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Seizures: Pathophysiology and Best Approaches. Drugs Implemented in Treatment
A seizure (also known as an epileptic fit) is a clinical manifestation of a brain abnormality that comes from its excessive electrical activity typical of diseases that bear the collective name of epilepsy. Outwardly, they may manifest themselves in the form of uncontrolled jerking and lead to the loss of consciousness. The first form is called a tonic-clonic seizure, whereas the second is an absence seizure. Two phenomena can be singled out in the pathophysiology of seizures: 1) hyper-excitability of one neuron; 2) hyper synchronization (which implies that one hyper-excitable neuron creates an abnormal electrical impulse by exciting a considerable number of surrounding neurons) (Moshé, Perucca, Ryvlin, & Tomson, 2015).
The best approach to treatment is the one that helps achieve a seizure-free status avoiding side effects. Most patients can achieve this taking anticonvulsant drugs; however, there are cases of refraction to medications. Monotherapy is the preferable treatment as it reduces the possibility of adverse effects that may arise due to a drug interaction. Medicines used to treat seizures include, among others (Engel, 2013):
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carbamazepine;
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diazepam;
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tranxene;
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eslicarbazepine;
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ethosuximide;
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felbamate;
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gabapentin;
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lacosamide;
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oxcarbazepine;
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phenobarbital;
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phenytoin;
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primidone;
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topiramate;
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valproate;
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zonisamide.
Drug treatment should be combined with psychological and social rehabilitation.
Antipsychotic Drugs: Implementation and Significant Side Effects
Antipsychotic drugs (neuroleptics or tranquilizers) belong to the class of medications used to treat various forms of psychosis that are mostly associated with schizophrenia or bipolar disorder; however, they are now also widely implemented for non-psychotic conditions (Leucht et al., 2013). Antipsychotic drugs are most commonly used in cases of (Owens, 2014):
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schizophrenia (as a critical component of the treatment algorithm);
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bipolar disorder (for which both typical and atypical antipsychotics are applied with the preference given to the latter as they are less likely to cause depression as a side effect);
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schizoaffective disorder (implemented in combination with antidepressants or mood stabilizers depending on whether the patient has the depressive or the bipolar condition);
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psychotic depression (in combination with antidepressants);
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treatment-resistant depression (in addition to typical treatment).
Antipsychotic drugs may bring about quite a significant number of side effects (including such minor ones as headaches, dizziness, anxiety, and dry mouth), the most notable of which are: parkinsonism, tremor, osteoporosis, dystonia, sexual dysfunction, problems with vision, movement disorders, metabolic syndrome, etc. They are also believed to increase mortality rates among people who have dementia (Owens, 2014).
Benzodiazepines and Barbiturates: their Use, Precautions, and Implementation for Seizures
Benzodiazepines (usually called benzos) belong to psychoactive drugs with a wide range of effects, including muscle relaxation and convulsion release. Moreover, they can also be used as sedative, hypnotic, and anxiolytic drugs. Their effect stems from their ability to activate neurotransmitter gamma-aminobutyric acid (GABA). This acid suppresses the activity of neurons that create anxiety. That is why benzos are used to treat insomnia, panic attacks, and muscle spasms. They should be used with caution as there is a high risk of dependence that can appear even within several days (Dellosso & Lader, 2013).
Barbiturates form a class of prescription medications derived from barbituric acid, the significant effect of which is to paralyze the central nervous system. This is achieved by regulating neurotransmitter GABA responsible for anxiety levels. They are implemented to deal with stress, insomnia, and epileptic seizures. However, they are currently being substituted for Benzodiazepines (Holtkamp, 2016).
Barbiturates are prescribed for a minimum term of use as they are even more addictive than benzos, which can be life-threatening (Holtkamp, 2016).
Both medication types are used in managing status epilepticus; yet, their chronic implementation can bring about hypnotic effects that distort the cognitive function.
References
Dellosso, B., & Lader, M. (2013). Do benzodiazepines still deserve a major role in the treatment of psychiatric disorders? A critical reappraisal. European Psychiatry, 28(1), 7-20.
Engel, J. (2013). Seizures and epilepsy (Vol. 83). Oxford , UK: Oxford University Press.
Holtkamp, M. (2016). Should barbiturates be used in refractory status epilepticus? Journal of Clinical Neurophysiology, 33(1), 22-24.
Leucht, S., Cipriani, A., Spineli, L., Mavridis, D., Örey, D., Richter, F.,& Kissling, W. (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: A multiple-treatments meta-analysis. The Lancet, 382(9896), 951-962.
Moshé, S. L., Perucca, E., Ryvlin, P., & Tomson, T. (2015). Epilepsy: New advances. The Lancet, 385(9971), 884-898.
Owens, D. C. (2014). A guide to the extrapyramidal side-effects of antipsychotic drugs. Cambridge, UK: Cambridge University Press.
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