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Absence Epilepsy: Presentation, Diagnosis,
and Treatment
Prepared and Presented by
Jon Manocchio, Pharm D
Blanchard Valley Hospital
September 2011
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Introduction
•Many different forms of Epilepsy
•Can affect a variety of patients
•Presentation will differ based on the
type of epilepsy
•Diagnosis is usually based on
sympomatology
•Treatment is very patient specific
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Definitions
•Seizure
–Abnormal, excessive, hypersynchronous discharge from an aggregate of CNS neurons
–Various manifestations will produce different seizure types
•Epilepsy
–A person who has recurrent seizures due to a chronic underlying process
–Two or more unprovoked seizures
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Classification •Partial Seizures
–Simple Partial
–Complex Partial
–Partial Seizures with Secondary Generalization
•Generalized Seizures
–Tonic-Clonic
–Myoclonic
–Atonic
–Absence*
•Epileptic Complications
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Various Causes of Epilepsy
• Alcohol
• Hypoglycemia
• Hyperglycemia
• Renal Failure
• Hepatic Failure
• Fever
• CNS Lesion
• Idiopathic
• Trauma
• Certain Medications
• Congenital
Abnormality
• Illicit Drug Use
• Infection
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Simple Partial Seizures
•Presentation
–Motor, sensory, autonomic, or psychic
symptoms
–No altered level of consciousness
–“Jacksonian March” phenomenon
–Possible localized paralysis
–Epilepsia partialis continua
–20-60 seconds in duration
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Simple Partial Seizures
•Diagnosis
–Based on presentation of symptoms
–EEG recordings may be altered depending on
area of the brain affected
•Treatment
–Many
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Complex Partial Seizures
•Presentation
–Frequently begin with an aura
–Motionless stare
–Involuntary autonomic movements
–Post-ictal confusion
–Anterograde amnesia
–30 seconds to 2 minutes in duration
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Complex Partial Seizures
•Diagnosis
–Based on presentation of symptoms
–EEG may show brief spikes in between
seizures
•Treatment
–Many
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Partial Seizures with Secondary
Generalization
•Presentation
–Presents like a partial seizure
–Spreads to produce a generalized seizure
–Difficult to distinguish
–1-2 minutes in duration
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Partial Seizures with Secondary
Generalization
•Diagnosis
–Based on presentation of symptoms
–Careful patient history
•Treatment
–Many
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Tonic-Clonic Seizures
•Presentation
–Begins abruptly without warning
–Initially the tonic phase
•10-20 seconds in duration
–Evolves into the clonic phase
•Can last up to a minute in duration
–The post-ictal phase
•Slow to regain baseline functioning
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Tonic-Clonic Seizures
•Diagnosis
–Based on presentation of symptoms
–EEG will show different patterns based on the
phase that the patient is experiencing
•Treatment
–Many
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Myoclonic Seizures
•Presentation
–Sudden and brief muscle contraction
–Usually coexist with generalized seizures
–1-5 seconds in duration
•Diagnosis
–Based on presentation of symptoms
–EEG may show spike and wave discharges
•Treatment
–Valproic Acid, Levetiracetam
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Atonic Seizures
•Presentation
–Sudden loss of postural muscle tone
•Sharp head nod
•Drop attack
–Brief loss of consciousness
–No post-ictal confusion
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Atonic Seizures
•Diagnosis
–Based on presentation of symptoms
–EEG will show a generalized spike and wave
discharge followed by slow waves
•Treatment
–Treat underlying syndrome
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Absence Seizures
•Presentation
–Main seizure type in children
–Sudden, brief lapses of consciousness
–Maintains postural control
–Associated with subtle motor signs
–No post-ictal confusion
–Manual seizure induction
–Less than 30 seconds in duration
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Absence Seizures
•Diagnosis
–Based on presentation of symptoms
–EEG has a characteristic 3 Hz spike
•Treatment
–Ethosuximide, Valproic Acid, Lamotrigine
–Journal club article
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Selected Epileptic Complications
•Status Epilepticus
•Juvenile Myoclonic Epilepsy
•Lennox-Gastaut Syndrome
•Reflex Epilepsy
•Temporal Lobe Epilepsy
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Conclusion
•Main forms of epileptic seizures
•Pharmacotherapeutic management
•Patient specific treatments
•Quality of life
•Compliance
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Anti-Epileptic Drugs (AEDS): Therapies for the Treatment of
Absence Epilepsy
Prepared and Presented by
Jon Manocchio, Pharm D
Blanchard Valley Hospital
September 2011
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Introduction
•Compliance
•Mechanisms of AED’s
–Inhibit voltage-gated Na+ channels
–Potentiate GABA-mediated inhibition
•Enhanced flux of Cl-
–Inhibit voltage-gated Ca++ channels
•Localize genetic causes
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AED’s in General •Topiramate
•Felbamate
•Zonisamide
•Lacosamide
•Rufinamide
•Vigabatrin
•Ethosuximide
•Primidone
•Phenytoin
•Phenobarbital
•Carbamazepine
•Oxcarbazepine
•Valproic Acid
•Gabapentin
•Lamotrigine
•Levetiracetam
•Tiagabine
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Ethosuximide (Zarontin®)
•Indication
–Treatment of absence seizures
•Normal Dose
–750mg - 1250mg per day
–Given daily or BID
•Pharmacokinetics
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Ethosuximide (Zarontin®)
•Adverse Effects
–Ataxia
–Lethargy
–Headache
–GI Irritation
–Skin rash
–Bone marrow suppression
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Lamotrigine (Lamictal®)
•Indication
–Lennox-Gastatut (adj), primary generalized tonic-
clonic seizures (adj), partial seizures (adj), bipolar
disorder
•Normal Dose
–150mg-500mg per day
–Given BID
–Complex dosing regimens based on biweekly tapers
•Pharmacokinetics
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Lamotrigine (Lamictal®)
•Adverse Effects
–Dizziness
–Diplopia
–Sedation
–Ataxia
–Headache
–Skin rash
–BBW
•Steven-Johnson Syndrome
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Valproic Acid (Depakene®)
•Indication
–Seizures, Mania, and Migraine prophylaxis
(status epilepticus and diabetic neuropathy
are unlabeled uses)
•Normal Dose
–750mg - 2000mg per day
–Dosed BID to QID
•Pharmacokinetics
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Valproic Acid (Depakene®)
•Adverse Reactions
–Ataxia
–Sedation
–Tremor
–Weight gain
–Alopecia
–BBW
•Hepatic Failure, Pancreatitis, Teratogenicity
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Discontinuation of Therapy
•Potential to remain seizure free
•After two years of therapy
•Slow taper
•Risk of recurrence
–Avoid risky behavior
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Conclusion
•General seizure control
•Multiple medications
•Risks vs. Benefits
•Non-pharmacological assistance
•Compliance
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