Generalized seizures absence

Lamotrigine Levetiracetam Oxcarbazepine Tiagabine Topiramate Generalized seizures absence (newly diagnosed) ... 

Primary generalized seizures are also heterogeneous with respect to their clinical features. Such seizures can impose as absence epilepsy, which is characterized by a brief interruption of consciousness due to highly synchronized neuronal activity involving thalamocortical networks without increases in neuronal firing rate. On the other hand, tonic-clonic convulsions with loss of consciousness are often also primarily generalized. 

Generalized seizures include absence, myoclonic, and tonic-clonic. Manifestations of a generalized tonic-clonic seizure include alternate contraction (tonic phase) and relaxation (clonic phase) of muscles, a loss of consciousness, and abnormal behavior. Myoclonic seizures involve sudden, forceful contractions involving the musculature of the trunk, neck, and extremities. Absence seizures, previously referred to as petit mal seizures, are seizures characterized by a brief loss of consciousness during which physical activity ceases. The seizures typically last a few seconds, occur many times a day, and may go unnoticed by others. 

It is useful as both adjunctive therapy for partial seizures and as monotherapy. It may also be a useful alternative for primary generalized seizures, such as absence and as adjunctive therapy for primary GTC seizures. 

It is first-line therapy for primary generalized seizures, such as absence, myoclonic, and atonic seizures, and is approved for adjunctive and monotherapy treatment of partial seizures. It can also be useful in mixed seizure disorders. 

Partial seizures Tonic-clonic Complex partial Absence Generalized seizures ... 

Phenobarbital is useful in the treatment of partial seizures and generalized tonic-clonic seizures, although the drug is often tried for virtually every seizure type, especially when attacks are difficult to control. There is little evidence for its effectiveness in generalized seizures such as absence, atonic attacks, and infantile spasms it may worsen certain patients with these seizure types. 

Several members of the benzodiazepine group are effective in treating epilepsy, but most are limited because of problems with sedation and tolerance. Some agents such as diazepam (Valium) and lorazepam (Ativan) are used in the acute treatment of status epilepti-cus (see Treatment of Status Epilepticus ), but only a few are used in the long-term treatment of epilepsy. Clonazepam (Klonopin) is recommended in specific forms of absence seizures (e.g., the Lennox-Gastaut variant) and may also be useful in minor generalized seizures such as akinetic spells and myoclonic jerks. Clorazepate (Tranxene) is another benzodiazepine that is occasionally used as an adjunct in certain partial seizures. 

Generalized seizures are bursts of abnormal electrical activity in the whole brain and result in loss of consciousness (petit mal epilepsy or absence seizure) or may result in repeated muscle contractions throughout the whole body (grand mal or tonic clonic epilepsy). 

Absence seizures generally occur in young children or adolescents and exhibit a sudden onset, interruption of ongoing activities, a blank stare, and possibly a brief upward rotation of the eyes. Absence seizures have a characteristic two to four cycle/second spike and slow-wave EEG pattern. In generalized seizures, motor symptoms are bilateral, and there is altered consciousness. 

Vigabatrin can exacerbate myoclonic and absence seizures and occasionally other seizure types, especially in children with generalized epilepsies. After the administration of vigabatrin, seizures worsened in all of four children with Angelman syndrome (10), and generalized seizures occurred for the first time in a boy with succinic semialdehyde dehydrogenase deficiency (SEDA-21, 77). De novo myoclonic jerks and precipitation of status epi-lepticus have also been reported (SEDA-20, 70). 

Valproic acid is used therapeutically as an anticonvulsant. It is a synthesized, simple, branched-chain carboxylic acid that is chemically unrelated to other anticonvulsants. Valproic acid and valproate are used in a variety of absence and generalized seizure disorders. 

CPS, complex partial seizures PGS, primary generalized seizures Abs, absence JME, juvenile myoclonicepilepsy LGS, Lennox-Gastaut syndrome IS, infantile spasms ENL, effective, not labeled (although no indication exists, studies support its use in pediatric patients) NE, not effective , not studied (no well-performed pediatric studies exist for this indication). Data are from Ref 17. 

I Place in Therapy. Valproic acid is first-line therapy for primary generalized seizures such as myoclonic, atonic, and absence seizures. It can be used as both monotherapy and adjunctive therapy for partial seizures, and it can be very useful in patients with mixed seizure disorders. 

Felbamate is an anticonvnlsant that reduces seizure spread in generalized tonic-clonic or partial seiznres and may increase seizure threshold in absence seizures. Felbamate is indicated as a monotherapy or adjunctive therapy in treatment of partial seiznres with and without generalization in epileptic adults, and as adjnnctive therapy in treatment of partial and generalized seizures associated with Lennox-Gastaut syndrome in children. 

List the major drugs used for partial seizures, generalized tonic-clonic seizures, absence and myoclonic seizures, and status epilepticus. 

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