Ethosuximide

INTRODUCTION

Indications

Absence seizures (petit mal).

Action

Elevates the seizure threshold. Suppresses abnormal wave and spike activity associated with absence (petit mal) seizures. Therapeutic Effects: Prevention of absence (petit mal) seizures.

Adverse Reactions/Side Effects

CNS: INCREASED FREQUENCY OF TONIC-CLONIC (GRAND MAL) SEIZURES, dizziness, drowsiness, euphoria, fatigue, headache, hyperactivity, irritability, psychiatric disturbances. EENT: myopia. GI: abdominal pain, anorexia, cramping, diarrhea, nausea, vomiting, weight loss, hiccups. GU: pink/brown discoloration of urine, vaginal bleeding. Derm: STEVENS-JOHNSON SYNDROME, hirsutism, rashes, urticaria. Hemat: agranulocytosis, eosinophilia, leukopenia, pancytopenia. Neuro: ataxia. Misc: systemic lupus erythematosus.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Document the number, duration, and severity of seizures to help determine if this drug is effective in reducing seizure activity. Be especially alert for tonic-clonic seizure activity, and report an increase in the frequency of these seizures to the physician immediately.

• Monitor skin reactions such as rash, itching/burning skin, hives, exfoliation, and dermatitis. Notify physician immediately about because certain skin reactions may indicate serious hypersensitivity reactions (Stevens-Johnson syndrome).

• Be alert for signs of agranulocytosis and leukopenia (fever, sore throat, mucosal lesions, signs of infection), eosinophilia (fatigue, weakness, myalgia), or fatigue and poor health that might be due to other blood dyscrasias. Report these signs to the physician immediately. Periodic blood tests may be needed to monitor WBC and RBC counts.

• Assess dizziness or ataxia that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor daytime drowsiness, euphoria, irritability, or other psychiatric disturbances. Repeated or excessive symptoms may require change in dose or medication.

• Monitor signs of drug-induced lupus syndrome, including increased blood pressure (BP), fever, joint pain, skin rashes, and redness/irritation of the eye (uveitis). Notify physician promptly if these signs appear.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight loss or decreased body fat.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth), especially if dizziness or ataxia affects gait and balance. Implement fall prevention strategies, especially if balance is impaired (See Appendix E).

Patient/Client-Related Instruction

• Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

• Advise patients on prolonged antiseizure therapy not to discontinue medication without consulting their physician. Abrupt withdrawal may cause increased seizures.

• Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. Use care if driving or in other activities that require strong ...