Epilepsy Medication and EEG correlation

• The document outlines various medications, their classifications, purposes, side effects, and EEG (electroencephalogram) correlations.

Phenytoin/Dilantin

• Classification: Narrow spectrum
• Purpose: Treats simple and complex partial seizures, generalized tonic-clonic seizures (GTC), and is administered intravenously to stop seizures in progress.
• Side Effects: Unsteadiness, cognitive problems, body/facial hair growth, and osteoporosis.
• EEG:
  • Therapeutic levels: No significant or mild slowing.
  • Toxic levels: Generalized delta activity.

Phenobarbital

• Classification: Narrow spectrum
• Purpose: Used as an adjunct therapy in single daily doses for focal aware, focal impaired, GTC, and neonatal seizures.
• Side Effects: Depression, hyperactivity, impaired attention, memory problems, slurred speech, and potential for addiction due to sedative/hypnotic and anti-anxiety properties.
• EEG:
  • Non-toxic doses: Beta activity is anterior, transitioning to posterior.
  • Toxic doses: Generalized beta activity progressing to burst suppression.

Carbamazepine/Tegretol

• Classification: Narrow spectrum
• Purpose: Treats focal aware seizures, focal impaired awareness, bilateral tonic-clonic seizures, tonic-clonic seizures and temporal lobe epilepsy.
• Side Effects: GI upset, weight gain, blurred vision, low blood/sodium count, and severe reactions like Stevens-Johnson syndrome.
• EEG: None or mild alpha slowing with increased beta activity.

Gabapentin/Neurontin

• Classification: Narrow spectrum
• Purpose: Used for focal aware seizures, focal impaired awareness and secondary generalized seizures.
• Side Effects: Unsteadiness, weight gain, fatigue, and dizziness; can worsen generalized seizures, with or without impairment in awareness.
• EEG: Minimally increased theta and delta activity with decreased alpha activity.

Pregabalin/Lyrica

• Classification: Narrow spectrum
• Purpose: Acts as a partial treatment
• Side Effects: Unsteadiness, weight gain, fatigue, and dizziness.
• EEG: Rhythmic discharges and posterior spike wave discharges may be observed in acute toxicity.

Vimpat/Lacosamide

• Classification: Narrow spectrum
• Purpose: Treats partial and secondary generalization seizures.
• Side Effects: Dizziness, headaches, nausea/vomiting, and fatigue.
• EEG: Decreased frequency of alpha rhythm with IV administration.

Vigabatrin/Sabril

• Classification: Narrow spectrum
• Purpose: Used for partial seizures (with or without secondary generalization) and infantile spasms.
• Side Effects: Weight gain, neuropathy, edema, and visual damage.
• EEG: None reported.

Oxcarbazepine/Trileptal

• Classification: Narrow spectrum
• Purpose: Treats partial seizures.
• Side Effects: Low blood sodium, headaches, fatigue, diplopia, nausea, Stevens-Johnson syndrome, toxic epidermal necrolysis, and hyponatremia.
• EEG: Slowing of peak frequencies with increased theta and delta activity.

Zonisamide/Zonegran

• Classification: Narrow spectrum
• Purpose: Treats partial seizures.
• Side Effects: Skin rash, hives, difficulty breathing, swelling of lips, tongue, face, throat, and mood changes.
• EEG: Early trials suggest an increase in theta and delta activity.

Ethosuximide/Zarontin

• Classification: Narrow spectrum
• Purpose: Treats absence seizures.
• Side Effects: Upset stomach, diarrhea, anorexia, drowsiness, and behavioral changes.
• EEG: Little to no appreciable effect but decreases spike and wave discharges.

Clonazepam/Klonopin

• Classification: Broad spectrum
• Purpose: Treats absence seizures, myoclonic seizures, atonic seizures and Lennox-Gastaut associated seizures.
• Side Effects: Sedation, thinking/memory impairment, mood changes, and addiction.
• EEG: Loss of background, decreased voltage, frontal beta activity, and some theta activity.

Lamotrigine/Lamictal

• Classification: Broad spectrum
• Purpose: Used as an adjunct for partial seizures and is safe for pregnant women.
• Side Effects: Dizziness, fatigue, and mild cognitive impairment.
• EEG: Increases interictal spikes and photoparoxysmal responses.

Levetiracetam/Keppra

• Classification: Broad spectrum
• Purpose: Treats partial and GTC seizures.
• Side Effects: Dizziness, fatigue, and insomnia.
• EEG: Increased fast activity and a decrease in theta/delta activity.

Lorazepam/Ativan

• Classification: Broad spectrum
• Purpose: Short-term treatment for all types of seizures and status epilepticus and GTC.
• Side Effects: Drowsiness, dizziness, fatigue, confusion, suicidal thoughts, hallucinations, and tremors.
• EEG: Loss of background rhythm, decreased voltage, frontal beta activity and some theta activity.

Rufinamide/Banzel

• Classification: Broad spectrum
• Purpose: Treats Lennox-Gastaut associated seizures, absence, myoclonic, and atonic seizures.
• Side Effects: Headaches, dizziness, fatigue, diplopia, and tremor.
• EEG: No data available.

Topiramate/Topamax

• Classification: Broad spectrum
• Purpose: Treats partial seizures, GTC seizures, and all seizure types.
• Side Effects: Thinking/memory issues and weight loss.
• EEG: No effect reported.

Valproic Acid/Valproate/Depakote/Depakene

• Classification: Broad spectrum
• Purpose: Treats partial seizures, complex absence seizures, GTC seizures, myoclonic seizures and infantile spasms.
• Side Effects: Weight gain, tremor, hair loss, GI issues, decreased blood count, hepatic or pancreatic injury, birth defects, and bone weakness.
• EEG: No effect reported.

Felbamate/Felbatol

• Classification: Broad spectrum
• Purpose: Used when all other medications fail; treats partial seizures, some generalized seizures and Lennox-Gastaut associated seizures.
• Side Effects: Nausea, vomiting, indigestion, headaches, loss of appetite, and insomnia.
• EEG: No data available.

Tiagabine/Gabitril

• Classification: Broad spectrum
• Purpose: Treats partial seizures and some generalized seizures.
• Side Effects: Trouble concentrating, dizziness, drowsiness, nervousness, irritability, and shaking.
• EEG: Worsening of spike-wave discharges.

Phenobarbital/Luminal

• Classification: Broad spectrum
• Purpose: Treats most seizure types (including febrile seizures), not to be used for absence seizures; treats status epilepticus and partial complex seizures when others fail.
• Side Effects: Sleepiness, thinking/memory problems, depression, and addictive for its sedative and anti-anxiety effects.
• EEG: Generalized anterior dominant fast activity (1.5-3.5Hz), with posterior fast activity observed in children.

Mysoline/Primidone

• Classification: Broad spectrum
• Purpose: Treats focal seizures, GTC seizures, and myoclonic seizures.
• Side Effects: Shakiness, unsteady gait, trembling, loss of muscle control, loss of coordination, anaphylactic reactions, skin blisters and worsening of seizures.
• EEG: Increased fast activity, frontally predominant, decreased alpha activity, and delta slowing at toxic levels.

Diazepam/Valium/Diastat

• Classification: Broad spectrum
• Purpose: Short-term treatment for all seizures and status epilepticus.
• Side Effects: Drowsiness, memory problems, dizziness, and nausea.
• EEG: Frontally predominant fast activity, but can be more diffuse.

Haloperidol Lactate / Haldol

• Classification: Antipsychotic
• Purpose: Schizophrenia, Tourette's Syndrome, Tremors and Huntington's Chorea.
• Side Effects: 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, cardiac abnormalities, tardive dyskinesia and neuroleptic malignant syndrome.
• EEG: Paradoxical effects with slow and fast activity.

Chloral Hydrate

• Classification: Sedative
• Purpose: Intended to calm patients and induce sleep.
• Side Effects: Drowsiness, upset stomach, diarrhea, cardiac depression and arrhythmias and respiratory depression.
• EEG: little to none, increased anterior dominant beta

Chlordiazepoxide HCL / Librium

• Classification: Sedative
• Purpose: Tranquilizer
• Side Effects: Drowsiness/fatigue, swelling, skin rash, nausea/vomiting, constipation and irregular menstrual cycle.
• EEG: Anterior dominant diffuse fast activity

Chlorpromazine / Thorazine

• Classification: Sedative
• Purpose: Sedation
• Side Effects: Twitching or uncontrolled movements of eyes, lips, tongue arms, face, tremors, drooling, difficulty swallowing, gait disturbance, restlessness or agitation and fainting
• EEG: Wake, Diffuse slowing

Morphine

• Classification: Analgesic & Antibiotics
• Purpose: Analgesic/Severe pain relief
• Side Effects: Hypotension, drowsiness, issuing of a relaxed easy state, feeling faint, dizziness, excessive sweating and nausea
• EEG:
  • Acute dosage: Decrease in frequency and amount of alpha
  • Chronic dosage: Alpha returns to normal and increases in amount
  • Toxic dosage: Diffuse slowing

Codeine (Acetaminophen)

• Classification: Analgesic & Antibiotic
• Purpose: Analgesic/Pain and cough relief
• Side Effects: Dizziness, drowsiness, nausea, headache or blurred vision
• EEG:
  • Acute Dosage: Decrease in frequency and alpha
  • Chronic Dosage: Alpha returns to normal and increases in amount
  • Toxic Dosage: Diffuse slowing

ACTH (Adrenocorticotropic Hormone)

• Classification: Polypeptide Tropic Hormone
• Purpose: Infantile spasms/Treatment of cerebral edema with brain tumors
• Side Effects: Scaly oily skin problems primarily on face and scalp, excessive hairiness, skin discolorations and easily angered or annoyed.
• EEG: Other than normalizing the EEG, there are no ill effects