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mg/minute) without risk of cardiovascular collapseIt is also more expensive7. If the above measures to abort status epilepticus are unsuccessful, intubate and administer phenobarbital (Luminal), 100 mg/minute IV to a maximum of 20 mg/kg.8. If still unsuccessful after 60 minutes, considergeneral anesthesia with propofol (Diprivan), loading dose of 3-5 mg/kg, followed by an infusion of 30-100 mcg/kg/min.D. Clinical pharmacology of the antiepileptic drugs (AEDs) (Table 6.1)E. Drugs for specific types of seizures (Table 6.2)
F. Titrate dosages to achieve adequate serum levels. If a first drug partially controls seizures at a maximal therapeutic level, add a second drug to achieve therapeutic levels. Evaluationof serum phenytoin may require additional correction based on serum albumin level and/orcurrent renal function; consult pharmacist for appropriate correction of phenytoin levels toavoid unnecessary dosage adjustments.G. If the patient is seizure-free, monitor the patient, not the levels.H. One should never abruptly withdraw an anticonvulsant from a patient; these drugs should be tapered.I. Vagus nerve stimulation is used in conjunctionwith medications by patients with severe, uncontrolled seizures. Stimulation is typically applied for 30 seconds every 5 minutes.When the vagus is stimulated, resultant impulses in some way interrupt or prevent abnormal neuronal firing.Pharmacologic AgentsDrug DosingDailyDosageTarget Serum LevelMcg/mlInduces Hepatic Drug MetabolismCarbamazepineTegretolEpitolTegretol XRCarbatrolEquetro3xdaily3xdaily2xdaily2xdaily2xdaily600-18004-12YesEthosuximideZarontin1-2 xdaily75040-100NoPhenobarbital1-2xdaily60-12015-45YesPhenytoinDilantin-125Dilantin InfatabPhenytekDilantin ER2-3xdaily2-3xdaily1xdaily1xdaily200-30010-20YesPrimidoneMysoline3-4xdaily500-7505-15YesValproic acidDepakeneDepakoteDepakote ERStavzor3-4xdaily3-4xdaily2xdaily2-3xdaily750-300040-100YesGabapentinNeurontin3xdaily1200-3600NDNoLacosamideVimpat2xdaily200-400NDNoLamotrigineLamictalLamictal ODTLamictal XR2xdaily2xdaily1xdaily400NDNoLevetiracetamKeppra2xdaily2000-3000NDNoOxcarbazepineTrileptal2xdaily900-24003-40NoPregabalinLyrica2-3xdaily150-600NDNoRufinamide2xdail320NDYes
GUILLAIN-BARRE SYNDROMEI. DefinitionA. Guillain-Barre syndrome (GBS) is an acute, usually rapidly progressive, form of inflammatory demyelinating radiculoneuropathy; typically motor greater than sensory.B. Characterized by a monophasic course of muscular weakness, mild distal sensory loss, and autonomic dysfunction, with the majority ofpatients reporting an antecedent infection1. The maximum deficit is usually attained by week 4.C. Most frequently acquired demyelinating neuropathyII. EtiologyA. Unknown, although an autoimmune basis is probableB. Majority of cases are triggered by an antecedent infection, suggesting a response involving antibodies cross-reacting with both humoral and cellular immunity with peripheral nerve GangliosidesC. Frequent antecedent infections include the