Epilepsy and its types, classification and its management by Pharmacological and Non- Pharmacological management.

1. Management of Epilepsy-
Through pharmacological and
Non- pharmacological methods
Presented by-
Mustaq Ahmad
Department of Pharmacology
DPSRU
To-
Dr. Ajit Kumar Thakur
Assistant Professor of
Pharmacology
DPSRU

2. CONTENTS
Introduction
Causes
Types of seizures
Management of epilepsy-
Pharamcological and Non-Pharmacological
management

4. •Epilepsy is a disorder of brain in which
a fit occurs because of abnormal
electrical discharge between certain
brain cells.
•a sudden loss of consciousness which is
often accompanied by repeated jerky
movements called convulsions.
•These attacks are sometimes called fits
or seizures.
•Epilepsy is due to disturbance in the
electrical activity of the brain.

6. 1. Primary( idiopathic) epilepsy:-
 Unknown genetic or biochemical
predisposition
2. Secondary epilepsy:-
a. Intracranial-
 Tumor
 Cerebro -vascular disease
 Arteriovenous malformation
 Trauma ( birth injury, depressed
fracture, penetrating wound)

7. Contd…
Infection ( meningitis, encephalitis)
Congenital and hereditary disease
(tuberous sclerosis)
b. Extra cranial-
Metabolic
Electrolyte
Biochemical
Inborn errors of metabolism
anoxia

8. Contd….
Hypoglycemia
Drugs
Drug withdrawal
Alcohol withdrawal

10. CLASSIFICATIONS
1. Generalized seizures-
 Major epilepsy( Grand mal
seizure/epilepsy)
 Minor epilepsy(Petit mal,
absence seizure)
 Myoclonic seizures
2. Partial seizures ( Focal/
Jacksonian seizure)
3. Status epilepticus

11. GENERALIZED SEIZURE
Involves the entire brain
Consciousness is lost and the
seizure may last from several
seconds to several minutes
Types include;
1.Major epilepsy
2.Minor epilepsy
3.Myoclonic epilepsy

12. 2. Partial seizure( Focal/Jacksonian)
It begins in a specific area of the
cerebral cortex.
A partial seizure can progress to a
generalized seizure.
It begins as a localized motor
seizure, with convulsions starting
in one part of the body eg. From
the thumb and gradually involving
hand and arms, face and other
parts.

14. 3.Status epilepticus
It is characterized by at least 30
min of repetitive seizure activity
with out return to consciousness.
In other words, it is state in
which a person has continuous
seizures lasting at least 30 min.
This is medical emergency and
requires prompt intervention to
prevent irreversible neurological
damage.

15. Contd..
Abrupt cessation of
anticonvulsant therapy is the
usual cause of status epilepticus.

16. MANAGEMENT OF
EPILEPSY

17. APPROACH CONSIDERATIONS:
THE GOAL OF TREATMENT IN
PATIENTS WITH EPILEPTIC
SEIZURES IS TO ACHIEVE A
SEIZURES FREE STATUS WITHOUT
ADVERSE EFFECTS. THIS GOAL IS
ACCOMPLISHED BY IN MORE THAN
60% OF PATIENTS WHO REQUIRE
TREATMENT WITH ANTI-
CONVULSANTS.

18. ANTICONVULSANT THERAPY:
THE MAINSTAY OF SEIZURE
TREATMENT IS ANTICONVULSANT
MEDICATION. THE DRUG OF CHOICE
DEPENDS ON AN ACCURATE
DIAGNOSIS OF THE EPILEPTIC
SYNDROME, AS RESPONSE TO
SPECIFIC ANTICONVULSANTS VARIES
AMONG DIFFERENT SYNDROMES.

19. ANTI CONVULSANTS CAN BE DIVIDED
INTO LARGE GROUP BASED ON THEIR
MECHANISM, AS FOLLOWS:-
• BLOKERS OF REPETITIVE ACTIVATION
OF THE SODIUM CHANNEL:
PHENYTOIN, CARBAMAZEPINE.
• ENHANCER OF SLOW INACTIVATION OF
THE SODIUM CHANNEL:
LACOSAMIDE, RUFINAMIDE.
• GABA-A RECEPTOR ENHANCERS:
PHENOBARBITAL.

20. •N AND L- CALCIUM CHANNEL
BLOCKERS: LAMOTRIGINE,
VALPORATE
•H- CURRENT MODULATORS:
GABAPENTIN, LAMOTRIGINE.
•BLOCKERS OF UNIQUE BINDING
SITES: GABAPENTIN
•NEURONAL POTASSIUM CHANNEL
OPENER: EZOGABINE.

22. THE TWO METHODS ARE:
 A KETOGENIC OR MODIFIED
ATKINS DIET( LOW
CARBOHYDATE DIET)
 VAGAL NERVE STIMULATION
(VNS)

23. THE KETOGENIC DIET, WHICH RELIES
HEAVILY ON THE USE OF FAT, SUCH AS
HYDROGENATED VEGETABLE OIL
SHORTENING, HAS A ROLE IN THE
TREATMENT OF CHILDREN WUTH
SEVERE EPILEPSY.
ALTHOUGH THIS DIET IS
UNQUESTIONABLY EFFECTIVE IN SOME
REFRECTORY CASES OF SEIZURE, A
KETOGENIC DIET IS DIFFICULT TO
MAINTAIN; LESS THAN 10% OF
PATIENTS CONTINUE THE DIET AFTER
YEAR.

24. FURTHERMORE, ANY SMALL
CARBOHYDRATES IN TAKE
RESETS KETONE METABOLISM
FOR 2 WEEKS, THEREBY
ELIMINATING ANTISEIZURE
EFFICACY.

25. VAGAL NERVE STIMULATION:
VNS IS A PALLIATIVE
TECHNIQUE THAT INVOLVES
SURGICAL IMPLANTATION OF A
STIMULATING DEVICE. IT IS
CURRENTLY INDICATED FOR
PATIENT OLDER THAN 12
YEARS WITH MEDICALLY
PARTIAL SEIZURE THAT ARE
NOT TREATED SURGICALLY.

26. • VNS MAY HAVE IMPROVED
EFFICACY OVER TIME.
•CHILDREN SHOULD BE
CAREFULLY MONITORED FOR
THE SITE OF INFECTION AFTER
VNS IMPLANTATION.

28.  LOBECTOMY
 LESIONECTOMY