Effect of Medicationson Recordings and Patients · Clonazepam/Klonopin Absence Myoclonic Atonic...
Transcript of Effect of Medicationson Recordings and Patients · Clonazepam/Klonopin Absence Myoclonic Atonic...
Effect of Medications on Recordings and Patients
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Medication Effect
Purpose, Effect on
EEG, Effect on People
AntiepilepticMedications
Sedatives Analgesics
Additional Classes
Generic/Brand Name• Seizure type treatedPurpose
• Either research evidence• Or none known
EEG Effects
• MildSide effects
• Life threatening side effectsSerious Side effects
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Antiepileptic/AntiseizureAnticonvulsant/AED/ASM
• Used to control or prevent serious seizures. The specific drug therapy is based on the type and frequency of the seizures.
Purpose & use
• At therapeutic levels most antiepileptic medications have little or no effect on the EEG signal. Medications exceeding toxic levels tend to increase beta activity.
Effects on EEG
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Broad Spectrum
• Valproic acid• Lamotrigine• Topiramate• Zonisamide• Levetiracetam• Clonazepam• Rufinamide• Felbamate
Narrow Spectrum
• Phenytoin• Phenobarbital• Carbamazepine• Oxcarbazepine• Gabapentin• Pregabalin• Lacosamide• Vigabatrin
Anticonvulsant Classes
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Narrow spectrum AEDs
phenytoin (Dilantin) phenobarbital carbamazepine
(Tegretol)
oxcarbazepine (Trileptal)
gabapentin (Neurontin)
pregabalin (Lyrica)
lacosamide(Vimpat)
vigabatrin (Sabril)
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Phenytoin / Dilantin
• Simple and Complex Partial• Generalized Tonic Clonic• IV administered to stop seizure in
progressPurpose
• Therapeutic levels• None• Mild slowing
• Toxic levels• Generalized delta
Effects on EEG
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Phenytoin Cont’d• Unsteadiness• Cognitive problems• Body/facial hair growth• Skin problems• Osteoporosis
Effects on patients
• Can cause a decrease in blood levels of other antiepileptic drugs & medications
Drug Interactions
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Phenobarbital
• Adjunctive therapy, single daily dose• Focal aware, focal impaired and generalized
tonic clonic seizures and neonatal seizures• Status epilepticus
Purpose
• Non-toxic doses: • Beta anterior transitioning to beta posterior
• Toxic doses:• Generalized beta progressing to burst
suppression
EEG affect
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Phenobarbital• Depression• Hyperactivity• Impaired attention• Memory problems• Slurred speech• Rash
Side effects
• Addictive (sedative/hypnotic/anxiolytic properties)• Proven to cause birth defects• Drug-drug interactions – particularly other
anticonvulsants and birth control
Significant side
effects
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Carbamazepine/Tegretol
• Focal aware, focal impaired awareness
• Generalized tonic-clonic• Temporal lobe epilepsy
Purpose
• None or mild alpha slowing• Increased beta
Effects on EEG
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Carbamazepine Cont’d• GI upset• Weight gain• Blurred vision• Low blood count• Low sodium count
Effects on
patients
• Stevens Johnson Syndrome, toxic epidermal necrolysis• Painful, blister skin condition syndrome
from mild to potentially fatal
Serious Side
Effects
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Gabapentin/Neurontin
• Focal aware, focal impaired awareness
• Secondary generalizationPurpose
• Minimally increased delta and theta
• Decreased alpha
Effects on EEG
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Gabapentin Cont’d• Unsteadiness• Weight gain• Fatigue• Dizziness
Effects on
patients
• Can worsen generalized seizures with and without impairment in awareness
Serious Side
effects
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Pregabalin/Lyrica
• Focal aware, focal impaired awarenessPurpose
• Rhythmic discharges and posterior spike wave discharges noted in acute toxicity
Effects on EEG
• Unsteadiness• Weight gain• Fatigue• Dizziness
Effect on Patient
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Vimpat/Lacosamide
• Focal aware, focal impaired awareness• Secondary generalizationPurpose
• Decreased frequency of alpha rhythm with IV administration
Effects on EEG
• Dizziness• Headaches• Nausea or vomiting• Fatigue
Effect on Patient
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Vigabatrin/Sabril
• Focal, with or without secondary generalization• Infantile spasmsPurpose
• NoneEffects on EEG
• Weight gain• Neuropathy• Edema• Permanent vision loss
Effect on Patient
Antiepileptic Medicationsfor Focal Seizures
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Oxcarbazepine/Trileptal
• Focal aware, focal impaired awarenessPurpose
• Slowing of peak frequency• Increased theta and delta
Effects on EEG
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Oxcarbazepine Cont’d• Hyponatremia• Headaches• Tiredness• Diplopia• Nausea• Balance disturbance
Effects on
patients
• Stevens-Johnson Syndrome• Toxic epidermal necrolysis• Hyponatremia• Anaphylaxis and angioedema
Serious Side
Effects
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Zonosamide/Zonegran
• PartialPurpose
• Possible mild increase of theta-delta activityEffects on EEG
• Skin rash, hives• Difficulty breathing• Swelling lips, tongue, face, throat• Mood changes, Anxiety
Effect on Patient
Antiepileptic Medicationsfor Generalized Seizures
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Ethosuximide/Zarontin
• AbsencePurpose
• Little to no appreciable effect• Decreased spike and wave
Effects on EEG
• Stomach upset• Diarrhea• Anorexia• Drowsiness, behavioral changes
Effect on Patient
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Ethosuximide Cont’d
• Psychological changes: anxiety, depression, panic attacks, trouble sleeping, agitated, hostile, aggressive, restless, hyperactivity
Side Effects
• Stevens-Johnson Syndrome• Suicidal thoughts
Serious side
effects
Broad Spectrum Antiepileptic Medications
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Broad Spectrum AEDs
Broad Spectrum
• Clonazepam• Lamotrigine• Levetiracetam• Rufinamide• Topiramate• Valproic acid• Zonisamide
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Clonazepam/Klonopin
• Absence• Myoclonic• Atonic• Lennox-Gastaut associated seizures
Purpose
• Loss of background• Decreased voltage• Frontal beta• Some theta
Effects on EEG
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Clonazepam Cont’d
• Sedation• Thinking and memory impairment• Mood changes• Addiction
Effects on
patients
• Allergic reaction• Jaundice• Hallucinations, confusion, or
changes in vision
Serious Side
effects
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Lamotrigine/Lamictal
• Focal, with or without secondary generalizationPurpose
• Increases interictal spikes inphoto- paroxysmal responses
Effects on EEG
• Dizziness• Fatigue• Mild cognitive impairment
Effect on Patient
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Levetiracetam/Keppra
• Focal, with or without secondary generalization• Generalized tonic-clonicPurpose
• Studies suggest: increase in faster activity and decrease in theta/delta activity
Effects on EEG
• Dizziness• Fatigue• Insomnia
Effect on Patient
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Lorazepam/Ativan
• Short term treatment of all seizures
• Status epilepticus• GTC
Purpose
• Loss of background rhythm• Decreased voltage• Frontal beta• Some theta
Effects on EEG
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Lorazepam Cont’d• Drowsiness• Dizziness• Tiredness• Confusion
Effects on
patients
• Allergic reactions• Suicidal thoughts, hallucinations• tremors
Serious Side
Effects
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Rufinamide/Banzel• Lennox-Gastaut associated seizures
• Absence• Myoclonic• Atonic
Purpose
• No data is available on the effect of rufinamide on EEGEffects on
EEG• Headaches• Dizziness• Fatigue• Diplopia• Tremor
Effects on patients
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Topiramate/Topamax• Focal, with or without secondary
generalization• All seizure types
Purpose
• No effectEffects on EEG
• Thinking and memory issues• Weight loss
Effect on Patient
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Valproic Acid/ Depakote, Depakene, Valproate, Depacon
• Focal• Complex Absence• GTC• Myoclonic
Purpose
• NoneEffects on EEG
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Valproic acid Cont’d• Weight gain• Tremor• Hair loss• GI issues• Decreased blood count
Effects on
patients
• Hepatic or pancreatic injury• Bone weakness over time• Birth defects
Serious Side
effects
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Felbamate/Felbatol• When all other medications fail• Focal• Some generalized• Lennox-Gastaut related seizures
Purpose
• No data availableEffects on
EEG• Nausea, vomiting, and indigestion• Headache• Loss of appetite• Insomnia
Effects on patients
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Tiagabine/Gabitril
• Partial• Some generalizedPurpose
• Worsening of spike wave discharges on EEGEffects on
EEG• Trouble concentrating• Dizziness• Drowsiness• Nervousness and irritability• Shaking
Effects on patients
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Phenobarbital / Luminal
• Most seizure types (including febrile)• Not to be used for Absence• Status epilepticus• Focal, when others fail
Purpose
• Generalized anterior dominant fast (15 - 35 Hz)
• Posterior fast (children)
Effects on EEG
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Phenobarbital Cont’d
• Sleepiness• Thinking or memory problems• Depression
Effects on
patients
• Addictive for its sedative-hypnotic and anti-anxiety effects
Serious side
effects
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Mysoline/Primidone
• Focal• GTC• Myoclonic
Purpose
• Increased fast activity, frontally predominant
• Decreased alpha• Toxic dosage - Delta
Effects on EEG
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Mysoline Cont’d• Shakiness• Unsteady gait• Trembling• Loss of muscle control• Loss of coordination
Effects on
patients
• Anaphylactic reactions• Blistering skin lesions• Worsening of seizures
Serious side
effects
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Diazepam/Valium/Diastat
• Short term treatment of all seizure types• Status epilepticusSeizure
• Frontally predominant beta activity, but can also be more diffuseEffects on
EEG• Drowsiness• Memory problems• Dizziness, spinning sensation• Muscle weakness• Nausea
Effects on patients
Additional Drug Classifications
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Antibiotics
Penicillin Cephalosporins
Antimycobacterial Quinolones
Antipsychotics
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Haloperidol lactate/Haldol
• Schizophrenia• Tourette’s Syndrome• Tremors• Huntington’s Chorea
Purpose
• Paradoxical effects• Slow and fast activity
Effects on EEG
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Haldol Cont’d• Difficulty speaking or swallowing• Inability to move eyes• Loss of balance control• Mask like face• Muscle spasms• Shuffling gait• Trembling and shaking of the fingers and hands
Effects on
patients
• Cardiac abnormalities• Tardive dyskinesia• Neuroleptic Malignant Syndrome
Serious side
effects
Sedatives
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Chloral Hydrate
• Calm patients and induce sleepPurpose
• Little to none• Increased anterior dominant beta
Effects on EEG
• Drowsiness• Upset stomach• Diarrhea
Effects on patients
• Cardiac depression & arrhythmias• Respiratory depression• Paradoxical reactions, delirium incoherence
Serious side effects
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Chlordiazepoxide HCL/Librium
•TranquilizerPurpose
•Anterior dominant diffuse fastEffects on
EEG• Drowsiness/Tiredness• Swelling• Skin rash• Nausea/Vomiting• Constipation• Irregular menstrual cycle
Effects on patients
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Chlorpromazine/Thorazine
• SedativePurpose
• Sleep• Sleep spindles and central transients
depressed• Wake
• Diffuse slowing
Effects on EEG
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Chlorpromazine Cont’d• Twitching or uncontrolled movements of your eyes, lips, tongue,
arms, face• Tremor• Drooling• Difficulty swallowing• Gait disturbance• Restlessness or agitation• Faintness
Effects on
patients
• Dementia related psychosis• Cardiovascular related events• Gastrointestinal necrosis• Neuroleptic Malignant Syndrome
Serious side
effects
Analgesics & Antibiotics
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Morphine
• Analgesic/Severe pain reliefPurpose
• Acute dosage• Decrease in frequency and amount of alpha
• Chronic dosage• Alpha returns to normal and increases in amount
• Toxic dosage• Diffuse slowing
Effects on EEG
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Morphine• Hypotension• Drowsiness• Issuing of a relaxed easy state• Feeling faint• Dizziness• Excessive sweating• Nausea
Effects on
patients
• Acute overdose• Myoclonic spasms• Respiratory depression• Cardiovascular changes• Psychiatric changes
Serious Side
Effects
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Codeine-Acetaminophen
• Analgesic (pain and cough relief)Purpose
• Acute dosage - decrease in frequency and amount of alpha• Chronic dosage - alpha return to normal and increases in
amount• Toxic dosage - diffuse slowing
Effects on EEG
• Dizziness• Drowsiness• Nausea• Headache or blurred vision
Effects on patients
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Antibiotics• SIRPIDs• Diffuse slowingCefepime
• NCSE• Triphasic wavesCephalosporins
• NCSE• Spike wave/polyspike wave
Penicillins: Fluoxacillin
Additional Drugs and Treatments to Know
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ACTH/Adrenocorticotrophic Hormone
• Treatment of cerebral edema with brain tumors• Infantile spasmsPurpose
• Other than normalizing the EEG, there are no ill effects per the latest research
Effects on EEG
• Scaly oily skin problems primarily on face and scalp• Excessive hairiness• Skin discolorations• Easily angered or annoyed• Cushing's Syndrome
Effects on patients
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Amytal
•Wada TestingPurpose
•Enhanced betaEffects on
EEG• Sedative• Agitation• Confusion• Ataxia• Dizziness• Anxiety
Effects on patients
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VNS or Vagal Nerve Stimulator
• Refractory Focal epilepsy• Refractory Symptomatic generalized epilepsy• Refractory Idiopathic generalized epilepsy
Purpose
• Small electrical impulses to the brain via the vagus nerve• Frequency and intensity of impulses can be programmed by physician• Implanted below the collarbone• Thin wires threaded around the vagus nerve in the neck
Mechanism of action
• Mild side effects occur only when the nerve is being stimulated. Brief hoarseness to the voice, difficulty swallowing and possibly a cough.Side effects
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Bibliographyhttps://www.fda.gov/Drugs
https://ghr.nlm.nih.gov/condition/stevens-johnson-syndrome-toxic-epidermal-necrolysis
https://www.cms.gov/medicare-medicaid-coordination/fraud-prevention/medicaid-integrity-education/pharmacy-education-materials/downloads/ac-adult-dosingchart.pdf
https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/surgery/tests-surgery/wada-test
https://www.epilepsy.com/learn/professionals/resource-library/tables/recommended-medications
https://www.epilepsy.com/learn/professionals/resource-library/tables/choosing-antiepileptic-drugs
https://www.epilepsy.com/article/2014/3/summary-antiepileptic-drugs
Epilepsydiagnosis.org