Epilepsy emergency

In addition to the restrictions on emergency supplies at the request of a patient of any controlled drugs in Schedules 1, 2 and 3 of the Misuse of Drugs Regulations (except phenobarbital or phenobarbital sodium for the treatment of epilepsy), emergency supplies at the request of a... 

A number of studies have shown that adenosine inhibits neuronal firing both in vitro and in vivo and is itself released during intense neuronal activity. It can protect against PTZ seizures in rodents while the antagonist theophylline is proconvulsant. No clear picture of its role in human epilepsy has emerged. 

McNamara JO (1999) Emerging insights into the genesis of epilepsy. Nature 399 Suppl A15-22. 

CH, a 42-year-old man, comes into the emergency department after his sister discovered him seizing at home. He has a history of hypertension, diabetes, epilepsy, and rheumatoid arthritis. His medications include hydrochlorothiazide, gly-buride, phenytoin, and aspirin. He smokes one pack per day, drinks heavily on the weekends, and has a history of cocaine use. Upon further discussion with his sister, you discover that he stopped taking his phenytoin 4 days ago due to failure to obtain a refill from his doctor. He is currently unarousable since his last seizure 10 minutes ago. 

Disulfiram works by irreversibly blocking the enzyme aldehyde dehydrogenase, a step in the metabolism of alcohol, resulting in increased blood levels of the toxic metabolite acetaldehyde. As levels of acetaldehyde increase, the patient experiences decreased blood pressure, increased heart rate, chest pain, palpitations, dizziness, flushing, sweating, weakness, nausea and vomiting, headache, shortness of breath, blurred vision, and syncope. These effects are commonly referred to as the disulfiram-ethanol reaction. Their severity increases with the amount of alcohol that is consumed, and they may warrant emergency treatment. Disulfiram is contraindicated in patients who have cardiovascular or cerebrovascular disease, because the hypotensive effects of the disulfiram-alcohol reaction could be fatal in such patients or in combination with antihypertensive medications. Disulfiram is relatively contraindicated in patients with diabetes, hypothyroidism, epilepsy, liver disease, and kidney disease as well as impulsively suicidal patients. 

Interestingly, many forms of partial epilepsy are characterized by a seizure-free interval lasting months to years between the occurrence of the causative insult and the emergence of epilepsy termed the latent period , this provides a valuable window of opportunity during which pharmacologic intervention might be implemented in high-risk individuals so that development of epilepsy could be prevented. 

Fig. 1. Example of a receptor structure. Some anti-epileptic drugs interact with a receptor site on a Na" " channel and enhance the activity of the inactivation gate (I) decreasing the ahihty of neurons to fire at high frequencies. (A) indicates the activation gate of this ion channel. (Reprinted by permission from McNamara JO. Emerging insights into the genesis of epilepsy. Nature 1999 399(Suppl) A15-22, 1999 Macmillan Magazines Ltd.)...

One of the authors recently encountered a 21-year-old male presenting to the emergency room in status epilepticus (prolonged, uncontrolled seizures). This patient had a seven-year history of epilepsy, well controlled with the drug phenytoin at a dose of 300 mg/day. Indeed, he had not experienced a seizure in more than a year. In the emergency... 

In the treatment of tetanus and emergency of epilepsy (status epilepticus). As a diagnostic tool for myasthenia gravis. 

As noted, the barbiturates once were used extensively as sedative-hypnotic drugs, but except for certain specialized uses they now have been replaced by the safer benzodiazepines. Short-acting barbiturates still are used to produce anesthesia. Other current uses include emergency treatment of convulsions and prevention of seizures in persons with certain types of epilepsy (Perrine, 1996). 

Emergency supplies (see Chapter 7) of Schedule 2 and Schedule 3 controlled drugs are not allowed except phenobarbital for the treatment of epilepsy. 

It is Saturday morning at around 11.00 am. A patient with whom you are familiar comes into the pharmacy and asks for your assistance. She has epilepsy and has run out of her medication. Her doctor s surgery is closed at the weekend and she cannot obtain a prescription form until Monday morning. Should you make the emergency supply ... 

The emergency supply of Schedule 1, 2 and 3 controlled dugs is prohibited, except phenobarbital and phenobarbital sodium for the treatment of epilepsy. 

A confusing picture emerges when cannabinoids are evaluated in animal models of epilepsy (Karler and Turkanis 1981 Consroe and Snider 1986). CBD has anticonvulsant properties with a spectrum distinct from standard anticonvulsants, apparently not hampered by the development of tolerance but with a varying profile according to the species tested. THC can produce seizures in some circumstances but is anticonvulsant in others. In a recent study, THC (10 mg/kg) completely abolished spontaneous seizures in the rat pilocarpine model of epilepsy (Wallace et al. 2003). The results also indicated that endogenous cannabinoid tone may modulate seizure termination and duration via the CBi receptor. 

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