Absence Epilepsy: Presentation, Diagnosis,

and Treatment

Prepared and Presented by

Jon Manocchio, Pharm D

Blanchard Valley Hospital

September 2011

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

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

Classification •Partial Seizures

–Simple Partial

–Complex Partial

–Partial Seizures with Secondary Generalization

•Generalized Seizures

–Tonic-Clonic

–Myoclonic

–Atonic

–Absence*

•Epileptic Complications

Various Causes of Epilepsy

• Alcohol

• Hypoglycemia

• Hyperglycemia

• Renal Failure

• Hepatic Failure

• Fever

• CNS Lesion

• Idiopathic

• Trauma

• Certain Medications

• Congenital

Abnormality

• Illicit Drug Use

• Infection

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

Simple Partial Seizures

•Diagnosis

–Based on presentation of symptoms

–EEG recordings may be altered depending on

area of the brain affected

•Treatment

–Many

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

Complex Partial Seizures

•Diagnosis

–Based on presentation of symptoms

–EEG may show brief spikes in between

seizures

•Treatment

–Many

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

Partial Seizures with Secondary

Generalization

•Diagnosis

–Based on presentation of symptoms

–Careful patient history

•Treatment

–Many

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

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

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

Atonic Seizures

•Presentation

–Sudden loss of postural muscle tone

•Sharp head nod

•Drop attack

–Brief loss of consciousness

–No post-ictal confusion

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

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

Absence Seizures

•Diagnosis

–Based on presentation of symptoms

–EEG has a characteristic 3 Hz spike

•Treatment

–Ethosuximide, Valproic Acid, Lamotrigine

–Journal club article

Selected Epileptic Complications

•Status Epilepticus

•Juvenile Myoclonic Epilepsy

•Lennox-Gastaut Syndrome

•Reflex Epilepsy

•Temporal Lobe Epilepsy

Conclusion

•Main forms of epileptic seizures

•Pharmacotherapeutic management

•Patient specific treatments

•Quality of life

•Compliance

Anti-Epileptic Drugs (AEDS): Therapies for the Treatment of

Absence Epilepsy

Prepared and Presented by

Jon Manocchio, Pharm D

Blanchard Valley Hospital

September 2011

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

AED’s in General •Topiramate

•Felbamate

•Zonisamide

•Lacosamide

•Rufinamide

•Vigabatrin

•Ethosuximide

•Primidone

•Phenytoin

•Phenobarbital

•Carbamazepine

•Oxcarbazepine

•Valproic Acid

•Gabapentin

•Lamotrigine

•Levetiracetam

•Tiagabine

Ethosuximide (Zarontin®)

•Indication

–Treatment of absence seizures

•Normal Dose

–750mg - 1250mg per day

–Given daily or BID

•Pharmacokinetics

Ethosuximide (Zarontin®)

•Adverse Effects

–Ataxia

–Lethargy

–Headache

–GI Irritation

–Skin rash

–Bone marrow suppression

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

Lamotrigine (Lamictal®)

•Adverse Effects

–Dizziness

–Diplopia

–Sedation

–Ataxia

–Headache

–Skin rash

–BBW

•Steven-Johnson Syndrome

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

Valproic Acid (Depakene®)

•Adverse Reactions

–Ataxia

–Sedation

–Tremor

–Weight gain

–Alopecia

–BBW

•Hepatic Failure, Pancreatitis, Teratogenicity

Discontinuation of Therapy

•Potential to remain seizure free

•After two years of therapy

•Slow taper

•Risk of recurrence

–Avoid risky behavior

Conclusion

•General seizure control

•Multiple medications

•Risks vs. Benefits

•Non-pharmacological assistance

•Compliance