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Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 24 Drugs for Epilepsy
2Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Definition of Epilepsy Group of disorders characterized by excessive excitability of neurons in the CNS Can produce a variety of symptoms ranging from brief periods of unconsciousness to violent convulsions May also cause problems with learning, memory, and mood
3Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Seizure: Generation Initiated by synchronous, high-frequency discharge from a group of hyperexcitable neurons called a focus Focus may result from Congenital defects Hypoxia at birth Head trauma Brain infection Stroke Cancer Genetic disorders
4Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Seizures: Types Partial (focal) seizures Simple partial Complex partial Secondarily generalized Generalized seizures Tonic-clonic (grand mal) Absence (petit mal) Atonic Myoclonic Status epilepticus (SE) Febrile
5Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Antiepileptic Drugs Effects Suppress discharge of neurons within a seizure focus Suppress propagation of seizure activity from the focus to other areas of the brain Mechanisms of action Suppression of sodium influx Suppression of calcium influx Antagonism of glutamate Potentiation of GABA
6Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Mixed Seizures: Lennox-Gastaut Syndrome Severe form of epilepsy that usually develops during the preschool years Developmental delay and a mixture of partial and generalized seizures
7Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Goal of Treatment Reduce seizures to a level that allows the patient to live as normal a life as possible Balance the desire for complete seizure control with the acceptability of side effects
8Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Epilepsy: Therapeutic Considerations Treatment goal and treatment options Neurosurgery (best success rate) Vagal nerve stimulation Ketogenic diet Diagnosis and drug selection Drug evaluation
9Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Epilepsy: Therapeutic Considerations Monitoring plasma drug levels Promoting patient adherence Withdrawing antiepileptic drugs Suicide risk – antiepileptic drugs
10Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Classification of Antiepileptic Drugs Two major categories Traditional antiepileptic drugs (AEDs) Phenytoin, carbamazepine, valproic acid, and others Phenytoin, carbamazepine, valproic acid, and others Newer AEDs Oxcarbazepine, gabapentin, zonisamide, and others Oxcarbazepine, gabapentin, zonisamide, and others
11Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Phenytoin (Dilantin) Partial and tonic-clonic seizures Mechanism of action: selective inhibition of sodium channels Varied oral absorption Half-life: 8 to 60 hours
12Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Fig. 24-1. Relationship between dose and plasma level for phenytoin compared with most other drugs.
13Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Phenytoin (Dilantin) Adverse effects Nystagmus Sedation Ataxia Diplopia Cognitive impairment Gingival hyperplasia Skin rash Effects in pregnancy Cardiovascular effects
14Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Phenytoin (Dilantin) Drug interactions Decreases the effects of oral contraceptives, warfarin, and glucocorticoids Increases levels of diazepam, isoniazid, cimetidine, alcohol, and valproic acid
15Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Carbamazepine (Tegretol) Uses Epilepsy Bipolar disorder Trigeminal and glossopharyngeal neuralgias Adverse effects Neurologic effects: nystagmus, ataxia Hematologic effects: leukopenia, anemia, thrombocytopenia Birth defects Hypo-osmolarity Dermatologic effects: rash, photosensitivity reactions
16Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Valproic Acid (Depakene, Depakote, Depacon) Uses Seizure disorders Bipolar disorder Migraine Adverse effects GI effects Hepatotoxicity: liver failure Pancreatitis Teratogenic effects
17Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Ethosuximide Drug of choice for absence seizures Generally devoid of significant adverse effects and interactions Initially may cause drowsiness, dizziness, and lethargy
18Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Phenobarbital Uses Epilepsy (partial and generalized tonic-clonic seizures) Promotes sleep and sedation
19Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Newer Antiepileptic Drugs Gabapentin Lamotrigine Levetiracetam Oxcarbazepine Tiagabine Topiramate Zonisamide
20Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Management of Generalized Convulsive Status Epilepticus Continuous series of tonic-clonic seizures lasting 20 to 30 minutes Goals of treatment Maintain ventilation Correct hypoglycemia Terminate seizures IV benzodiazepines (lorazepam or diazepam) IV benzodiazepines (lorazepam or diazepam) Initiate or continue long-term suppression drugs
Anticonvulsants David G. Standaert, MD, PhD Massachusetts General Hospital Harvard Medical School.
دکتر محمد ربانی گروه فارماکولوژی
DRUGS USED FOR TREATMENT OF EPILEPSY Prof. Mohammad Saad AL-Humayyd.
ANTICONVULSANTS SAMUEL AGUAZIM (MD) 1. What is a Epilepsy? Epilepsy is a chronic disorder characterized by recurrent episodes in which the brain is subject.
Chapter 16:Anticonvulsants DH206: Pharmacology Lisa Mayo, RDH, BSDH Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
EPILEPSY Seizures - Transient alteration of sensation, awareness or behavior due to disordered, abnormal firing of brain neurons. Epilepsy is a chronic.
Antiseizure Drugs Kaukab Azim, MBBS, PhD.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
PHCL-3720 Pharmacology II Dr. William Messer Department of Pharmacology The University of Toledo March 25, 2002.
Zenaida N. Maglaya,MD,FPSECP Department of Pharmacology
Antiepileptic Drugs Department of Pharmacology Zhang Yan-mei.
Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program NEREG.
Anti Epileptic Drugs (AEDs) Sampath Charya, MD, FAAN, FAASM VAMC, Fayetteville, NC.
Management of Seizure Disorders Mark Kotlarewsky, MD FACP Department of Medicine Medstar Washington Hospital Center.
Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 16 Anticonvulsants.
Definition The epilepsies are a group of disorders characterized by chronic recurrent paroxysmal changes in neurologic function caused by abnormalities.
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