Documente Academic
Documente Profesional
Documente Cultură
Presented By Amol.B.Lavate
(M.Pharm)1st year Pharmacy Practice,
KLES University Belgaum.
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CONTENT
INTRODUCTION
FACTS
CAUSES OF SEIZURES
POSSIBLE SEIZURE TRIGGERS
PATHOPHYSIOLOGY
TYPES OF EPILEPSY
CLASSIFICATION OF SEIZURES
PREVALENCE
SYMPTOMS OF EPILEPSY
SCREENING & DIAGNOSIS
TREATMENT
ACTIONS OF ANTISEIZURE DRUGS
USE OF ANTISEIZURE DRUGS 2
INTRODUCTION
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PATHOPHYSIOLOGY (I)
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PATHOPHYSIOLOGY (II)
•Neurotransmitters cross the synaptic gap between neurons
and fix to receptor points of the adjoining neuron
•Some neurotransmitters function to excite the joining
neuron (eg. glutamate) to send a further electrical signal.
Other neurotransmitters function to inhibit the joining
neuron (eg. GABA) and inhibit electrical signals passing
down that neuron
•It is by these electrical and chemical pathways that the
millions of neurons within the brain communicate and
function normally
•seizures occur when there is an imbalance within these
excitatory and inhibitory circuits in the brain, either
throughout the brain (generalized epilepsy) or in a
localized part of the brain (focal epilepsy), such that
neurons fire off in an abnormal fashion
•Mechanism of AEDs to prevent
–Altering electrical transmission along neurons
by affecting ion (Na+, K+ , Ca2+) channels in
the cell membrane.
–Altering chemical transmission between
neurons by affecting neurotransmitters
(GABA,glutamate) in the synapse
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CLASSIFICATION OF SEIZURES
Seizure Classification
Partial Generalized
seizure activity starts in one seizure involves whole brain &
area of the brain consciousness is affected
Simple Complex
Retains awareness Altered awareness and
behavior
Secondary
generalization
( spreading from one area to
the whole brain )
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SEIZURE CLASSIFICATIONS:
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Generalized Seizures
Absence seizures (petit mal)
• These seizures are characterized by staring, subtle body movement and
brief lapses of awareness.
•
Myoclonic seizures
• These seizures usually appear as sudden jerks of your arms and legs.
•
Atonic seizures
• Also known as drop attacks, these seizures cause you to suddenly
collapse or fall down.
•
Other
generalized,
8%
Partial
unknown, 7%
Absence, 6%
Complex
Partial, 36% Myoclonic, 3%
Unclassified, 13
3%
Symptoms of Epilepsy
lsion with or
Blackout
withoutoraSudden
confused
fever fear , anger for Blank
memory staring
no reason SuddenMuscle
stiffening
jerks of arms, legs o
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Screening & Diagnosis
Electroencephalogram (EEG)
Computerized tomography (CT)
Magnetic resonance imaging (MRI)
Positron emission tomography (PET)
•
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electroencephalography
The EEG or electroencephalography,
developed by Professor Hans Berger in
the 1920’s is one of the most
determinant and specific diagnostic
tests due to the fact that it records the
electrical activity of the brain in a safe
and painless graphical manner. Each
trace of its recording corresponds to a
different region of the brain and they
could be easily interpreted by the
specialists.
Computerized tomography (CT)
The CT scan, which stands for
computed tomography, is
equivalent to an X-Ray of the
head which would usually appear
normal in most patients with
Epilepsy. Decreases in brain
substance, scar tissue, tumors,
abnormal blood vessels or
abnormal spinal fluid circulation
are a few of the abnormalities
that might be projected with this
kind of test.
MAGNETIC RESONANCE IMAGING(MRI)
Magnetic Resonance Imaging [MRI] was first introduced in the USA in the
early 1980s revolutionizing the practice of neurology and neurosurgery
because of the excellent detail resemblance of the brain’s structure.
This is extremely helpful because it identifies brain scar tissue, areas
of abnormal brain development or dysplasia, small brain tumors, blood
vessel abnormalities, and changes in the brain’s white matter.
Positron emission tomography
PET scans use injected radioactive material to help visualize
active areas of the brain. The radioactive material is
tagged in a way that makes it attracted to glucose.
Because the brain uses glucose for energy, the parts that
are working harder will be brighter on a PET image.
•• After the radioactive material is injected, it will take between
•Phenytoin
•Tiagabine
•Topiramate
•Vigabatrin
•Pregabalin
•Zonisamide
•Gabapentin
•Lamotrigine
•Phenytoin
•Topiramate
•Vigabatrin
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Actions of antiseizure drugs
neurotransmitter
•delaying the influx of sodium and calcium
antiseizure meds:
•1. Barbiturates
•2. Benzodiazepines
Barbiturates
phenobarbital ( Luminal ) 60 - 180mg / day
primidone750 - 1000mg / day
MOA : potentiate the effects of GABA
Indication :
tonic- clonic seizures ,status epilepticus
adjuncts to anesthesia
SE :
drowsiness
dizziness
hypotension
respiratory depression
drug tolerance
physical drug dependency & withdrawal syndrome
Benzodiazepines
diazepam ( Valium ) 4 - 40mg / day
clonazepam (Klonopin)1-12mg/day
lorazepam (Ativan)2-6mg/day
clorazepate (Tranxene)7.5-22.5mg/day
MOA : intensify GABA action
Indication :
short -term severe convulsions, status epilepticus
relieve tension , anxiety & skeletal muscle spasms
SE :
ataxia
cardiac depression
drug tolerance
physical drug dependency with withdrawal syndrome
Hydantoin
phenytoin ( Dilantin ) 300 - 400mg / day
MOA : delay influx of sodium ions into neurons
Indication :
all types of seizure except for absence seizures
Side Effects :
gingival hyperplasia
slurred speech
confusion , headache & depression
blood dyscrasias
severe liver toxicity
alopecia
hirsutism
Stevens –Johnson syndrome
Succinimides
Ethosuximide (Zarontin)750-1250mg/day
MOA : delay calcium influx into neurons
Indication : DOC for absence seizures
SE ;
anorexia & vomiting
blood dyscrasia
Stevens- johnson syndrome
Other antiseizure drugs
Valproates750-2000mg/day Iminostilbenes
valporic acid ( Depakene) carbamazepine
divalproex Na (Depakote) (Tegretol)600-1800mg/day
Indication:
gabapentin (Neurontin)900-
2400mg/day
absence seizures lamotrigine150-500mg/day
mania topiramate200-400mg/day
migraine headache Indication:
SE: seizure DO that have not
GI upset responded to other convulsants
Hepatotoxic trigeminal neuralgia
DOC for partial seizures
SE;
Blood dyscrasia
CNS depression
GI upset
Stevens- johnson syndrome
OPERATIVE
STATISTICS SHOW THAT…
LESIONECTOM
in lesions, such as areas of injury, tumors, or malformed blood vessels.
Y
In a FUNCTIONAL
HEMISPHERECTOMY, one
hemisphere is disconnected
from the rest of the brain, but
only a specific area of brain
tissue is removed. This surgery
is typically done on children
younger than 13 years old who
have one hemisphere that is
not functioning normally.
FUNCTIONAL
HEMISPHERECTOMY
MULTIPLE SUBPIAL
MULTIPLE TRANSECTION (MST) is
used to help control
SUBPIAL seizures that begin in
areas of the brain that
TRANSECTION cannot be safely
removed. The surgeon
makes a series of
shallow cuts or
transections in the brain
tissue to interrupt the
course of seizure
impulses but do not
disturb normal brain
activity, leaving the
person's abilities intact.
Ketogenic Diet
The ketogenic diet is primarily used in childhood
epilepsy.
The mechanism of ketogenic diet is unknown. The
high-fat, low-protein, no-carbohydrate diet
mimics some effects of starvation that seem to
inhibit seizures.
The diet is very rigid and carefully controlled and
must be supervised by a physician -- sometimes
in a hospital setting.
Ketogenic diets have been used for children with
epilepsy for many years with a success rate of 36
approximately 50 percent.
Vagus Nerve Stimulation (VNS)
•Vagus nerve stimulation (VNS) is approved
to treat partial seizures in patients 12
years of age or older
•Approximately 30 to 50 percent of patients
can be expected to have less seizure
activity with VNS
•The vagus nerve stimulator is surgically
implanted under the skin in the chest. The
device is attached to a wire that is
tunneled under the skin and attached to
the vagus nerve, which is located in the
left side of the neck
•The vagus nerve stimulator is adjusted to
automatically stimulate the vagus nerve
from every few seconds to every few
minutes.
•The device does not detect seizure activity.
It can be adjusted easily in a physician's
office using a laptop computer
OTHER TREATMENTS FOR
EPILEPSY
NATUROPATHY
YOGA THERAPY
ACUPUNCTURE
HYPNOTISM
COLLOIDAL SILVER
Naturopathy
NATUROPATHY is the belief that avoiding
certain drugs such as caffeine and alcohol;
chemicals; and maintaining a well-balanced
diet high in vitamins D and B6, as well as
zinc, calcium, and magnesium, which have
anticonvulsant properties, and the amino
acid taurine, would help control seizures.
Yoga therapy
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