Tonic-clonic seizures Antiseizure drugs

Most of the sedative-hypnotics are capable of inhibiting the development and spread of epileptiform activity in the central nervous system. Some selectivity exists in that some members of the group can exert anticonvulsant effects without marked central nervous system depression (although psychomotor function may be impaired). Several benzodiazepines—including clonazepam, nitrazepam, lorazepam, and diazepam—are sufficiently selective to be clinically useful in the management of seizure states (see Chapter 24 Antiseizure Drugs). Of the barbiturates, phenobarbital and metharbital (converted to phenobarbital in the body) are effective in the treatment of generalized tonic-clonic seizures. 

Preliminary evidence suggests that topiramate, a drug used for partial and generalized tonic-clonic seizures (Chapter 24 Antiseizure Drugs), may be effective in reducing craving in chronic alcoholics. 

Withdrawal Withdrawal from antiseizure drugs should be accomplished gradually to avoid increased seizure frequency and severity. In general, withdrawal from anti-absence drugs is more easily accomplished than withdrawal from drugs used in partial or generalized tonic-clonic seizure states. 

There are two problems with regard to withdrawal from antiseizure drugs the effects of withdrawal itself and the need to continue suppression of seizures. Dose-tapering is an important principle in antiseizure drug withdrawal. As a rule, withdrawal from drugs used in absence seizures is easier than withdrawal from drugs used for partial and tonic-clonic seizures. Withdrawal is most difficult in patients who have been treated with barbiturates and benzodiazepines. The answer is (C). 

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