Shaken not stirred

Well, we are nearing the end of our journey. I feel as though I have made good progress. I should be somewhere near 180 surveys (I have some paper surveys that I still need to enter from the last week). In the next 3 weeks I hope to not only hit the required 200 surveys, but to surpass it.

This has been a good experience. I feel like I know much more about the medications that I am constantly around, and I feel like I have gained a lot of insight into research in general. I am glad I got to do this thing.

As far as the matter of 'Drug of the Week' features go there has been some straying off the chosen topic. Mostly because of things I have wanted to learn more about that were issues that I was personally dealing with or issues that the world at large was dealing with (see last weeks post about Tamiflu and the Swine Flu Virus). We will, however, be getting back on schedule. Especially because I have had occasion to speak with a large amount of Neurologists in the last week trying to get their support so that I can get some more information about anti-epilepsy medications.

With this in mind I am going to post today on a med that is relative new to me: Fosphenytoin. The brand name of this drug is Cerebyx, but we will just call it Fosphenytoin.
So - drum roll please - let us begin with...! THE ORGANIC MOLECULE!
And, here is the 3D model. The 3D model doesn't really help us understand anything about the drug itself; it just looks cool.
'The colors children! The colors!'

Fosphenytoin was approved by the FDA for use in treating epilepsy on August 5, 1996.
Fosphenytoin is used for treating certain types of seizures ie: status epilepticus (I have often heard this term at the hospital when referring to children who have come out of a seizure but are still a little loopy. Basically after a major seizure the brain needs time to sort itself out. That time varies depending on the length of the seizure, a lot of children just fall asleep after a prolonged seizure due the exertion on their bodies)

According to the Epilepsy Foundation Status Epilepticus referrs to any seizure activity that lasts longer than 30 minutes. Other defintions exist, but that was the most succint I could find. Typically neurologists at work have a standing order to be paged when seizure activity lasts longer than 5 minutes and to administer Atavan (It is easiest to think of Atavan as like mega Valium, it mellows you out in a hurry. I will probably post on Atavan in the next few 'DotW' features).
This graph illustrates the damaging effects of continued Status Epilepticus activity. After viewing this graph it is not hard to see why a drug like Fosphenytoin is administered for 'status-type' seizure activity.

Fosphenytoin is also used to prevent potential seizure activity after brain or nervous system surgery. (http://www.drugs.com/cdi/fosphenytoin.html)
This would likely explain why I seem to hear of it's use fairly frequently because we work with neurosurgeons in addition to neurologists. Fosphenytoin is administered as a subcutaneous injection - read needle.

Seizure activity is usually measured via a procedure known as an EEG or Electro Encephalograph. This device measures electrical activity in the brain. Here is an example of what the read out looks like:
Despite having seen countless patients having this procedure done, I still can't read the thing worth a darn. The EEG techs and neurologists can; all I ever know is if the leads are connected properly.
This image was actually taken from an EEG where a patient had been treated with Fosphenytoin which altered the electrical activity, but did not help the patient clinically.

The next image is one comparing the relative concentrations of Fosphenytoin and the length of time that was required for a seizure to stop. Administration in this case was for a Status Epliepticus type seizure:
Phenytoin is essentially the same thing as Fosphenytoin; they act in the same way.
The primary anticonvulsant mechanism is modulation of sodium channels.
(http://www.medlink.com/medlinkcontent.asp)

Well, I am trying to think of some way to some up my research and interest in this med. Personally I like to see when things are administered for preventative measures. It will be interesting to see the results of the paper surveys that I am giving out to local neurologist offices. I will be in a better position to understand what, if any, problems and complications are associated with this med and I will get it from those who have tried it.

So, I think I will have to say, to be continued....