1. Epilepsy & its
Management

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1. Epilepsy
2. Epidemiology
3. Aetiology
4. Classification
Outline
5. 5. Pathophysiology
6. Signs and symptoms
7. Management

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Epilepsy
Epilepsy is a brain disorder in which
clusters of nerve cells, or neurons, in the
brain sometimes signal abnormally.
It produces changes
in a person's
movement,
behavior or
consciousness

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Epidemiology
About 1% of people worldwide
(65 million) have epilepsy, and nearly
80% of cases occur in developing
countries.
More than 2 million people in the
United States -- about 1 in 100 -- have
experienced an unprovoked seizure or
been diagnosed with epilepsy.

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Aetiology
The cause is unknown in 70% of cases
 Brain Trauma (e.g. injury, stroke)
 Brain Lesions (e.g. tumors)
 Poisoning (e.g. lead)
 Infections of the brain (e.g.
meningitis)
Chronic alcohol/ drug abuse
Genetic causes

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Classification
1. Common generalized seizure
 Tonic-clonic seizure– 1-2 min
 Absence seizure– 3-5 sec
 Myoclonic seizures– Several min
 Atonic seizure
 Intractable seizure

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Cont.…
2. Common partial seizures
 Simple partial seizure– 90 sec
 Complex partial– 1-2 min
 Secondary generalization--
 Status epilepticus– 30 min

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Nerve impulse propagates in the brain
in a synchronous manner and for that
the electrical potential reaches to zero.
Pathophysiology

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Blackout
Episodes of staring
Involuntary movement of arms and
legs
Odd sounds
Odd sensations
Visual hallucinations
Emotional changes
 Muscle spasms
Signs and symptoms

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1. Medications
Hydantoins: phenytoin
Barbiturates: phenobarbitone
Iminostilbene: carbamazepine
Succinimide: ethosuximide
GABA transaminase inhibitiors:
valproic acid
Benzodiazepines: diazepam
GABA analouges: vigabatrin
Management

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Mechanism of action
 Na+ , Ca++
Adverse effects
 Epigastric pain
 Ataxia
 Anorexia
Dose
20mg/kg
Phenytion

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Mechanism of action:
Na+
Adverse effects :
Vertigo
Blurring of vision
Dizziness
Dose :
200-400 mg
Carbamazepine

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Mechanism of action :
Ca++
Adverse effects:
Lethargy,
Euphoria,
Leukopenia,
Urticaria
Ethosuximide

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Valproic acid
Mechanism of action :
 GABA, Na+ , Ca++
Adverse effects:
Tremors
Rashes
Alopecia

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Diazepam & Vigabatrine
Diazepam is a drug of choice in
status epilepticus and febrile
convulsions
Vigabatrine is an GABA analouge
which acts by irreversibily inhibiting
the enzyme GABA transminase
thereby raising brain GABA levels

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2. Surgery
The goal of surgery is total control of
seizures and this may be achieved in
60–70% of cases.
3. Other
A ketogenic diet
Sensitive to light, wearing dark
glasses may be useful
Seizure response dogs
Cont.…

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Basis of Therapeutics. 12th
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 Clark, Michelle A. et al., Lippincott’s Illustrated Reviews Pharmacology. 5th
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 Rang, H P. et al., Rang and Dales Pharmacology. 7th
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Livingstone Elsevier, 2012. Print.
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United Stated of America: Mosby, 1994. Print.
 Golan, David E. et al., eds. Principles of Pharmacology: The Pathophysiologic
Basis of Drug Therapy. 1th
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Print.
 Goth, Andres. et al., eds. Medical Pharmacology: Principles and Concept. 11th
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1996. Print.
 Berry, Tricia M. Clinical Pharmacology Made Incredibly Easy. 3th
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Lippincott Williams & Wilkins, 2009. Print.
 Craig, Charles R. et al., Modern Pharmacology with Clinical Applications. 6th
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New York: Lippincott Williams & Wilkins, 2009. Print.
References

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Any ?