What are Epilepsies?

Groupf of disorders of the CNS characterized by paroxysmal cerebral dysrhythmia, manifesting as brief episodes (seizure) of loss of consciousness, with or without characteristic body movements (convulsions), sensory or psychiatric phenomena

What are seizures?

A seizure is a transient alteration of behaviour due to the disordered, synchronous, and rythmic firing of populations of brain neurones. Seizure can be non-epileptic and can be evoked in normal brain. A seizure is a paroxysmal behavioral spell generally caused by an excessive disorderly discharge of cortical nerve cells.

Clinical Presentation of Epilepsies

Epilepsy is a syndrome of two or more unprovoked or recurrent seizures on more than one occasion. Epileptic seizures range from clinically undetectable(electrographic seizures) to convulsions

Types
1) A) B) C) D) E) Generalized Generalized tonic-clonic seizures Absence seizures Atonic seizure Myoclonic seizures Infantile spasms

Types
2) Partial (focal) Seizures A. Simple partial seizures B. Complex partial seizures

Causes of Epilepsy
Acute Congenital

Causes of epilepsy
Acute epilepsy
Cortical damage Trauma Stroke Neoplasm Autoimmune effects

Classification of antiepileptic drugs

Hydantoins: Phenytoin. Phosphenytoin Barbiturates: Phenobarbitone Iminostilbenes: carbamazepine, oxcarbazepine Succinimides: Ethosuximide Aliphatic carboxylic acid: Valproic Benzodiazepines: Clonazepam, diazepam, lorazepam New agents: Gabapentin, lemotrigine, tiagabine, topiramate

Mechanisms of seizure and antiseizure drugs

Common ones Modification of ion conductance
Prolongation of Na+ channels inactivation Inhibition of T type Ca++ current

Increase inhibitory (GABAergic) transmission Glutamate receptor antagonism (NMDA, AMPA, or Kainic acid) Genetic Mechanisms

Anticonvulsant Mechanism
The sodium Channel: A) RESTING STATE B) Arrival of action potential causes depolarization and channel opens allowing sodium to flow in. C) Refractory State, Inactivation reduce the rate of recovery.

Sodium channel
Drugs acting via this channel:
Phenytoin, sodium valproate, Carbamazepine, lamotrigine, Topiramide and zonisamide

Anticonvulsant mechanism
T type Ca++ current inhibition: T type current is responsible for 3 Hz spike and wave Throughout the thalamus T current has large amplitudes Burst of action potential is by action of T current In absence seizure Drugs ethosuximide, valproate and trimethadione

Anticonvulsant mechanism
The GABA mediated Cl channel opening Drugs: barbiturates, benzodiazepines, Vigabatrin, gabapentin and valproate

Phenobarbitone
Mechanism of action