Status epilepticus partial

Anticonvulsant As adjunctive therapy in the management of partial seizures (clorazepate) adjunctively in status epilepticus and severe recurrent convulsive seizures (diazepam IV) adjunctively in convulsive disorders (diazepam oral). Preoperative For preoperative apprehension and anxiety (chlordiazepoxide, diazepam IV) prior to cardioversion for the relief of anxiety and tension and to diminish patient s recall (diazepam IV) adjunctively prior to endoscopic procedures for apprehension, anxiety, or acute stress reactions and to diminish patient s recall (diazepam) ... 

Status epilepticus Among the patients treated with tiagabine across all epilepsy studies (controlled and uncontrolled), 5% had some form of status epilepticus. Of the 5%, 57% of patients experienced complex partial status epilepticus. A critical risk factor for status epilepticus was the presence of the condition history 33% of patients with a history of status epilepticus had recurrence during tiagabine treatment. 

Phenobarbital is still used for the management of partial seizures, generalized tonic-clonic seizures and for the control of status epilepticus. However because of its low therapeutic index and the possibility of dependence, phenobarbital has largely been displaced by other anticonvulsants. For newborns phenobarbital is often the drug of first choice. If given together with sodium valproate the metabolism of phenobarbital may be inhibited while in combination with carbamazepine the serum concentrations of carbamazepine will be reduced due to enzyme induction by phenobarbital. 

Unlabeled Uses Prevention of migraine treatment of behavior disorders in Alzheimer s disease bipolar disorder chorea, myoclonic, simple partial, and tonic-clonic seizures organic brain syndrome schizophrenia status epilepticus tardive dyskinesia... 

It is used in prophylactic treatment of all varieties of partial epilepsy whether or not seizure becomes secondarily generalised. It is also used in prophylactic treatment of generalised convulsive seizures and treatment of status epilepticus prophylactic management of certain forms of supraventricular cardiac arrhythmia as it has an ability to selectively inhibit high frequency firing prophylactic management of certain... 

Phenobarbital Enhances phasic GABAa receptor responses reduces excitatory synaptic responses Nearly complete absorption not significantly bound to plasma proteins peak concentrations in Vi to 4 h no active metabolites tjy2 varies from 75 to 125 h Generalized tonic-clonic seizures, partial seizures, myoclonic seizures, generalized seizures, neonatal seizures, status epilepticus Toxicity Sedation, cognitive issues, ataxia, hyperactivity Interactions Valproate, carbamazepine, felbamate, phenytoin, cyclosporine, felodipine, lamotrigine, nifedipine, nimodipine, steroids, theophylline, verapamil, others... 

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. 

Diphenylhydantoin is the most widely used drug in the treatment of all types of partial seizures, generalized tonic-clonic seizures and status epilepticus. It is relatively non-sedative. There is a good correlation between the increase in the blood levels of the drug and the occurrence of neurotoxicity, concentrations about 25 yg/ml usually being associated with such symptoms. 

M, Albers GW (1999) MRI abnormalities associated with partial status epilepticus. Neurology 52 1021-1027... 

Jacobs DA, Fung KM, Cook NM, Schalepfer WW, Goldberg HI, Stecker MM. Complex partial status epilepticus associated with anti-Hu paraneoplastic syndrome. J Neurol Sci 2003 213(1 2) 77 82. 

Therapeutic uses Phenytoin is highly effective for all partial seizures (simple and complex), for tonic-clonic seizures, and in the treatment of status epilepticus caused by recurrent tonic-clonic seizures (Figure 15.3). Phenytoin is not effective for absence seizures, which often may worsen if such a patient is treated with this drug. 

A1 Tahan A. Paradoxic response to diazepam in complex partial status epilepticus. Arch Med Res 2000 31(l) 101-4. 

There have been cases of generalized non-convnlsive status epilepticus in patients with chronic partial epilepsy treated with tiagabine, on one occasion specifically associated with frontal lobe discharges (15). 

Brouns R, Van Paesschen W. Recurrent complex partial status epilepticus associated with tiagabine rechaUenge. Acta Neurol Belg 2002 102(l) 19-20. 

Trinka E, Moroder T, Nagler M, Staffen W, Loscher W, Ladurner G. Chnical and EEG findings in complex partial status epilepticus with tiagabine. Seizure 1999 8(l) 41-4. 

Doses of vigabatrin up to 10 g have been taken without serious effects. Toxic manifestations include vertigo, tremor, sedation, coma, myoclonic jerks, and psychosis. Gastric lavage within 1-2 hours is recommended after doses in excess of 12 g in adults and 2 g in children (SEDA-22,85). The development of discontinuous partial complex status epilepticus in a patient with partial epilepsy who had taken a 20 g overdose 6 days earher was considered to be a possible effect of withdrawal (SEDA-22, 85). 

Recently it was described that an 11-year-old boy who developed status epilepticus after a prolonged right-side simple partial motor seizure, which was unresponsive to long-term aggressive treatment with several AEDs [51]. The control of seizures was achieved at a plasma valproic acid level of 108 pg/ml, but electrical status epilepticus persisted, and the child remained comatose. On day 37, a treatment with verapamil (a calcium L-channel blocker) was started, and 1.5 h after the initiation of the infusion, the patient regained consciousness, breathed spontaneously, and the electrical status promptly disappeared. The authors suggested that verapamil, a... 

Although diazepam is an effective agent for treatment of status epilepticus, its short duration of action is a disadvantage, leading to the more frequent use of lorazepam. Although diazepam is not useful as an oral agent for the treatment of seizure disorders, clorazepate is effective in combination with certain other drugs in the treatment of partial seizures. The maximal initial dose of clorazepate is 22.6 mg per day in three portions for adults and 15 mg per day in two doses in children. Clorazepate is not recommended for children under the age of 9. 

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

Phenytoin is indicated for initial monotherapy or adjunct treatment of complex partial or tonic-clonic seizures, convulsive status epilepticus, and prophylaxis. It often is selected for initial monotherapy because of its high efficacy and relatively low incidence of side effects (29). Phenytoin is not used in the treatment of absence seizures, because it may increase their frequency of occurrence (30,31). Phenytoin binds to and stabilizes the inactivated state of sodium channels, thus producing a use-dependent blockade of repetitive firing and inhibition of the spread of seizure activity to adjacent cortical areas. 

Phenytoin is used orally for the prevention of generalized (grand mal) and partial complex seizures. Intravenous phenytoin is used to treat status epilepticus and occasionally as an antiarrhythmic agent. Oral formulations include suspensions, capsules, and tablet preparations. The brand Dilantin Kapseals exhibits delayed absorption characteristics not usually shared by generic products. 

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