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  • 1. Dr AELIYA ZAIDI HOUSE OFFICER MEDICAL UNIT ll HFH,Rwp March 25th, 2006
  • 2. DRUG TREATMENT OF EPILEPSY
  • 3. SEIZURES • Any abnormal clinical event caused by an electrical discharge from the brain.
  • 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. 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. MANAGEMENT • Explain the nature & cause of seizures to the relatives. • Immediate care. • Restrictions. • Anticonvulsant drug therapy.
  • 7. ANTICONVULSANT DRUG THERAPY
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. THANKYOU