Seizure disorders valproate

Support is scant for the efficacy of anticonvulsant agents in the treatment of OCD (Jenike 1990 Joffe and Swinson 1987). If there is a role for carbamazepine in OCD, it may be in patients with clinical or electroen-cephalographic evidence of a seizure disorder (Jenike and Brotman 1984 Khanna 1988). The anti-OC efficacy of combined SRI-carbamazepine treatment has not been adequately studied. Sodium valproate was found ineffective in two cases of OCD (McElroy and Pope 1988 McElroy et al. 1987). However, one author has suggested that sodium valproate may be a useful pretreatment for patients with OCD who might otherwise tolerate SRIs poorly (Deltito 1994). The anticonvulsant clonazepam is discussed earlier in this chapter. 

Because CBZ and valproate have been used for many years to treat seizure disorders in children and adolescents, more systematic knowledge about their clinical pharmacology in this age group is available than there is about lithium. However, pediatric patients with epilepsy are often on concomitant therapy with other anticonvulsants. That fact complicates attempts to extrapolate from this experience to the use of CBZ or valproate as monotherapy for childhood or adolescent bipolar disorder. For example, the risk of serious and potentially fatal hepatotoxicity with valproate occurs almost exclusively in children younger than age 10 years (usually 2 years or younger) who are on multiple anticonvulsants for congenital seizure disorders. How or whether this risk translates to children or adolescents who are on monotherapy with valproate for bipolar disorder is unknown. Nonetheless, clinicians need to be aware of this possible risk and take the following steps to increase the likelihood of early detection in case this problem arises ... 

Convulsions. Sodium valproate orally is preferred as it is effective for a wide range of seizure disorders (for status epilepticus see p. 417). 

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. 

Hepatic disease hypersensitivity to valproate pregnancy (FDA category D) children < 2 years (especially those on multiple antiwnvulsant therapy, those with congenital metabolic disorders, those with severe seizure disorders, and those with organic brain disease) pancreatitis. 

Lennox-Gastaut syndrome is a mixed seizure disorder combining the atypical absence seizures with tonic, tonic-clonic, or myoclonic motor patterns. The syndrome begins in childhood and usually Includes mental retardation. Although adequate control of the seizures rarely Is achieved, valproate, phenytoin, felbamate, lamotrigine, topiramate, and clonazepam have been... 

Which data should the nurse assess for the client with a seizure disorder who is taking valproate (Depakote) ... 

The increased prevalence of polycystic ovary sjmdrome associated with valproate has been reviewed [386 ]. The risk seems to be higher in women with epilepsy than in women with bipolar disorders, and this might be due to underljdng neuroendocrine dysfunction related to the seizure disorder. 

Weiss SRB, Post RM, Sohn E, et al Cross tolerance between carbamazepine and valproate on amygdala-kindled seizures. Epilepsy Res 16 37-44, 1993 Weiss SRB, Clark M, Rosen JB, et al Contingent tolerance to the anticonvulsant effects of carbamazepine relationship to loss of endogenous adaptive mechanisms. Brain Res Brain Res Rev 20 305-325, 1995 Weissman MM Panic disorder impact on the quality of life. J Clin Psychiatry 52 [suppl) 6-8, 1991... 

These findings have important implications for the treatment of bipolar affective disorder. Some agents used to treat partial-complex seizures such as carbamazepine and various valproate formulations have been found to be effective in bipolar affective disorder (Bowden 1995). One such agent, divalproex, is now the most commonly prescribed antimanic agent. These agents may be more effective in subtypes of mania that are not lithium responsive. As noted earlier, African Americans are more often prescribed antipsychotics. Poor tolerance of lithium maybe a factor. Improving access to alternatives to lithium may reduce the need for antipsychotics in some African Americans with mania. 

Epilepsy is a disorder characterized by recurrent spontaneous electrical discharges within the brain which are manifested by clinical seizures. Four million patients in the United States are afflicted with this ailment 20% of these have seizures that cannot be controlled sufficiently with existing medications to permit normal activities of everyday life. The market for anticonvulsants is substantial a historical growth rate of 10 to 12% is expected to be sustained thereafter. Epileptic seizures can be classified as primary epilepsies (35%) or partial epilepsies (65%). Primary epilepsies (generalized convulsions) can be controlled with valproate (Depakote), carbamazepine (Tegretol), phenytoin (Dilantin), or phenobarbi-tol. Most partial epilepsies have resisted control with chemotherapeutic agents. 

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