C H A P T E R 2 3
Antiseizure agents
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Drugs used in the treatment of partial seizures
include drugs that stabilise the nerve membrane by
altering electrolyte movement or increasing GABA
activity.
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Some of the drugs used to treat generalised seizures
have also been found to be useful in treating partial
seizures.
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Adverse effects associated with the use of drugs used
in treating partial seizures include CNS depressive
effects and dermatological disorders.
CHAPTER SUMMARY
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Epilepsy is a collection of different syndromes, all
of which have the same characteristic: a sudden
discharge of excessive electrical energy from nerve
cells located within the brain. This event is called a
seizure.
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Seizures can be divided into two groups: generalised
and partial (focal).
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Generalised seizures can be further classified as:
tonic–clonic (grand mal); absence (petit mal);
myoclonic; febrile; and rapidly recurrent (status
epilepticus).
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Partial (focal) seizures can be further classified as
simple or complex.
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Drug treatment depends on the type of seizure
that the person has experienced and the toxicity
associated with the available agents.
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Drug treatment is directed at stabilising the
overexcited nerve membranes and/or increasing
the effectiveness of GABA, an inhibitory
neurotransmitter.
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Adverse effects associated with antiepileptics
(e.g. insomnia, fatigue, confusion, GI depression,
bradycardia) reflect the CNS depression caused by
the drugs.
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People being treated with an antiepileptics should be
advised to wear or carry a MedicAlert notification
to alert emergency medical professionals to their
epilepsy and their use of antiepileptics drugs.
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People being treated with antiepileptic are often
on long-term therapy, which requires compliance
with their drug regimen and restrictions
associated with their disorder and the drug effects.
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KEY POINTS
Implementation with rationale
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Administer the drug with food
to alleviate GI
irritation if GI upset is a problem.
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Monitor FBC before and periodically during
therapy
to detect and prevent serious bone marrow
suppression.
■
■
Protect the person from exposure to infection
if
bone marrow suppression occurs.
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Discontinue the drug if skin rash, bone marrow
suppression, unusual depression or personality
changes occur
to prevent further serious adverse
effects.
■
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Discontinue the drug slowly, and never withdraw
the drug quickly,
because rapid withdrawal may
precipitate seizures.
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Arrange for counselling for women of childbearing
age who are taking these drugs.
Because these
drugs have the potential to cause serious damage
to the fetus
, women should understand the risk
of birth defects and use barrier contraceptives to
avoid pregnancy.
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Evaluate for therapeutic blood levels of
carbamazepine (4 to 12 mcg/mL)
to ensure that the
most effective dose is being used.
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Provide safety measures to protect the person from
injury or falls
if CNS changes occur.
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Provide teaching, including drug name and
prescribed dosage, as well as measures for
avoidance of adverse effects, warning signs that
may indicate possible problems and the need for
periodic laboratory testing and monitoring and
evaluation
to enhance knowledge about drug
therapy and to promote compliance.
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Suggest that the person wear or carry a
MedicAlert bracelet
to alert emergency workers
and healthcare providers about the use of an
antiepileptic drug.
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Offer support and encouragement
to help the
person cope with the drug regimen.
Evaluation
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Monitor response to the drug (decrease in incidence
or absence of seizures).
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Monitor for adverse effects (CNS changes, GI
depression, bone marrow suppression, severe
dermatological reactions, liver toxicity, renal
stones).
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Evaluate the effectiveness of the teaching plan
(person can give the drug name and dosage and
name possible adverse effects to watch for and
specific measures to prevent them; person is aware
of the risk of birth defects and the need to carry
information about the diagnosis and use of this
drug).
