effects to the medications; not a do it yourself diet and may be harmful if not carefully monitored by skilled professionals gamma-aminobutyric acid (GABA) the primary inhibitory neurotransmitter in the brain; stimulate an influx of chloride ions that interact with the GABA receptor-chloride channel molecule when allows chloride ions to move into the cell, suppressing the firing of neurons barbiturates intensify the effect of GABA in the brain and depresses the firing of CNS neurons i.e. phenobarbital (Luminal). Useful against all seizures except absence seizures. Avoid alcohol, nicotine, and driving. Rebound seizures if discontinued abruptly, drug often used illegally. phenobarbital (Luminal) therapeutic class: antiseizure drug; sedative pharmacologic class: barbiturate, receptor agonist indications: sedation, insomnia, tonic-clonic and cortical focal seizures, emergency control of certain acute convulsive episodes, preanesthetic action: increases GABA- decreases electrical impulses pharmacokinetics: oral, IM, Sub Q, IV (metabolized in the liver) schedule IV drug- may cause dependence adverse effects: drowsiness, vitamin deficiencies, larynogospasms, overdose, severe respiratory depression, CNS depression, coma, death benzodiazepines intensify the effect of GABA in the brain; bind directly to the GABA receptor, suppressing abnormal neuronal foci i.e. diazepam (Valium). Liver and kidney functions should be monitored. Respiratory depression may result with other CNS depressants. One of the most widely prescribed classes of drugs, used to not only control seizures, but also to control anxiety, skeletal muscle spasms, and alcohol withdrawal symptoms. diazepam (Valium) benzodiazepine Mechanisms of action: similar to that of barbiturates but safer primary use: for short term seizure control due to tolerance and dependency adverse effects: drowsiness and dizziness, IV- hypotension, Muscular weakness, tachycardia, respiratory depression antidote: flumazeril (Romazicon) Hydantoin dampen CNS activity by delaying an influx of sodium ions across neuronal membranes. (desensitizes sodium channel therefor decreasing threshold of neuronal firing) i.e. phenytoin (Dilantin) monitor liver and kidney function and monitor for signs of toxicity, and blood dyscrasias and bleeding disorders phenytoin (Dilantin) MOA: to desensitize sodium channels. prevents spread of disruptive electrical charges -narrow therapeutic range-blood serum levels drawn periodically Primary use: treating all types of epilepsy except absence seizures adverse effects: CNS depression, gingival hyperplasia, skin rash, cardiac dysrhythmias, and hypotension most common valproic acid (Depakene) phenytoin-like drug MOA: desensitize sodium channels primary use: or absence seizures adverse effects: limited CNS depression, visual disturbances, ataxia, vertigo, headache, GI effects, hepatotoxicity, pancreatitis