Clinical Pharmacy.....An over view on Epilepsy disease.....

1. Epilepsy
Prepared By:
Imran Ahammad Chowdhury

2. Epilepsy
Epilepsy is a group of neurological diseases characterized by epileptic seizures. Epileptic seizures are episodes that can vary from brief and nearly undetectable to long periods
of vigorous shaking. In epilepsy, seizures tend to recur, and have no immediate underlying cause while seizures that occur due to a specific cause are not deemed to represent
epilepsy.
Types of seizures:
There are three types of diagnoses a doctor might make when treating a patient with epilepsy:
1. Idiopathic - this means there is no apparent cause.
2.Cryptogenic - this means the doctor thinks there is most probably a cause, but cannot pinpoint it.
3.Symptomatic - this means that the doctor knows what the cause is.
There are three descriptions of seizures, depending on what part of the brain the epileptic activity started:
A. Partial seizure: A partial seizure means the epileptic activity took place in just part of the patient's brain. There are two types of partial seizure:
a. Simple Partial Seizure: the patient is conscious during the seizure. In most cases the patient is also aware of his/her surroundings, even though the seizure is in
progress.
b. Complex Partial Seizure: the patient's consciousness is impaired. The patient will generally not remember the seizure, and if he/she does, the recollection of it will be
vague.
B. Generalized Seizure: A generalized seizure occurs when both halves of the brain have epileptic activity. The patient's consciousness is lost while the seizure is in progress.
C. Secondary Generalized Seizure: A secondary generalized seizure occurs when the epileptic activity starts as a partial seizure, but then spreads to both halves of the brain.
As this development happens, the patient loses consciousness.

3. Sign and Symptoms of epilepsy:
The main symptoms of epilepsy are repeated seizures. There are some symptoms which may indicate a person has epilepsy. If one or more of these symptoms are
present a medical exam is advised, especially if they recur:
• A convulsion with no temperature (no fever).
• Short spells of blackout, or confused memory.
• Intermittent fainting spells, during which bowel or bladder control is lost. This is frequently followed by extreme tiredness.
• For a short period the person is unresponsive to instructions or questions.
• The person becomes stiff, suddenly, for no obvious reason
• The person suddenly falls for no clear reason
• Sudden bouts of blinking without apparent stimuli
• Sudden bouts of chewing, without any apparent reason
• For a short time the person seems dazed, and unable to communicate
• Repetitive movements that seem inappropriate
• The person becomes fearful for no apparent reason, he/she may even panic or become angry
• Peculiar changes in senses, such as smell, touch and sound
• The arms, legs, or body jerk, in babies these will appear as cluster of rapid jerking movements.
Mechanism:
Its activity is regulated by various factors both within the neuron and the cellular environment. Factors within the neuron include the type, number and distribution of
ion channels, changes to receptors and changes of gene expression. Factors around the neuron include ion concentrations, synaptic plasticity and regulation of
transmitter breakdown by glial cells.

4. Diagnosis & Tests:
Diagnosis:
• Diagnosing Epilepsy: Epilepsy Tests
• Syncope
• Psychological disorders
• Metabolic disturbances
• Migraine
• TIA
• Sleep disorders
• Movement disorders
Tests:
• Epilepsy EEG Test
• Epilepsy and Blood Testing
• Epilepsy and the PET Scan
• Epilepsy and the Spinal Tap

5. Treatment:
• When a diagnosis of seizures or epilepsy is made, the doctor will then discuss with the patient or the patient's family what the best treatment options are. If an
underlying correctable brain condition was causing the seizures, sometimes surgery may stop them. If epilepsy is diagnosed (ongoing tendency to have seizures), the
doctor will prescribe seizure-preventing drugs or anti-epileptic drugs.
• If drugs do not work, the next option could be surgery, a special diet or VNS (vagus nerve stimulation). Trigeminal nerve stimulation may also be effective,
according to this study.
Here is a list of the most commonly prescribed anti-epileptic drugs (AEDs):
• acetazolomide modified release;
• Carbamazepine;
• carbamazepine modified release;
• Clobazam;
• Clonazepam;
• Ethosuximide;
• Gabapentin;
• Lacosamide;
• Lamotrigine.