1. Main function ACTIONDRUGS ↓Na currentDPH, CBZ, LTG, TOP, PRI ↑ GABAergic inhibitionPB, VA, BZD, CNZ, VGB, GPT ↓ transient Ca currentESX, VA

2. Vigabatrin: inhibition of GABA aminotransferase Gabapentin: facilitate glutamic acid decarboxylase (GAD)

3. Treatment of epilepsy Partial and GTC AbsenceAbsenceMyoclonic DPH++00 CBZ++00 PRI++00 VA++ PB+0+ CNZ++++ ESX0++0

4. Pharmacokinetics All bind to plasma protein Phenytoin: zero order kinetics

5. CBZ Enzyme inducer

6. Drug interactions serum level influence by combine therapy Antibiotics:↑DPH, CBZ, PB ↑ contraceptives metabolism DPH: ↓coumadin (anticoagulant) CBZ, DPH: ↓theophylline

7. Side effects of DPH nausea, dizziness, visual disturbance Nystagmus, diplopia, ataxia Cognitive impairment, confusion Allergic reaction Hirsutism, coarsening of facial Gingival hyperplasia Drug-induce hepatitis

8. Side effect of CBZ nausea, dizziness, diplopia, ataxia Allergic reaction Stevens-Johnson syndrome Aplastic anemia Granulocyte suppression Titration therapy

9. Side effect of VA nausea, dizziness, diplopia, lethargy ↑NH 3, Fetal hepatitis (1/40,000) Age <2, multiple medication Tremor Wt gain aleopecia

10. VA: Spina bifida,neural tube defect (20X)

11. Pregnancy in epilepsy Risk for seizure (mother and baby) Risk for teratogenicity Single-drug therapy Lowest dose divide dose to minimize peak levels

12. DPH, CBZ: Carniofacial defects, cleft palate, cleft lip, septum defect, fingernail hypoplasia, delay development

13. Fetal hydantoin syndrome

14. Status epilepticus Continuous seizure > 30 min Recurrent seizure without complete recovery of consciousness between attacks Mortality 8-35% Neurological emergency

15. Management of status epilepticus 0-5 min assessment airway; blood draw: drug level, toxin, glucose 5-10 min start IV infusion administer: thiamine; glucose

16. Management of SE 10-30 min lorazepam or diazepam and phenytoin monitor Bp, arrhythmia 30-60 min phenobarbital > 60 min pentobarbital coma

17. 結語 中古世紀 — 怪力亂神 二十一世紀 — 新的希望 癲癇不影響個人成就 — 人盡其才