Seizure specific agents

Signs of nerve agent toxicity vary in rapidity of onset, severity, and duration of exposure. These are dependent on the specific agent, route of exposure, and dose. At the higher doses, convulsions and seizures indicate CNS toxicity. 

An extensive search of all standard references, as well as reports of studies in humans, shows that there have been no case reports of toxic exposure to V. agnus-castus use. However, one case of nocturnal seizures, possibly attributed to V. agnus-castus, has been reported. The patient was taking concomitantly black cohosh root (Cimicifuga racemosa), V. agnus-castus, and evening primrose as well (34). Thus, attribution of effect to a specific agent was not possible. 

Ifosfamide -alkylating agent noncell cycle specific -bone marrow suppression -hemorrhagic cystitis (need Mesna uroprotection) -nausea and vomiting—mild to moderate -mucocutaneous effects (mucositis, stomatitis, diarrhea) -CNS toxicity—lethargy, stupor, coma, seizures... 

Levetiracetam (Keppra) has recently been approved for the treatment of partial-onset seizures. It appears to be safe and effective its exact therapeutic profile has yet to be determined. It does not appear to share any of the mechanisms of action of agents that have been discussed to this point. It does have a highly specific brain binding site, but the significance of this observation to its mechanism of action has not been elucidated. 

Specific factors to consider are both psychiatric and physical contraindications. For example, bupropion is contraindicated in a depressed patient with a history of seizures due to the increased risk of recurrence while on this agent. Conversely, it may be an appropriate choice for a bipolar disorder with intermittent depressive episodes that is otherwise under good control with standard mood stabilizers. This consideration is based on the limited data suggesting that bupropion is less likely to induce a manic switch in comparison with standard heterocyclic antidepressants. Another example is the avoidance of benzodiazepines for the treatment of panic disorder in a patient with a history of alcohol or sedative-hypnotic abuse due to the increased risk of misuse or dependency. In this situation, a selective serotonin reuptake inhibitor (SSRI) may be more appropriate. 

Even though this agent has been found to be superior to neuroleptics, as well as to placebo, and beneficial in a substantial proportion of nonresponders, its side effect profile has been a major obstacle to its widespread use. Specifically, agranulocytosis (approximately 0.5 % to 1% incidence) and seizures (usually with higher doses) are the most serious side effects. 

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. 

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