You are on page 1of 31

DRUGS FOR

EPILEPSY
Subgroup 6

SEIZURE
Abnormal electrical discharges in the
Central Nervous System resulting in
abnormal motor, sensory and
psychomotor experiences.

EPILEPSY
Is a medical disorder marked by recurrent,
unprovoked seizures.

CLASSIFICATION OF EPILEPSY
FOCAL
GENERALISED

FOCAL EPILEPSY
Involves only a portion of the brain,
typically part of one lobe of one
hemisphere.
Simple partial- caused by a group of
hyperactive neurons exhibiting abnormal
electrical activity and are localized to a
single locus of the brain. Patient does not
lose consciousness.

Complex

partial- exhibits complex


sensory hallucinations and mental
distortion. Consciousness is altered.
Simple partial seizures may spread to
become complex.

GENERALIZED EPILEPSY
May

begin locally and then progress to


include abnormal electrical discharges
throughout both hemispheres of the
brain. Consciousness is lost
immediately.

Tonic-clonic
Absence
Myoclonic
Clonic
Myoclonic
Clonic
Tonic
atonic

PATHOPHYSIOLOGY OF
EPILEPSY
Seizures

are paroxysmal manifestations


of the electrical properties of the
cerebral cortex. A seizure results when a
sudden imbalance occurs between the
excitatory and inhibitory forces within
the network of cortical neurons in favor
of a sudden-onset net excitation.

Genetic

epilepsy
Structural/ metabolic epilepsy
Unknown cause

Phenytoin
Mechanism:

blocks Na channels in their


inactivated form, prevents seizure
propagation.
Use : in seizure state
Side effect: CNS depression , gingival
hyperplasia, hirsutism, osteomalacia(due
to decrease absorption Vit D),
megaloblastic anemia( decrease folate),
cleft lip and palate

SODIUM VALPORATE
Mechanism:

block axonal Na channel in


their inactive state, also inhibit GABA
transaminase and blockade T type Ca
channels.
Use: in seizure state, mania of bipolar
disorder and as migraine prophylaxis
Side effect: hepatotoxicity, alopecia,
pancreatitis, thrombocytopenia, spinal
bifida

ETHOSUXIMIIDE
Mechanism:

reduces propagation of
abnormal electrical activity, inhibits Ttype Ca channels
Use: in treating absence seizure

DIAZEPAM
Mechanism:

potentiate GABA , increase


the frequency of Cl channel opening
Use : Anxiety, preoperative sedative,
muscle relaxation, seizure
Side effect: rebound insomnia, anxiety,

CLINICAL SKETCH
A patient with long standing epilepsy has
admitted because of recurrent tonic clonic
seizures for the preceding 12 hrs. she is
unconscious, stiff and is having repeated
episodes of clonic limp movements.

QUESTIONS
What

kind of seizure did the patient


develop?
Status epilepticus: two or more seizures
occur without recovery of full
consciousness in between the episodes

If

this patient came to you, what will you


do next?
Secure airway, breathing and circulation
1. She should be admitted
2. Rectal administration of Diazepam
3. Followed by IM Fosphenytoin
4. Monitor the patient until she regains
consciousness

There

are many drugs those are


available to treat epilepsy , which one
will be the first choice for this patient.
Benzodiazepines (Diazepam)

An

18 month old toddler was brought to


A&E by his distraught parent. He has
been unwell for two days with a viral
illness and they have been wrapping
him up warm. He is having clonic
movements and his rectal temperature
is 40 degrees

QUESTIONS
What

kind of patient did the patient


develop?
Febrile seizures

What will you do next if the patient comes to


you
Secure airway, breathing and circulation
1. Rectal administration of Diazepam
2. The cause of febrile illness should be sought and
treated
3. Antipyretics should be considered , such
ibuprofen .
4. Parental anxiety and fear that their child may or
would develop brain damage need to be
addressed with reassurance and education

Which

will you treat first, lower the body


temperature or treat the epilepsy.
I will treat the epilepsy first before the
lowering the temperature.

There

are many drugs those are


available to treat epilepsy , which one
will be the first choice for this patient.
Benzodiazepines (Diazepam)

30 year old woman has epilepsy since


a head injury 10 years ago. The fits
were frequent but she now take
carbamazepine and has been fit free for
4 years. She now holds a driving license
that is renewed every three years. She
is pregnant and want advice.

Why

did she develop epilepsy after the


injury?
Head injury leads to cortical lesions which
are seemed to be important to the
genesis epileptic activity

Can

she drive?
yes, because has proven fits free for the
past four years.

Do

you have some advice for her


pregnancy?
I would advise her on the drugs and their
toxicity to the baby. I will tell her to
continue with the Carbamazepine or
change to Lamotrigine since they do not
increase the risk of impaired cognitive
function.

SUBGROUP 6
KWADWO

SARPONG 913905004
ANKOMAH ERIC KOBBY 913905006
ARIANE MAELLE FEUKENG 913905010
140101618
140101606
140101629