Management Of Epilepsy-PATEL

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Management Of Epilepsy:

Management Of Epilepsy P.MEGARAJ PATEL

Obiectives:

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:

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:

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:

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:

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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