Seizure disorder

The anticonvulsant progabide 24) is useful in a wide variety of seizure disorders. It was synthesiied as a y-aniinobutync acid (GABA) prodrug but its activity appears to reside in the parent drug and its acid metabolite, as well as the GABA liberated [21],... 

This drug is contraindicated in patients with known hypersensitivity to die drug and during die first trimester of pregnancy (Category B). This drug is used cautiously in patients widi blood dyscrasias, seizure disorders, and hepatic dysfunction. Safety in children (odier dian orally for amebiasis) lias not been established. 

Amantadine is used cautiously in patients with seizure disorders, psychiatric problems, renal impairment, and cardiac disease. Amantadine is a Pregnancy Category B drug and is used cautiously during pregnancy and lactation. Concurrent use of antihistamines, phenothiazines, tricyclic antidepressants, disopyramide, and quinidine may increase the anticholinergic effects (dry mouth, blurred vision, constipation) of amantadine... 

The terms convulsion and seizure are often used interchangeably and basically have the same meaning. A seizure may be defined as a periodic attack of disturbed cerebral function. A seizure may also be described as an abnormal disturbance in the electrical activity in one or more areas of the brain. Seizures may be classified as partial (focal) or generalized. Each different type of seizure disorder is characterized by a specific pattern of events, as well as a different pattern of motor or sensory manifestation. 

Seizure disorders are generally categorized as idiopathic or acquired. Idiopathic seizures have no known cause acquired seizure disorders have a known cause, including high fever, electrolyte imbalances, uremia, hypoglycemia, hypoxia, brain tumors, and some drug withdrawal reactions. Once the cause is removed (if it can be removed), the seizures theoretically cease. 

Epilepsy may be defined as a permanent, recurrent seizure disorder. Examples of the known causes of epilepsy include brain injury at birth, head injuries, and inborn errors of metabolism, hi some patients, the cause of epilepsy is never determined. 

Generally, anticonvulsants reduce the excitability of the neurons (nerve cells) of the brain. When neuron excitability is decreased, seizures are theoretically reduced in intensity and frequency of occurrence or, in some instances, are virtually eliminated. For some patients, only partial control of the seizure disorder may be obtained with anticonvulsant drug therapy. 

Seizures that occur in the outpatient setting are almost always seen first by family members or friends, rather than by a member of the medical profession. The occurrence of abnormal behavior patterns or convulsive movements usually prompts the patient to visit the primary health care provider s office or a neurologic clinic. A thorough patient history is necessary to identify the type of seizure disorder. Information the nurse should obtain from those who have observed the seizure is listed in Display 28-1. 

D Risk for Injury related to seizure disorder, adverse drug reactions (drowsiness, ataxia)... 

Additional patient information should include a family history of seizures (if any) and recent drug therapy (all drag s currently being used). Depending on die type of seizure disorder, other information may be needed, such as a history of ahead injury or a thorough medical history. 

The nurse obtains the vital signs at die time of the initial assessment to provide baseline data. The primary healtii care provider may order many laboratory and diagnostic tests, such as an electroencephalogram, computed tomographic scan, complete blood count, and hepatic and renal function tests to confirm the diagnosis and identify a possible cause of the seizure disorder, as well as to provide a baseline during therapy with anticonvulsants. 

OXAZOLIDINEDIONES. The oxazolidinediones are used only when other, less-toxic dm have not been effective in controlling the seizure disorder because they have been associated with fetal abnormalities and serious adverse reactions. 

Carry identification, such as a Medic-Alert tag, indicating drug use and die type of seizure disorder. 

These drug are used cautiously in patients with renal or hepatic disease, bladder obstruction, seizure disorders, sick sinus syndrome, gastrointestinal bleeding, and asthma Individuals with a history of ulcer disease may have a recurrence of the bleeding. 

The xanHiine derivatives are contraindicated in Hiose wiHi known hypersensitivity, peptic ulcers, seizure disorders (unless well controlled with appropriate anticonvulsant medication), serious uncontrolled arrhytinnias, and hyperthyroidism. 

Side effects. The primary side effects reported with bupropion administration in cigarette smokers are headache, dry mouth, nausea and vomiting, insomnia, and activation. Although most of these adverse effects occur during the first week of treatment, insomnia can persist. Seizures are of exceedingly low occurrence (<0.5%) at doses of 300 mg daily or less, but a prior history of seizures or a seizure disorder contraindicate its use. 

The central nervous system is a major target of endosulfan-induced toxicity in both humans and animals (Blanco-Coronado et al. 1992 Boyd and Dobos 1969 Boyd et al. 1970 Garg et al. 1980 Kiran and Varma 1988 Terziev et al. 1974). Therefore, individuals with seizure disorders, such as epilepsy, may be particularly susceptible because exposure to endosulfan may reduce the threshold for tremors, seizures, and other forms of neurotoxicity, as demonstrated in studies in rats (Gilbert and Mack 1995 Gilbert 1992). 

FIGURE 27-2. Treatment algorithm for management of seizure disorders. 

He has no history of medical illness, head trauma, or seizure disorder. 

CVA, seizure disorders, dementia, stroke, migraine, encephalitis, vestibular dysfunction Cardiovascular Disorders... 

Stimulants should be initiated at recommended starting doses and titrated up with a consistent dosing schedule to the appropriate response while minimizing side effects (Table 39-2). Generally, stimulants should not be used in patients who have glaucoma, severe hypertension or cardiovascular disease, hyperthyroidism, severe anxiety, or previous illicit or stimulant drug abuse. Further, stimulants can be used, albeit cautiously, in patients with seizure disorders, Tourette s syndrome, and motor tics.14... 

People with any condition that can compromise respiratory function or the handling of respiratory secretions (i.e., a condition that makes it hard to breathe or swallow, such as brain injury or disease, spinal cord injuries, seizure disorders, or other nerve or muscle disorders)... 

The answer is c. (Hardman7 p 408.) Clozapine differs from other neuroleptic agents in that it can induce seizures in nonepileptic patients In patients with a history of epileptic seizures for which they are not receiving treatment, stimulation of seizures can occur following the administration of neuroleptic agents because they lower seizure threshold and cause brain discharge patterns reminiscent of epileptic seizure disorders. 

Both nicotinic and muscarinic receptors are widespread in the CNS. Muscarinic receptors with a high affinity for pirenzepine (PZ), M, receptors, predominate in the hippocampus and cerebral cortex, whereas M2 receptors predominate in the cerebellum and brainstem, and M4 receptors are most abundant in the striatum. Central muscarinic and nicotinic receptors are targets of intense pharmacological interest for their potential roles in regulating abnormal neurological signaling in Alzheimer s disease, Parkinson s disease and certain seizure disorders. Nicotinic receptors are largely localized at prejunctional sites and control the release of neurotransmitters [10,11],... 

Nonketotic hyperglycinemia causes a severe seizure disorder and profound brain damage 673... 

Nonketotic hyperglycinemia causes a severe seizure disorder and profound brain damage. Infants affected by deficiency of the glycine cleavage system become ill with seizures by the first or second day of life. 

---