Chapter 9 Anticonvulsant Drugs
• Seizures are episodes of abnormal electrical activity in the brain that may lead to involuntary movements and sensations, which are accompanied by characteristic changes on electroencephalography (EEG).
• Increased risk of suicidal behavior or ideation (U.S. Food and Drug Administration [FDA] Special Alert; February 2008)
TABLE 9-1 International Classification of Partial and Generalized Seizures
| Classification | Origin and Features |
|---|---|
| Partial (Focal) Seizures | Arising in one cerebral hemisphere |
| Simple partial seizure | No alteration of consciousness |
| Complex partial seizure | Altered consciousness, automatisms, and behavioral changes |
| Secondarily generalized seizure | Focal seizure becoming generalized and accompanied by loss of consciousness |
| Generalized seizures | Arising in both cerebral hemispheres and accompanied by loss of consciousness |
| Tonic-clonic (grand mal) seizure | Increased muscle tone followed by spasms of muscle contraction and relaxation |
| Tonic seizure | Increased muscle tone |
| Clonic seizure | Spasms of muscle contraction and relaxation |
| Myoclonic seizure | Rhythmic, jerking spasms |
| Atonic seizure | Sudden loss of all muscle tone |
| Absence (petit mal) seizure | Brief loss of consciousness, with minor muscle twitches and eye blinking |
(From Kester M, et al.: Elsevier’s Integrated Pharmacology. Philadelphia, Mosby, 2007, Figure 13-3.)
II. Drugs Used in the Treatment of Partial Seizures and Generalized Tonic-Clonic Seizures (Box 9-1; see also Table 9-2)
BOX 9-1 Anticonvulsants
b. First-order kinetics (low blood levels) can switch to zero-order kinetics (high blood levels), i.e., dose-dependent pharmacokinetics.
b. Fosphenytoin is given to control generalized convulsive status epilepticus and prevent and treat seizures occurring during neurosurgery
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