Sunday, February, 12, 2012

Epilepsy - Surgery

Table of Contents

Note: Citrus fruit, especially grapefruit, can increase carbamazepine's adverse effects.

Phenytoin

Phenytoin (Dilantin, generic) is effective for adults who have the following seizures or conditions:

  • Grand mal seizures
  • Partial seizures
  • Status epilepticus
  • Can be effective for people with head injuries who are at high risk for seizures

This drug is not useful for the following seizures:

  • Petit mal seizures
  • Myoclonic seizures
  • Atonic seizures

Side Effects. Side effects are sometimes difficult to control. Some people may develop a toxic response to normal doses, while others may require higher doses to achieve benefits. As with any drug, side effects generally depend on dosage and duration. Side effects may include:

  • Excess body hair, eruptions and coarsening of the skin, and weight loss
  • Gum disease
  • Staggering, lethargy, nausea, depression, eye-muscle problems, anemia, and an increase in seizures can occur as a result of excessive doses.
  • Liver damage may develop in rare cases.
  • Bone density loss from long-term therapy. Patients should take preventive calcium and vitamin D supplements and exercise regularly to improve bone mass.
  • Severe and even rare life-threatening skin reactions (Stevens-Johnson syndrome, toxic epidemral necrosis)
  • A possible increased risk for birth defects (cleft palate, poor thinking skills)

Barbiturates (Phenobarbital and Primidone)

Phenobarbital (Luminal, generic), also called phenobaritone, is a barbiturate anticonvulsant. Primidone (Mysoline, generic) is converted in the body to phenobarbital, and has the same benefits and adverse effects.

Barbiturates may be used to prevent grand mal (tonic-clonic) seizures or partial seizures. They are no longer typically used as first-line drugs, although they may be the initial drug prescribed for newborns and young children.

Side Effects. Phenobarbital has fewer toxic effects on other parts of the body than most anti-epileptic drugs, and drug dependence is rare, given the low doses used for treating epilepsy. Nevertheless, many patients experience difficulty with side effects.

Patients sometimes describe their state as "zombie-like." The most common and troublesome side effects are:

  • Drowsiness
  • Memory problems
  • Problems with tasks requiring sustained performance
  • Problems with motor skills
  • Hyperactivity in some patients, particularly in children and the elderly
  • Depression in some adults

Review Date: 01/28/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)