Epilepsy Ppt

Bijoy ThomasPharm D

1. Definition2. Epidemiology3. Etiology4. Pathophysiology5. classification 6. laboratory tests7. Treatment8. Reference

Epilepsy implies a periodic recurrence of seizures with or without convulsions.

Epilepsy is a disorder that is best viewed as a symptom of disturbed electrical activity in the brain caused by a wide variety of etiologies.

incidence of epilepsy is 44 per 100,000 person-years.

Each year, about 125,000 new epilepsy cases occur

one peak occurring in newborn and young children and the second peak occurring in patients older than age 65.

1. Anything that disrupts the normal homeostasis of the neuron and disturbs its stability

2. Patients with mental retardation and cerebral palsy 3. idiopathic epilepsy include cerebrovascular disease (both

ischemic and hemorrhagic stroke), neurodegenerative disorders, tumor, head trauma, metabolic disorders, and CNS infections, sleep deprivation, sensory stimuli, and emotional stress may initiate seizures.

4. Hormonal changes 5. AEDs in toxic concentrations

The seizure originates from the gray matter . Normal membrane conductances and inhibitory synaptic currents

break down, and excess excitability spreads, either locally to produce a focal seizure or more widely to produce a generalized seizure.

An abnormality of potassium conductance, a defect in the voltage-sensitive ion channels, or a deficiency in the membrane ATPases linked to ion transport may result in neuronal membrane instability and a seizure.

Systemic pH During a seizure, there is a large increase in the demand for blood

flow to the brain to carry off CO2 and to bring substrates for neuronal metabolic activity.

The more prolonged the seizure, the more likely the brain is to suffer ischemia that may result in neuronal destruction and brain damage

I. Partial seizures II. Generalized seizures III. Unclassified seizures IV. Status epilepticus

No specific diagnostic laboratory tests for epilepsy.

serum prolactin levels may be transiently elevated.

EEG(may be normal in some patients who still have the clinical diagnosis of epilepsy)

MRI is very useful (especially imaging of the temporal lobes)

DESIRED OUTCOME The ultimate goal of treatment for

epilepsy is no seizures and no side effects with an optimal quality of life.

identification of goals, assessment of seizure type and frequency, development of a care plan, and a follow-up evaluation.

Patient characteristics such as age, medical condition, ability to comply with a prescribed regimen, and insurance coverage also should be explored

If the therapeutic goal is not achieved with maximal monotherapy, a second drug may be added

withdrawal of AEDs include a seizure-free period of 2 to 4 years, complete seizure control within 1 year of onset

Diet Surgery vagal nerve stimulation (VNS)

Seizure Type First-Line Drugs Alternative Drugs Partial seizures Carbamazepine Gabapentin Phenytoin Topiramate Lamotrigine Levetiracetam Valproic acid Zonisamide Oxcarbazepine Tiagabine Primidone, phenobarbital Felbamate Generalized seizures   Absence Valproic acid, ethosuximide Lamotrigine, levetiracetam   Myoclonic Valproic acid, clonazepam Lamotrigine, topiramate, felbamate, zonisamide, levetiracetam Tonic-clonic Phenytoin, carbamazepine, valproic acid Lamotrigine, topiramate, phenobarbital, primidone, oxcarbazepine, levetiracetam

clinical monitoring, drug utilization review quality-of-life assessments. Patients should be questioned regularly

to determine whether they are seizure-free.

DAVIDSONS PRINCIPLE AND PRACTICE OF MEDICINE 6TH EDITION

PHARMACOTHERAPY A PATHOPHYSIOLOGIC APPROACH BY JOSEPH T.DIPIRO5TH EDITION