Antiepileptics - need help before a seizure occurs

[zeevee]

I have some doubts about the usage of these drugs .
Mostly because UW and FA contradict each other or give a different approach each ; both look correct but incomplete

UW QID 355 divides the drugs into (a) broad spectrum for generalized seizures and (b) narrow spectrum for focal seizures .

Broad spectrum drugs are : Lamotrigine , Levetiracetam , Topiramate , Valproic acid
Narrow spectrum drugs are : Carbamezapine , Gabapentin , Phenytoin , Phenobarbital

This question ignores many other drugs given in FA namely Tiagabine , vagabatrine . I understand benzodiazepines are missing in the list because they are specific to status epilepticus and ethosuxamide is an absence seizure drug only so they can be ignored here .However ,

FA says the first line drug'S' of choice for tonic clonic seizures are : Phenytoin , Carbamezapine and Valproic acid ( all 3 of them )
UW on the other hand puts carbamezapine and phenytoin into focal seizure narrow spectrum drugs slot and ignores their "FIRST LINE " use against tonic clonic seizures.


The list of doubts goes deeper but I think this is the biggest one .
I will be very grateful if someone with good knowledge and latest notes from their school or in clinical practice ( eg after talking to their prof ) can share the information that can help us answer questions to the dot in the exam and remove the ambiguity .

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[chillaxbro]

Yeah if someone could shed some light on this. I had the same problem with FA and UW giving different information for seizure meds after doing this prob

 

[zeevee]

anyone ?

 

[zhopv10]

In class we were taught that carbamazepine is for the partial seizures (complex partial/simple partial big time for complex partial though). The rest is as you mentioned. Our teachers (one writes for the boards and knows his stuff big time) said that the key to seizure drugs is to loosely know the indications (carbamazepine for partials, ethosuximide for absence, etc as you said) but to really know key AE's. Carbamazepine and agranulocytosis, and valproic with liver, phenytoin with the gingival hyperplasia, levetiracetam and messed up mood (nickname the divorce drug), lamotrigine can give steven johnsons etc. (and the birth defects for these). They told us that the detailed indications get messy and in clinic it comes largely to preference therefore=not nearly as testable aside from a couple specific cases, as the MOA and the AE's


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[zeevee]

@ zhopv Thanks buddy .Your reply tells that I am confused for a good reason .I am bound to be if doctors are still working on a hit and trial method
.Levetiracetam side effects are not mentioned in FA and wikipedia says there are mild neuropsychiatric disturbances in 13% only .
Can you shed some more light on that ?

 

[zhopv10]

Ya I don't know why they don't talk about it much. I mean it's not crazy or anything certainly better than pretty much any of the other ones but it is still there (I think the mild disturbances you mentioned fits the idea ). I wouldn't worry about the low incidence, I mean I feel like most of the AE we learn about are fairly low incidence In general but they are important for us to know for safety stuff or w/e in the wards, to have at least an idea that it happens. That came from our neurologist that taught and incidentally a patient we saw after described exactly what he was talking about (made him more moody and irritable). Idk probably not a major point but a true one to shove in the back of the memory banks haha.


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