Dr AELIYA ZAIDI
HOUSE OFFICER
MEDICAL UNIT ll
HFH,Rwp
March 25th, 2006
DRUG TREATMENT OF
EPILEPSY
SEIZURES
• Any abnormal clinical event caused by an
electrical discharge from the brain.
EPILEPSY
• Tendency to have seizures.
• Symptom of a brain disease tan disease
itself.
• Single seizure is not epilepsy.
•...
CLASSIFICATION
•
•

1)SEIZURE TYPE
Simple partial
Complex partial
Absence
Tonic Clonic
Tonic
Atonic
Myoclonic
2)ELECTROPHY...
MANAGEMENT
• Explain the nature & cause of seizures to
the relatives.
• Immediate care.
• Restrictions.
• Anticonvulsant d...
ANTICONVULSANT DRUG
THERAPY
GUIDELINES FOR
ANTICONVULSANT THERAPY
• Start with one 1st line drug.
• Start with low dose;gradually increase to
effectiv...
CHOICEOF AED
Epilepsy
Type

1st LINE

2nd LINE

3rdLINE

Partial&/2n Carbamaze Lamotrigine
dry GTCS pine
Topiramate
Valpro...
CHOICEOF AED
PRIMARY
GTCS

VALPROA
TE

CARBAMA
ZEPINE
LAMOTRIG
INE
TOPIRAMA
TE

ABSENCE

ETHOSUXI VALPROA
MIDE
TE

PHENYTO...
AED’S
DRUG

Seizure
Type

Dose
range
mg/day

Doses/
day

Carbama Partial/2n 200-2000 2-3
zepine
dry
GTCS
Clonaepa Partial
...
AED’S
Primidon Partial
e
2ndry
GTCS

2501000

1-2

50-150

Lamotrig
ine

_

25-500

1-2

NA

Phenoba
rbitone

_

60-180

1...
Valproat Primary 400e
2ndry
2500
GTCS,
Absence
Myoclon
us

1-2

NA

Gabapen Partial
til

3

NA

1-2

NA

3002400

Vigabatr...
ANTICONVULSANT DRUG
BLOOD LEVELS
• Can be a useful guide in case of some
drugs.
• In valproate,no relationship b/w level &...
WITHDRAWL OF AED’S
• Can be considered after complete control
of seizures for 2-4 years.
• Should be undertaken slowly, re...
OUTCOME AFTER
20 YEARS
• 50% seizure free, without drugs for last 5
years.
• 20% seizure free for last 5 years but
continu...
THANKYOU
Drug treatment of epilepsy
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Drug treatment of epilepsy

  1. 1. Dr AELIYA ZAIDI HOUSE OFFICER MEDICAL UNIT ll HFH,Rwp March 25th, 2006
  2. 2. DRUG TREATMENT OF EPILEPSY
  3. 3. SEIZURES • Any abnormal clinical event caused by an electrical discharge from the brain.
  4. 4. EPILEPSY • Tendency to have seizures. • Symptom of a brain disease tan disease itself. • Single seizure is not epilepsy. • In a group of disorders,it is the only or main symptom,in others,its just one of the manifestations.
  5. 5. CLASSIFICATION • • 1)SEIZURE TYPE Simple partial Complex partial Absence Tonic Clonic Tonic Atonic Myoclonic 2)ELECTROPHYSIOLOGY Focal spikes/sharp waves Generalized spikes & waves • 3)ANATOMICAL a: CORTEX Frontal Temporal Parietal Occipital b:GENERALISED Diencephalon c:MULTIFOCAL 4)PATHOLOGICAL CAUSES
  6. 6. MANAGEMENT • Explain the nature & cause of seizures to the relatives. • Immediate care. • Restrictions. • Anticonvulsant drug therapy.
  7. 7. ANTICONVULSANT DRUG THERAPY
  8. 8. GUIDELINES FOR ANTICONVULSANT THERAPY • Start with one 1st line drug. • Start with low dose;gradually increase to effective control of seizures or side effects.If 1 st drug fails,start 2nd line drug whilst gradually withdrawing 1st. • Try 3 agents singly before using combinations. • Do not use more than 3 drugs in combination. • If above fails.consider occult structural or metabolic cause.
  9. 9. CHOICEOF AED Epilepsy Type 1st LINE 2nd LINE 3rdLINE Partial&/2n Carbamaze Lamotrigine dry GTCS pine Topiramate Valproate Phenytoin Gabapentin Clobazam Primidone Phenobarb Vigabatrin Myoclonic Phenobarbi tone Valproate Clonazepa m
  10. 10. CHOICEOF AED PRIMARY GTCS VALPROA TE CARBAMA ZEPINE LAMOTRIG INE TOPIRAMA TE ABSENCE ETHOSUXI VALPROA MIDE TE PHENYTOI N GABAPEN TIN PHENOBA RBITONE LAMOTRIG INE CLONAZE PAM
  11. 11. AED’S DRUG Seizure Type Dose range mg/day Doses/ day Carbama Partial/2n 200-2000 2-3 zepine dry GTCS Clonaepa Partial 1-8 m Myoclonu s 2 Ethosuxi Childhoo 500-1500 2 mide d Absence Therapeu tic range 30-50 _ 200-700
  12. 12. AED’S Primidon Partial e 2ndry GTCS 2501000 1-2 50-150 Lamotrig ine _ 25-500 1-2 NA Phenoba rbitone _ 60-180 1 50-150 Phenytoi n _ 150-300 1 40-80 Topiram ate _ 200-600 1-2 NA
  13. 13. Valproat Primary 400e 2ndry 2500 GTCS, Absence Myoclon us 1-2 NA Gabapen Partial til 3 NA 1-2 NA 3002400 Vigabatri Partial 2000n 2ndry 6000 GTCS,Inf antile spasms
  14. 14. ANTICONVULSANT DRUG BLOOD LEVELS • Can be a useful guide in case of some drugs. • In valproate,no relationship b/w level & anticonvulsant efficacy. • Particularly useful in phenytoin & carbamazepine.
  15. 15. WITHDRAWL OF AED’S • Can be considered after complete control of seizures for 2-4 years. • Should be undertaken slowly, reducing the drug dose gradually over 6-12 months.
  16. 16. OUTCOME AFTER 20 YEARS • 50% seizure free, without drugs for last 5 years. • 20% seizure free for last 5 years but continue to take medication. • 30% seizures continue in spite of anti epileptic therapy.
  17. 17. THANKYOU
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