EPILEPSY AND ANTI-EPILEPTIC DRUGS For Presentation
EPILEPSY AND ANTI-EPILEPTIC DRUGS For Presentation
EPILEPSY AND ANTI-EPILEPTIC DRUGS For Presentation
Prepared by:
Miguelita Digal Espinosa, M. D.
Epilepsy:
is a group of neurological disorders,
characterized by unprovoked seizures that can affect
mental and physical functions.
Epileptic Seizures:
are episodes of brief to nearly undetectable periods
to longer periods of vigorous shaking;
1. Partial Seizures:
A. Simple Partial Seizures:
a) Consciousness not impaired.
b) Motor signs present.
c) With special sensory or somatosensory symptoms.
d) ANS symptoms or signs present.
e) Ma have psychic symptoms.
B. Complex Partial Seizures:
a) Simple partial seizures followed by
impairment of consciousness.
b) With impairment of consciousness at onset.
C. Partial seizures evolving to secondary
generalized seizures:
a) Simple partial seizures evolving to secondary
generalized seizure.
b) Complex partial seizures evolving to secondary
generalized seizure.
c) Simple partial seizures evolving to
Complex partial seizures and further evolving
to secondary generalized seizure.
11.Generalized Seizures:
(Convulsive or Non-convulsive)
A. Absence or Atypical Absence Seizures
B. Myoclonic Seizures
C. Clonic seizures
D. Tonic seizures
E. Tonic-clonic seizures
F. Atonic seizures
Seizure:
a transient alteration of behavior,
due to disorders in the synchronous and rhythmic
firing of certain populations of brain neurons.
Epilepsy:
a disorder of brain function,
characterized by periodic and unpredictable seizures,
due to disorders of neuronal excitability.
Epileptic Seizures:
= “Epileptic" Seizures:
can occur without evident provocation.
= Anti-seizure Drugs;
pharmacologic agents used to inhibit seizures.
Treatment for Epilepsy:
is basically:
1) symptomatic
2) for the prevention of seizures.
= Absence seizure,
AED work by the inhibition of the voltage-
activated T-type of Ca++ channels.
B. Generalized Seizures:
1) Absence Seizure:
= An abrupt onset of impaired consciousness.
= associated with staring and cessation of the
ongoing activities.
= typically lasting less than 30 seconds.
b) Etiology
c) Age of onset
Epileptic Syndromes:
= More than 50 distinct Epileptic Syndromes are
identified and categorized into;
partial versus generalized epilepsies.
AMPA Receptor:
a non-NMDA-type of ionotropic trans-membrane
receptor for Glutamate, (iGlut receptor)
= Glutamate molecules;
bind to recognition sites of both AMPA and NMDA Receptors.
= Rise in voltage:
dislodges the Mg++ ions, the NMDA receptor
blocking ion.
opens the voltage-gated Ca+ ion channels.
MOA of the NMDA Receptors:
seen in generalized
Absence Seizures
Both Benzodiazepines and Barbiturates:
Tiagabine MOA:
1) inhibits the GABA transporter, GAT-1,
MOA:
Limits the repetitive firing of APs
mediated by a slowing of the rate of recovery of
the voltage-activated Na+ channels from inactivation.
= Valproate compete with Phenytoin;
for protein binding sites, thus it;
= Like Phenytoin,
Carbamazepine, Oxcarbazepine,
Phenobarbital, and Primidone;
Phenytoin Toxicity:
= Sedation,
the most frequent undesirable effect of phenobarbital,
3) Megaloblastic anemia;
that responds to folate.
4) Osteomalacia;
that responds to high doses of vitamin D.
Therapeutic Uses of Phenobarbital:
= Effective agent for generalized tonic-clonic
and partial seizures.
MOA:
= Like Phenytoin, it limits the repetitive firing of Aps,
mediated by a slowing of the rate of recovery of
voltage-activated Na+ channels from inactivation.
= Its metabolite, 10,11-epoxycarbamazepine, still
limits sustained repetitive firing at therapeutic levels.
= 10,11-epoxide.
Metabolite is as active as the parent compound,
its concentrations in plasma and brain may reach 50% of
the Carbamazepine dose, especially if co- administered
with Phenytoin or Phenobarbital.
= Metabolism of Carbamazepine;
inhibited by Propoxyphene, Erythromycin,
Cimetidine, Fluoxetine, and Isoniazid.
= Carbamazepine
the primary agent for the treatment of:
1) Trigeminal neuralgia.
2) Glossopharyngeal neuralgias (70% relief).
3) Lightning-type ("tabetic") pain associated
with bodily wasting.
4) Also for the treatment of Bipolar affective disorders.
Succinimides:
Ethosuximide (ZARONTIN, others):
a primary agent, selective for the treatment of
Absence Seizures.
Clonazepam:
= The t1/2 in plasma is ~23 hours.
Lorazepam:
= is metabolized chiefly by conjugation with glucuronic acid;
its t1/2 in plasma is ~14 hours.
Toxicity of Benzodiazepines:
Gabapentin:
designed as a centrally active GABA agonist,
its high lipid solubility facilitate transfer across BBB.
Case No. 1:
C. T. a 67 –year old male, former teacher in grade school, who
developed a single generalized tonic-clonic seizures for the first
time, two months after he was discharged from the hospital for
stroke. Patient is hypertensive with maintenance medications:
1) Telmisartan 40 mgs/Amlodipine 5mgs daily.
2) Rosuvastatin 20 mgs daily
3) Multivitamins and Minerals one tablet daily
He has good compliance in his medications as well as his
follow-up visits to his attending physicians.
Case No 2.
C.S. a 26- year old single house helper, often had her attention
called by her employer for her low output in whatever job
she is assigned to. Suddenly she started having nausea and
occasional vomiting. Her self administered pregnancy test
turned positive.
While she was in the doctor’s clinic for prenatal check up
she was noticed to have a brief period of unconscious
and blank stare.
Diagnosis: Pregnancy 16 weeks, with
Absence Epileptic episode.