This document summarizes information about different drugs used to treat convulsive disorders like epilepsy. It discusses several commonly used anti-epileptic drugs including carbamazepine, clonazepam, gabapentin, lamotrigine, phenytoin, and vigabatrin. For each drug, it provides brief details on how the drug works, common dosages, potential side effects, and other relevant information. The overall document aims to educate about effective pharmaceutical options for controlling seizures and convulsive disorders.

1. Drug effective in convulsive
disorder
By:
Dr. Mohan Kumar
LECTURE No.1

2. Convulsive disorder (Epilepsy)
• Epilepsy is a central nervous system (neurological) disorder in which
brain activity becomes abnormal, causing seizures or periods of
unusual behavior, sensations, and sometimes loss of awareness.
• Anyone can develop epilepsy. Epilepsy affects both males and
females of all races, ethnic backgrounds and ages.
• Seizure symptoms can vary widely.
• Some people with epilepsy simply stare blankly for a few seconds
during a seizure, while others repeatedly twitch their arms or legs.
• Having a single seizure doesn't mean you have epilepsy. At least
two unprovoked seizures are generally required for an epilepsy
diagnosis.
• Treatment with medications or sometimes surgery can control
seizures for the majority of people with epilepsy. Some people
require lifelong treatment to control seizures, but for others, the
seizures eventually go away. Some children with epilepsy may
outgrow the condition with age.

3. Seizure
• A seizure is usually defined as a sudden alteration of behavior due
to a temporary change in the electrical functioning of the brain.
• Normally, the brain continuously generates tiny electrical impulses
in an orderly pattern.
• These impulses travel along neurons — the network of nerve cells
in the brain — and throughout the whole body via chemical
messengers called neurotransmitters.
• In epilepsy the brain's electrical rhythms have a tendency to
become imbalanced, resulting in recurrent seizures.
• In patients with seizures, the normal electrical pattern is disrupted
by sudden and synchronized bursts of electrical energy that may
briefly affect their consciousness, movements or sensations.

4. Symptoms
• Epilepsy is caused by abnormal activity in the brain, seizures can
affect any process your brain coordinates and the Seizure signs and
symptoms may include:-
• Temporary confusion
• A staring spell
• Uncontrollable jerking movements of the arms and legs
• Loss of consciousness or awareness
• Psychic symptoms such as fear, anxiety
• Symptoms vary depending on the type of seizure. In most cases, a
person with epilepsy will tend to have the same type of seizure
each time, so the symptoms will be similar from episode to
episode.
• Doctors generally classify seizures as either focal or generalized,
based on how the abnormal brain activity begins.

5. Anti-epileptic drug
• Antiepileptic drugs are medicines that reduce
the frequency of epileptic seizures.
• This class of drugs includes some drugs that
have other uses as well. Phenobarbital is a
barbiturate.

6. Different drugs used are:-
• Carbamazepine
• Clonazepam
• Gabapentin
• Lamotrigine
• Phenytoin
• Vigabatrin

7. Carbamazepine
• carbamazepine (Tegretol, Carbatrol): A favorite partial
seizure medicine in the developed world.
Carbamazepine affects sodium channels, and inhibits
rapid firing of brain cells.
• Long-acting forms such as Carbatrol or Tegretol-XR can
be given once a day.
• Potential side effects include GI upset, weight gain,
blurred vision, low blood counts, low blood sodium
(hyponatremia).
• Carbamazepine causes a rash rate of a few percent,
sometimes even the dangerous rash called Stevens-
Johnson syndrome. People of Asian descent with HLA-
B*1502 antigen are more at risk. Typical adult dose is
400 mg tid

8. Clonazepam
• clonazepam (Klonopin): Clonazepam is a member of the
drug class known as benzodiazepines, to which diazepam
(Valium), lorazepam (Ativan), clorazepate (Tranxene),
alprazolam (Xanax) also belong.
• Benzodiazepines are used as anti-seizure drugs, sedatives,
tranquilizers and muscle relaxants. Benzodiazepines
increase the effectiveness of GABA, the brain’s main
inhibitory neurotransmitter.
• Clonazepam is more long-acting against seizures than are
diazepam or lorazepam.
• Side effects of clonazepam include sedation,
thinking/memory impairment, mood changes, addiction.
More so than most, its effects wear off over time.
• A typical adult dose is 0.5-1.0 mg three times a day.

9. Gabapentin
• gabapentin (Neurontin): Gabapentin has the
reputation of being a safe but not particularly powerful
AED. The effectiveness criticism probably is because it
is often prescribed at too low a dose.
• The drug probably works by influencing transport of
GABA and effects on calcium channels.
• It has no drug interactions, is not metabolized in the
liver and it does not bind to blood proteins. Side effects
are unsteadiness, weight gain, fatigue, dizziness.
• Typical adult dose is 300-600 mg three times a, but
doses can be up to 1200 mg three times a day.

10. Lamotrigine
• lamotrigine (Lamictal): A broad-spectrum alternative to
VPA, with a better side effect profile. However, LTG may not
be as effective for myoclonic seizures.
• Lamotrigine works by several mechanisms including
blocking release of glutamate, the brain’s main excitatory
neurotransmitter.
• It has the usual side effects of dizziness and fatigue, usually
mild cognitive (thinking) impairment. Severe medical side
effects are unusual. The practical side effect issue is rash,
occurring in several percent of people who take it,
especially if the dose is increased too fast.
• Therefore, it takes a couple of months to get up to the
typical adult dose of 200 mg twice a day.

11. Phenytoin
• phenytoin (Dilantin):
• Phenytoin alters brain cell sodium channels, which has the effect of
limiting rapid firing of the brain cells.
• It is inexpensive.
• Common side effects are unsteadiness and moderate cognitive
problems.
• There are long-term potential cosmetic (body/face hair growth, skin
problems), and bone problems (osteoporosis).
• Phenytoin causes a rash rate of a few percent, sometimes even the
dangerous rash called Stevens-Johnson syndrome.
• Typical adult dose is 300-400 mg per day, usually with 100 mg pills.
Phenytoin can be started quickly in an emergency with intravenous
administration, or a large dose of capsules if an immediate effect is
required. Small changes in phenytoin dose can cause large changes
in serum drug levels, so the blood levels can be hard to regulate.
The target serum level is 10-20 mcg per ml

12. Vigabatrin
• vigabatrin (Sabril):
• Vigabatrin is a “designer drug,” made to block
metabolism of GABA, the brain’s main
inhibitory neurotransmitter.
• Regular vision testing is recommended for all
people on this drug. A typical regimen begins
with 500 mg twice a day, and can increase
over a month or two to 1500 mg twice a day

13. Thanks