Management Of Epilepsy-PATEL

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Management Of Epilepsy:

Management Of Epilepsy P.MEGARAJ PATEL


Obiectives nature of epilepsy. Classification of epilepsy. To know the most important investigations Drugs used and their indictions in different types of epilepsy and their SEs.

Nature of Epilepsy:

Nature of Epilepsy Epilepsy affects about 0.5% of the population. The characteristic event is the seizure, which is often associated with convulsion, but may occur in many other forms. Seizure Vs. Epilepsy ??

Classification of Epilepsy:

Classification of Epilepsy Primary : occur before the age of 20 With no specfic cause and no neurological abnormality Secondary : due to definitive Cause, either; -genetics -metabolic -Infections -CNS dysfunctions -Systemic diseases

Two major ..:

Two major .. Partial; one part of cerebrum ( simple , complex ) Generalized; involvement of RAS Diffuse regions of both hemi ( absence , tonic-clonic , myoclonic , atonic ) - prodorm -aura ( haluciantion , epigastric discomfort) -tonic ( contration of muscle ) -clonic ( bitting , incontinence , jerking of face and limbs ) -Post-ictal : deep un consciousness


Diagnosis First : careful History taking from patient and an observer. -Qs should be related to Dx before , during and after seizure in order to distinguishes seizure from other similar conditions. -Events leading up to attack -low sleep , drugs and alcohols -Dx of Aura -Salivation, tongue bitting and urinary incontinace


Diagnosis Second : careful general and neurological examinations -Auscultation of neck and eyes for bruits -pulse, blood pressure , heart auscultation -head for trauma and etc ..


Diagnosis Third : Investigations which are ; 1) serum , blood , lumbar puncture work up to roll out metabolic or infectious causes of epliepsy . 2) Urine , blood toxins screen if toxicity suspected 3) EEG: may help establish and characterize the type of epilepsy. -Sleep-deprived EEG provides greater yield

Treatment of Epilepsy:

Treatment of Epilepsy Repeated epileptic discharge can cause neuronal death (excitotoxicity). Current drug therapy is effective in 70-80% of patients.

Mechanism of Action:

Mechanism of Action Current antiepileptic drugs are thought to act mainly by two main mechanisms:

Mechanism of Action:

Mechanism of Action Reducing electrical excitability of cell membranes, possibly through inhibition of sodium channel. (Cabergic) Enhancing GABA-mediated synaptic inhibition. This may be achieved by an enhanced pre- or post- synaptic action of GABA, by inhibiting GABA-transaminase, or by drugs with direct GABA-agonist properties.

The Major Antiepileptic Drugs:

The Major Antiepileptic Drugs The main drugs in current use are: phenytoin, carbamazepine, valproate and ethosuximide. Secondary drugs include: Phenobarbitone: highly sedative Various benzodiazepines (e.g. clonazepam);

Choice of AEDs:

Choice of AEDs Epilepsy Type First-line Second-line Primary gerneralized tonic - clonic Na Valproic Acid Lamotrigine Phenytoin Partial or secondary Carbamazepine Na Valproic Acid Lamotrigine Myoclonic Na Valproic Acid Clon azepam Absence Ethosuimide Na Valproic Acid

Specific conditions:

Specific conditions 1) Status Epilepticus : A condition when consciousness does not return between seizures for more than 30 min. This state may be life-threatening with the development of pyrexia, deepening coma and circullatory collapse. Death occurs in 5-10%. Most common causes are anticonvulsant withdrawal/noncompliance Diazepam: preferred drugs for Status epilepticus. 2)Pregnancy : the drug of choice is Lamotrigine because of the tetarogencity of other drugs

PowerPoint Presentation:

Drug It’s SEs Phenotyin -Gastrointestinal irritation -Ataxia and diplopia. -Blood dyscrasias. -Gingival hyperplasia -Drug interaction: increase plasm concentration Carbamazepine Effective in most form of epilepsy except in Absence seizure . -Low incindance of SEs -sedation, ataxia, mental disturbances, water retention Na Valproic Acid Inhbits GABA transaminase . Rare but dangerous SEs anorexia, nausea, teratogenicity, liver damage Ethosuximide A T-type Ca channel blocker , the main drug to treat absence seizure, Relatively few unwanted effects, mainly nausea and anorexia. ( mental disturbances )


Attentions Selection of an appropriate antiseizure agent Use of single drug -prevents Interactions -compliance improves Gradual Withdrawal and Toxicity Drug discontinuation o nly when the patient has been seizure free for atleast 3 years.

PowerPoint Presentation:

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