Effect of Medicationson Recordings and Patients · Clonazepam/Klonopin Absence Myoclonic Atonic Lennox-Gastaut associated seizures Purpose Loss of background Decreased voltage Frontal

Effect of Medications on Recordings and Patients

© Trusted Neurodiagnostics Academy

Medication Effect

Purpose, Effect on

EEG, Effect on People

AntiepilepticMedications

Sedatives Analgesics

Additional Classes

Generic/Brand Name• Seizure type treatedPurpose

• Either research evidence• Or none known

EEG Effects

• MildSide effects

• Life threatening side effectsSerious Side effects


Antiepileptic/AntiseizureAnticonvulsant/AED/ASM

• Used to control or prevent serious seizures. The specific drug therapy is based on the type and frequency of the seizures.

Purpose & use

• At therapeutic levels most antiepileptic medications have little or no effect on the EEG signal. Medications exceeding toxic levels tend to increase beta activity.

Effects on EEG


Broad Spectrum

• Valproic acid• Lamotrigine• Topiramate• Zonisamide• Levetiracetam• Clonazepam• Rufinamide• Felbamate

Narrow Spectrum

• Phenytoin• Phenobarbital• Carbamazepine• Oxcarbazepine• Gabapentin• Pregabalin• Lacosamide• Vigabatrin

Anticonvulsant Classes


Narrow spectrum AEDs

phenytoin (Dilantin) phenobarbital carbamazepine

(Tegretol)

oxcarbazepine (Trileptal)

gabapentin (Neurontin)

pregabalin (Lyrica)

lacosamide(Vimpat)

vigabatrin (Sabril)


Phenytoin / Dilantin

• Simple and Complex Partial• Generalized Tonic Clonic• IV administered to stop seizure in

progressPurpose

• Therapeutic levels• None• Mild slowing

• Toxic levels• Generalized delta

Effects on EEG


Phenytoin Cont’d• Unsteadiness• Cognitive problems• Body/facial hair growth• Skin problems• Osteoporosis

Effects on patients

• Can cause a decrease in blood levels of other antiepileptic drugs & medications

Drug Interactions


Phenobarbital

• Adjunctive therapy, single daily dose• Focal aware, focal impaired and generalized

tonic clonic seizures and neonatal seizures• Status epilepticus

Purpose

• Non-toxic doses: • Beta anterior transitioning to beta posterior

• Toxic doses:• Generalized beta progressing to burst

suppression

EEG affect


Phenobarbital• Depression• Hyperactivity• Impaired attention• Memory problems• Slurred speech• Rash

Side effects

• Addictive (sedative/hypnotic/anxiolytic properties)• Proven to cause birth defects• Drug-drug interactions – particularly other

anticonvulsants and birth control

Significant side

effects


Carbamazepine/Tegretol

• Focal aware, focal impaired awareness

• Generalized tonic-clonic• Temporal lobe epilepsy

Purpose

• None or mild alpha slowing• Increased beta

Effects on EEG


Carbamazepine Cont’d• GI upset• Weight gain• Blurred vision• Low blood count• Low sodium count

Effects on

patients

• Stevens Johnson Syndrome, toxic epidermal necrolysis• Painful, blister skin condition syndrome

from mild to potentially fatal

Serious Side

Effects


Gabapentin/Neurontin

• Focal aware, focal impaired awareness

• Secondary generalizationPurpose

• Minimally increased delta and theta

• Decreased alpha

Effects on EEG


Gabapentin Cont’d• Unsteadiness• Weight gain• Fatigue• Dizziness

Effects on

patients

• Can worsen generalized seizures with and without impairment in awareness

Serious Side

effects


Pregabalin/Lyrica

• Focal aware, focal impaired awarenessPurpose

• Rhythmic discharges and posterior spike wave discharges noted in acute toxicity

Effects on EEG

• Unsteadiness• Weight gain• Fatigue• Dizziness

Effect on Patient


Vimpat/Lacosamide

• Focal aware, focal impaired awareness• Secondary generalizationPurpose

• Decreased frequency of alpha rhythm with IV administration

Effects on EEG

• Dizziness• Headaches• Nausea or vomiting• Fatigue

Effect on Patient


Vigabatrin/Sabril

• Focal, with or without secondary generalization• Infantile spasmsPurpose

• NoneEffects on EEG

• Weight gain• Neuropathy• Edema• Permanent vision loss

Effect on Patient

Antiepileptic Medicationsfor Focal Seizures


Oxcarbazepine/Trileptal

• Focal aware, focal impaired awarenessPurpose

• Slowing of peak frequency• Increased theta and delta

Effects on EEG


Oxcarbazepine Cont’d• Hyponatremia• Headaches• Tiredness• Diplopia• Nausea• Balance disturbance

Effects on

patients

• Stevens-Johnson Syndrome• Toxic epidermal necrolysis• Hyponatremia• Anaphylaxis and angioedema

Serious Side

Effects


Zonosamide/Zonegran

• PartialPurpose

• Possible mild increase of theta-delta activityEffects on EEG

• Skin rash, hives• Difficulty breathing• Swelling lips, tongue, face, throat• Mood changes, Anxiety

Effect on Patient

Antiepileptic Medicationsfor Generalized Seizures


Ethosuximide/Zarontin

• AbsencePurpose

• Little to no appreciable effect• Decreased spike and wave

Effects on EEG

• Stomach upset• Diarrhea• Anorexia• Drowsiness, behavioral changes

Effect on Patient


Ethosuximide Cont’d

• Psychological changes: anxiety, depression, panic attacks, trouble sleeping, agitated, hostile, aggressive, restless, hyperactivity

Side Effects

• Stevens-Johnson Syndrome• Suicidal thoughts

Serious side

effects

Broad Spectrum Antiepileptic Medications


Broad Spectrum AEDs

Broad Spectrum

• Clonazepam• Lamotrigine• Levetiracetam• Rufinamide• Topiramate• Valproic acid• Zonisamide


Clonazepam/Klonopin

• Absence• Myoclonic• Atonic• Lennox-Gastaut associated seizures

Purpose

• Loss of background• Decreased voltage• Frontal beta• Some theta

Effects on EEG


Clonazepam Cont’d

• Sedation• Thinking and memory impairment• Mood changes• Addiction

Effects on

patients

• Allergic reaction• Jaundice• Hallucinations, confusion, or

changes in vision

Serious Side

effects


Lamotrigine/Lamictal

• Focal, with or without secondary generalizationPurpose

• Increases interictal spikes inphoto- paroxysmal responses

Effects on EEG

• Dizziness• Fatigue• Mild cognitive impairment

Effect on Patient


Levetiracetam/Keppra

• Focal, with or without secondary generalization• Generalized tonic-clonicPurpose

• Studies suggest: increase in faster activity and decrease in theta/delta activity

Effects on EEG

• Dizziness• Fatigue• Insomnia

Effect on Patient


Lorazepam/Ativan

• Short term treatment of all seizures

• Status epilepticus• GTC

Purpose

• Loss of background rhythm• Decreased voltage• Frontal beta• Some theta

Effects on EEG


Lorazepam Cont’d• Drowsiness• Dizziness• Tiredness• Confusion

Effects on

patients

• Allergic reactions• Suicidal thoughts, hallucinations• tremors

Serious Side

Effects


Rufinamide/Banzel• Lennox-Gastaut associated seizures

• Absence• Myoclonic• Atonic

Purpose

• No data is available on the effect of rufinamide on EEGEffects on

EEG• Headaches• Dizziness• Fatigue• Diplopia• Tremor

Effects on patients


Topiramate/Topamax• Focal, with or without secondary

generalization• All seizure types

Purpose

• No effectEffects on EEG

• Thinking and memory issues• Weight loss

Effect on Patient


Valproic Acid/ Depakote, Depakene, Valproate, Depacon

• Focal• Complex Absence• GTC• Myoclonic

Purpose

• NoneEffects on EEG


Valproic acid Cont’d• Weight gain• Tremor• Hair loss• GI issues• Decreased blood count

Effects on

patients

• Hepatic or pancreatic injury• Bone weakness over time• Birth defects

Serious Side

effects


Felbamate/Felbatol• When all other medications fail• Focal• Some generalized• Lennox-Gastaut related seizures

Purpose

• No data availableEffects on

EEG• Nausea, vomiting, and indigestion• Headache• Loss of appetite• Insomnia

Effects on patients


Tiagabine/Gabitril

• Partial• Some generalizedPurpose

• Worsening of spike wave discharges on EEGEffects on

EEG• Trouble concentrating• Dizziness• Drowsiness• Nervousness and irritability• Shaking

Effects on patients


Phenobarbital / Luminal

• Most seizure types (including febrile)• Not to be used for Absence• Status epilepticus• Focal, when others fail

Purpose

• Generalized anterior dominant fast (15 - 35 Hz)

• Posterior fast (children)

Effects on EEG


Phenobarbital Cont’d

• Sleepiness• Thinking or memory problems• Depression

Effects on

patients

• Addictive for its sedative-hypnotic and anti-anxiety effects

Serious side

effects


Mysoline/Primidone

• Focal• GTC• Myoclonic

Purpose

• Increased fast activity, frontally predominant

• Decreased alpha• Toxic dosage - Delta

Effects on EEG


Mysoline Cont’d• Shakiness• Unsteady gait• Trembling• Loss of muscle control• Loss of coordination

Effects on

patients

• Anaphylactic reactions• Blistering skin lesions• Worsening of seizures

Serious side

effects


Diazepam/Valium/Diastat

• Short term treatment of all seizure types• Status epilepticusSeizure

• Frontally predominant beta activity, but can also be more diffuseEffects on

EEG• Drowsiness• Memory problems• Dizziness, spinning sensation• Muscle weakness• Nausea

Effects on patients

Additional Drug Classifications


Antibiotics

Penicillin Cephalosporins

Antimycobacterial Quinolones

Antipsychotics


Haloperidol lactate/Haldol

• Schizophrenia• Tourette’s Syndrome• Tremors• Huntington’s Chorea

Purpose

• Paradoxical effects• Slow and fast activity

Effects on EEG


Haldol Cont’d• 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

Effects on

patients

• Cardiac abnormalities• Tardive dyskinesia• Neuroleptic Malignant Syndrome

Serious side

effects

Sedatives


Chloral Hydrate

• Calm patients and induce sleepPurpose

• Little to none• Increased anterior dominant beta

Effects on EEG

• Drowsiness• Upset stomach• Diarrhea

Effects on patients

• Cardiac depression & arrhythmias• Respiratory depression• Paradoxical reactions, delirium incoherence

Serious side effects


Chlordiazepoxide HCL/Librium

•TranquilizerPurpose

•Anterior dominant diffuse fastEffects on

EEG• Drowsiness/Tiredness• Swelling• Skin rash• Nausea/Vomiting• Constipation• Irregular menstrual cycle

Effects on patients


Chlorpromazine/Thorazine

• SedativePurpose

• Sleep• Sleep spindles and central transients

depressed• Wake

• Diffuse slowing

Effects on EEG


Chlorpromazine Cont’d• Twitching or uncontrolled movements of your eyes, lips, tongue,

arms, face• Tremor• Drooling• Difficulty swallowing• Gait disturbance• Restlessness or agitation• Faintness

Effects on

patients

• Dementia related psychosis• Cardiovascular related events• Gastrointestinal necrosis• Neuroleptic Malignant Syndrome

Serious side

effects

Analgesics & Antibiotics


Morphine

• Analgesic/Severe pain reliefPurpose

• Acute dosage• Decrease in frequency and amount of alpha

• Chronic dosage• Alpha returns to normal and increases in amount

• Toxic dosage• Diffuse slowing

Effects on EEG


Morphine• Hypotension• Drowsiness• Issuing of a relaxed easy state• Feeling faint• Dizziness• Excessive sweating• Nausea

Effects on

patients

• Acute overdose• Myoclonic spasms• Respiratory depression• Cardiovascular changes• Psychiatric changes

Serious Side

Effects


Codeine-Acetaminophen

• Analgesic (pain and cough relief)Purpose

• Acute dosage - decrease in frequency and amount of alpha• Chronic dosage - alpha return to normal and increases in

amount• Toxic dosage - diffuse slowing

Effects on EEG

• Dizziness• Drowsiness• Nausea• Headache or blurred vision

Effects on patients


Antibiotics• SIRPIDs• Diffuse slowingCefepime

• NCSE• Triphasic wavesCephalosporins

• NCSE• Spike wave/polyspike wave

Penicillins: Fluoxacillin

Additional Drugs and Treatments to Know


ACTH/Adrenocorticotrophic Hormone

• Treatment of cerebral edema with brain tumors• Infantile spasmsPurpose

• Other than normalizing the EEG, there are no ill effects per the latest research

Effects on EEG

• Scaly oily skin problems primarily on face and scalp• Excessive hairiness• Skin discolorations• Easily angered or annoyed• Cushing's Syndrome

Effects on patients


Amytal

•Wada TestingPurpose

•Enhanced betaEffects on

EEG• Sedative• Agitation• Confusion• Ataxia• Dizziness• Anxiety

Effects on patients


VNS or Vagal Nerve Stimulator

• Refractory Focal epilepsy• Refractory Symptomatic generalized epilepsy• Refractory Idiopathic generalized epilepsy

Purpose

• Small electrical impulses to the brain via the vagus nerve• Frequency and intensity of impulses can be programmed by physician• Implanted below the collarbone• Thin wires threaded around the vagus nerve in the neck

Mechanism of action

• Mild side effects occur only when the nerve is being stimulated. Brief hoarseness to the voice, difficulty swallowing and possibly a cough.Side effects


Bibliographyhttps://www.fda.gov/Drugs

https://ghr.nlm.nih.gov/condition/stevens-johnson-syndrome-toxic-epidermal-necrolysis

https://www.cms.gov/medicare-medicaid-coordination/fraud-prevention/medicaid-integrity-education/pharmacy-education-materials/downloads/ac-adult-dosingchart.pdf

https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/surgery/tests-surgery/wada-test

https://www.epilepsy.com/learn/professionals/resource-library/tables/recommended-medications

https://www.epilepsy.com/learn/professionals/resource-library/tables/choosing-antiepileptic-drugs

https://www.epilepsy.com/article/2014/3/summary-antiepileptic-drugs

Epilepsydiagnosis.org

Documents

Effect of Medicationson Recordings and Patients · Clonazepam/Klonopin Absence Myoclonic Atonic Lennox-Gastaut associated seizures Purpose Loss of background Decreased voltage Frontal