This document discusses the treatment of epilepsy through antiepileptic medications and new treatments. It provides a history of antiepileptic medications from 1912 to the present, describing key medications introduced over time. It discusses factors that influence drug selection and compliance, side effects of medications, and newer antiepileptic medications that have been approved. It also briefly discusses non-medication treatments for epilepsy including neurostimulators, deep brain stimulation, and magnetoencephalography.
This is an introduction to pediatric psychopharmacology. Presentation done on July 25th as a part of the nuts and bolts lecture series. Thanks to all the chief fellows over the last 6 years who have contributed to the development of these slides. Please refer to scientific literature for accuracy. This can serve as a rough guide to pediatric psychopharm for child and adol psychiatry fellows as well as residents, and medical students. If you have any questions please feel free to send them my way at pallavpareek@gmail.com
This is an introduction to pediatric psychopharmacology. Presentation done on July 25th as a part of the nuts and bolts lecture series. Thanks to all the chief fellows over the last 6 years who have contributed to the development of these slides. Please refer to scientific literature for accuracy. This can serve as a rough guide to pediatric psychopharm for child and adol psychiatry fellows as well as residents, and medical students. If you have any questions please feel free to send them my way at pallavpareek@gmail.com
LGS Foundation 2016 Conference - Friday MorningLGS Foundation
Topics Include: Therapies for LGS (Part One) - Pharmacological, presented by Angus A WIlfong, MD and Therapies for LGS (Part 2) - Non-Pharmacological presented by Scott Demarest, MD
The Centers for Medicare and Medicaid Services (CMS) recently released S&C Memo 13-35-NH, which discusses the use of psychopharmacological medications and behavioral management in America’s Nursing Homes. The management of behavioral or psychological symptoms of dementia (BPSD) is a challenge in Nursing Homes. In this presentation viewers will learn valuable behavioral management techniques that can be utilized to decrease patient dependency on psychopharmacological medication. Important government initiatives, including The Partnership to Improve Dementia Care in Nursing Homes are discussed. The presentation also discusses the recent updates to interpretive guidelines of F309 (Quality of Care) and F329 (Unnecessary Drugs), and details the Seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD.
1. Learn the content of S&C Memo 13-35-NH and the implications of this memo on daily resident care
2. Learn to articulate the intent and impact of F309 and F329 on resident health and well-being, and identify strategies to maintain compliance with the regulatory intent of these regulations
3. Learn about the seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD
4. Identify the seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD
New Treatment Devices and Clinical Trials jgreenberger
Dr. Kathryn Davis from Penn Epilepsy Center present on new treatment devices and clinical trials for epilepsy. From the 2014 Epilepsy Education Exchange.
The high prevalence of substance use in pregnant women highlights the importance of improving public education on the -
- Risks of substance use in pregnancy
- Increasing preventive services
- Providing treatment for pregnant women who are in need
LGS Foundation 2016 Conference - Friday MorningLGS Foundation
Topics Include: Therapies for LGS (Part One) - Pharmacological, presented by Angus A WIlfong, MD and Therapies for LGS (Part 2) - Non-Pharmacological presented by Scott Demarest, MD
The Centers for Medicare and Medicaid Services (CMS) recently released S&C Memo 13-35-NH, which discusses the use of psychopharmacological medications and behavioral management in America’s Nursing Homes. The management of behavioral or psychological symptoms of dementia (BPSD) is a challenge in Nursing Homes. In this presentation viewers will learn valuable behavioral management techniques that can be utilized to decrease patient dependency on psychopharmacological medication. Important government initiatives, including The Partnership to Improve Dementia Care in Nursing Homes are discussed. The presentation also discusses the recent updates to interpretive guidelines of F309 (Quality of Care) and F329 (Unnecessary Drugs), and details the Seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD.
1. Learn the content of S&C Memo 13-35-NH and the implications of this memo on daily resident care
2. Learn to articulate the intent and impact of F309 and F329 on resident health and well-being, and identify strategies to maintain compliance with the regulatory intent of these regulations
3. Learn about the seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD
4. Identify the seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD
New Treatment Devices and Clinical Trials jgreenberger
Dr. Kathryn Davis from Penn Epilepsy Center present on new treatment devices and clinical trials for epilepsy. From the 2014 Epilepsy Education Exchange.
The high prevalence of substance use in pregnant women highlights the importance of improving public education on the -
- Risks of substance use in pregnancy
- Increasing preventive services
- Providing treatment for pregnant women who are in need
Basic rules of geriatric psychpharmacologyIhab M Saleh
1- Who are Geriatrics?
2- Why are they considered a specific group?
3- Pharmacokinetic and Pharmacodynamic changes in Geriatrics
4- Changes of the aged brain.
5- Psychiatric drugs using in Geriatrics in:
- Depression and Anxiety
- Mania
- Schizophrenia and Psychosis
- Mild cognitive impairment and Dementia
Effects of Overdose of Analgesics | NSAIDS and Opioids Overdose effects Dr. Rajat Sachdeva
Analgesics aka Pain killer not only relieving from pain but they also have bad effects on overdose.
Intentionally or unknowingly, it affects both. NSAIDS and Opiods both affects systemically.
Opioids interacts its receptor in brain and prevents a chemical GABA from release, these controls Dopamine. Increase in Dopamine concentration causes feeling of euphoria, constipation, itching, ineffective ventilation respiratory effects during sleep or sleep apnea.
NSAIDs affects Liver, kidney, pregnant, breastfeeding, Peptic ulcer, Asthma, Allergies, Chron's disease.
Pain killer along with alcohol is more harmfull as it depresses brain synergistically.
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R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
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CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
5. History of Antiepileptic
Medications
1912
• Phenobarbital was the primary medication used
for seizures.
• Used for generalized tonic-clonic and to a lesser
extent partial seizures. No effect on absence
seizures.
• Sedative effect occurred in many people.
Hyperactivity noted in children.
6. History of Antiepileptic
Medications
1938
• Diphenylhydantoin (Dilantin) was
discovered to have antiepileptic properties.
• Similar effectiveness to phenobarbital.
• Less sedative side effects.
7. History of Antiepileptic
Medications
1960-1974
• U.S. Food and Drug Administration (FDA)
imposed new regulations on pharmaceutical
companies.
• Medications were now required not only to be safe
but they had to be proven effective against the
illness it was designed to treat.
• Only one medication for seizures was developed
during this time. Valium was found to be an
effective treatment for status epilepticus.
8. History of Antiepileptic
Medications
• 1974: Carbamazepine (Tegretol)
• 1978: Valproic acid (Depakote)
• 1993-Present: Rapid emergence of very
effective seizure medications.
11. When to Treat?
• Are the episodes really seizures?
• EEG: Normal or abnormal?
• Frequency and type of episodes?
• Are there other neurologic problems?
• What is the cause of the seizures? Can the
underlying problem be treated rather then
treating the symptom (i.e. the seizure)?
12. When Not to Treat
• Single seizure
• No history
• Neurologically normal
• Young age
• Side effect concerns
13. First Seizure
• Studies have shown that a otherwise normal
child who had a single seizure has a 15%
chance of having a second seizure if left
untreated.
• Physicians will typically wait until a second
or third seizure before initiating treatment
with antiepileptic medication.
14. First Seizure
• For a child who is neurologically abnormal
or has an abnormal EEG- the risk of
subsequent seizures is substantially
increased to between 50-60%.
15. When to Treat?
Risk-Benefit Ratio
• In determining whether to treat physicians
consider many factors.
• The benefits of further seizure activity is
weighed against the potential side effects of
the antiepileptic medications.
• The decision to treat is a highly individualized
one.
16. Key Concepts in Antiepileptic
Treatment
-Metabolism-
• The process by which medications are
broken down and eliminated by the body.
• Most antiepileptic medications are
metabolized by the liver.
• Some antiepileptic medications are
metabolized by the kidneys.
17. Key Concepts in Antiepileptic
Treatment
-Metabolism-
• Children generally have a faster metabolism
and thus require higher then expected
dosages of medications to maintain
adequate blood levels.
• Older people typically have slower
metabolisms and thus require less
medication. Often they can become toxic on
normal dosages of medication.
18. Key Concepts in Antiepileptic
Treatment
Half-life
• The time it takes your body to eliminate half the
medication in your body.
• After one half-life the amount of medication in
your body will decrease by 50 %.
• After 5 half-lives 95% of the medication will be
removed from your body.
• Half-lives vary greatly among seizure medications.
19. Key Concepts in Antiepileptic
Treatment
Steady State
• A balance obtained when the amount of
medication you take into your body equals
the amount being eliminated.
• May take days to reach a steady state when
starting or changing doses of medications.
• Full therapeutic effect of a medication is not
reached until steady state is achieved.
20. Key Concepts in Antiepileptic
Treatment
Therapeutic Range
• The blood levels of medication that for
most people will provide an adequate
seizure reducing effect without excessive
side effects.
• Treat the person not the range! Everyone
responds differently. Some people can be
effectively treated with blood levels above
or below the therapeutic range.
21. Key Concepts in Antiepileptic
Treatment
Mechanism of Action
• How do medications work? For many
medications this is still not well understood
• Proposed mechanisms involve increasing
the amount of inhibitory neurotransmitters
or changes in the flow of ions (sodium or
chloride) across the neuron cell membrane.
22. Factor Influencing Drug
Selection
• Many antiepileptic medications are
effective against specific seizure types.
• It is very important to know the specific
type or types of seizures a patient is having
so that the appropriate medication can be
chosen.
• On occasion the wrong medication can
actually make seizures worse.
23. Factor Influencing Drug
Selection
• Seizure type
• Syndrome
• Side effects
• Patient age
• Lifestyle
• Childbearing potential
• Other medications
24. Factor Influencing Drug
Selection
Monotherapy or Polytherapy
• Monotherapy is usually the preferred
treatment.
• A single drug is prescribed in increasing
increments until seizures are controlled or
toxicity occurs.
• If the drug is ineffective or side effects
occur, the drug is slowly withdrawn while
another medication is slowly introduced.
25. Advantages of Monotherapy
• 70-80% of patients are controlled on
monotherapy.
• Fewer side effects.
• No drug interactions.
• Easier dosing = Greater compliance
• Lower cost.
26. Advantages of Polytherapy
• May control an additional 20% of patients
that could not be controlled with
monotherapy.
• May provide synergistic effects. (1+1=3)
27. Side Effects
• All seizure medications can have side
effects.
• Side effects can be grouped as:
– Dose related
– Dose unrelated (occur at any dosage)
– Idiosyncratic
28. Side Effects
Dose related
• Some effects are dose related. That is they
become more likely as the amount of
medication is increased.
• Sleepiness, slurred speech, and unsteadiness
are common effects of seizure medications
at higher doses.
29. Side Effects
Dose unrelated
(Common at any dose)
• Some side effects can occur at any dosage.
• Examples include double vision, weight gain,
hyperactivity, sleep disturbances, irritability, hair
growth, gum growth, and changes in mood.
• On occasion these effects are seen at the start of
treatment and gradually get better with time.
30. Side Effects
Idiosyncratic
• A rare side effect that occurs because of a
patients individual sensitivity or allergic
reaction to a particular medication.
• Examples include: Liver failure, aplastic
anemia, severe rashs (Steven Johnson
Syndrome).
32. Side Effects
Pregnancy
• All seizures medication pose some risk to the
developing fetus.
• None of the commonly used seizure
medication are absolutely contraindicated in
pregnancy.
• Possible side effects include cleft palate/lips,
cardiac abnormalities, and spinal tube
defects.
33. Side Effects
Pregnancy
• Antiepileptic medications can reduce the
effectiveness of certain birth control pills.
• It is important to tell your doctors about all
the medications you are taking so that
potential interactions can be discussed and
avoided.
34. Side Effects
Pregnancy
• Folic acid is frequently prescribed to all
women of child baring age as it is believed
to protect against some birth defects.
• Good news! 90% of women with epilepsy
who become pregnant will give birth to
normal healthy babies.
35. Compliance
• The degree to which the patient follows the
physicians directions on how and when
medications should be taken.
• 73% of people with epilepsy were found to
be compliant with medications.
• Compliance is very important in epilepsy
treatment as blood levels of medications
will fall low if dosages are missed.
36. Reasons for non-compliance
• Do not need so much medication
• Unpleasant side effects
• Making the drug last longer because of cost
• Forgetfulness
• Confusion about dosages and times
• Inconvenience of schedule
• Misunderstand directions
37. Effectiveness of Treatment
• 75-80% of patients with epilepsy will have
reliable long term control of their seizures
with currently available medications.
• For the remainder of patients with intractable
seizures other options exist such as epilepsy
surgery, neuro-stimulators and the ketogenic
diet.
38. Discontinuing Antiepileptic
Medications
• Antiepileptic medications may not have to
be taken for a lifetime.
• When seizures have been controlled over a
period of time (usually one to two years),
there is a good chance that withdrawal of
medication will be successful.
39. Factors Associated with Seizure
Recurrence
• Abnormal EEG
• Hard to control seizures
• Neurologic deficits
• Epilepsy type
40. Factors Associated with
Non-Recurrence in Adults
• Primary generalized seizure type
• Under 30 years of age
• Prompt initial control
• 2-5 years of seizure freedom
43. Sabril (Vigabatrin)
• Approved as monotherapy for patients 1
month to 2 years of age with infantile
spasms.
• Approved as add-on therapy for adults with
complex partial seizures.
• Can cause eye injury (Retinal damage).
44. Banzel (Rufinamide)
• Approved for the treatment of seizures for
children and adults (> 4 years old) with
Lennox-Gastaut Syndrome.
45. Clobazam (Onfi)
• New Drug on market:
• MOA: works on GABA receptors
• Indication: Adjunctive treatment of seizures
associated with Lennox-Gestault syndrome
• Dosage: initiate at 5mg daily, then slowly titrate
to 10mg twice daily.
• Significant reduction in drop seizures was end
point of trials
• Side effects: somnolence, fever, drooling,
lethargy, constipation
46. Vimpat (Lacosamide)
• Approved as add-on treatment in adults
with partial onset seizures.
• Unique mechanism of action.
• Low side effect profile.
47. Seizures: Eslicarbazepine acetate
(Aptiom)
• New drug on market
• Indicated for adjunctive treatment for partial onset
seizures in adults
• Dosage: 400mg/day x 1 week, max 1200mg/day,
taken whole or crushed, with or without food
• Inhibits voltage gated sodium channel
• Metabolized in liver, excreted in urine
• Side effects: dizziness, somnolence, nausea,
vomiting, headache, diplopia, fatigue, blurred
vision, abnormal gait, hyponatremia
48. Seizures: Eslicarbazepine acetate
(Aptiom)
• No clinically significant drug-drug interactions
when administered with valproate, lamotrigine,
topiramate, leviteracetam, or gabapentin.
Dosage adjustments if used with
carbamazepine or phenytoin
• Does not induce its own metabolism
• No therapeutic drug monitoring required
• Not a controlled substance
49. Seizures: Perampanel (Fycompa)
• New drug on market
• Indicated for adjunctive treatment of partial onset seizures
• MOA: reduces glutamate-mediated neuronal excitation
• Metabolized in liver, excreted in urine/feces
• Start at 4mg and increase to 8-12 mg
• Side effects: dizziness, somnolence, headache, fatigue, falls,
irritability, hyponatremia
• Black box warning: serious or life threatening reactions
including aggression, hostility, irritability, anger, homicidal
ideation and threats w/ or w/o previous psychiatric diagnosis
50. Seizures: Ezogabine (Potiga)
• New drug on market
• Indicated for adjunctive therapy for partial seizures
• MOA: activates potassium ion channels, stabilizing
neuronal membranes and reducing brain excitability,
augments GABA
• Dosing: 200-400mg tid, start at 100mg tid
• Metabolized in liver, excreted in urine
• Side effects: dizziness, somnolence, fatigue, nausea,
diplopia, tremor, confusion
• Black box warning: retinal abnormalities and potential
vision loss (similar to vigabatrin (Sabril))
51. Seizures: Topiramate (Qudexy
XR)
• Long acting formulation of drug on market
• Indication: monotherapy and adjunctive therapy in partial
seizures; monotherapy and adjunctive therapy in primary
generalized seizures; adjunctive therapy in Lennox-Gastaut
seizures
• Dosage: 200-400mg/day (start at 50mg x1 wk, then increase
weekly as needed)
• MOA: blocks voltage dependent sodium channels; augments
GABA activity; antagonizes glutamate receptors; inhibits
carbonic anhydrase (inhibits fluid buildup)
• Metabolized in liver, excreted in kidney
• Side effects: metabolic acidosis, somnolence, dizziness, weight
loss, fatigue, anorexia, cognitive issues
52. Briviact (Brivaracetam)9,14
• Approved by the FDA in February 2016
• Approved for the treatment of partial onset seizures related to
epilepsy
• Studied use alongside carbamazepine, lacosamide, lamotrigine,
keppra, oxcarbazepine, phenobarbital, phenytoin, pregabalin,
topiramate, valproic acid, and zonisamide
• Antiepileptic
• Mechanism of Action is currently unknown
• Class-V controlled substance
• Why develop med?
– For patients not adequately controlled by 1-2 concomitant
AED’s and available in multiple formulations.
53. Briviact (Brivaracetam)9,14
• FDA approval of Briviact stems from three major trials that evaluated
the efficacy of Briviact.
• Available in tablet, oral solution, and IV administration formulations
– May give tablet formulation with or without food and are to be
swallowed with liquid.
– Injection should be administered intravenously over 2-15 minutes.
– May further dilute or mix with 0.9% NS, Lactated Ringer’s, or
D5W injections.
• Recommended starting dose is 50mg twice daily (100mg daily).
• May adjust dosage to as low as 25mg twice daily (50mg daily) or
100mg twice daily (200mg daily).
54. Briviact (Brivaracetam)9,14
• Warning
– May increase the risk of suicidal behavior and/or suicidal
ideation
• Side-Effects:
– Somnolence/sedation
– Dizziness
– Fatigue
– Nausea/vomiting
– Euphoria
– Infusion site pain
– Feelings of “drunkenness”
55. Newer Treatments
Neuro-stimulators
Deep Brain Stimulation
• Promising new technology for medically-
refractory seizures.
• Stimulator electrodes are placed deep
within the brain and are connected to a
pacemaker-like device in the chest.
56. Newer Developments
MEG
(Magnetoencephalography)
• Measures the small electrical currents
arising inside the neurons of the brain.
• Similar to EEG but provides greater
accuracy.
• Used to locate where seizures are coming
from within the brain.
• Can be used to map brain functions
Editor's Notes
Studied use while alongside carbamazepine, lacosamide, lamotrigine, keppra, oxcarbazepine, phenobarbital, phenytoin, pregabalin, topiramate, valproic acid, and zonisamide. No benefit was seen while using Briviact alongside lamotrigine.