Epilepsy happens as a result of abnormal electrical brain activity, also known as a seizure, kind of like an electrical storm inside your head. And because your brain controls so much, a lot of different things can go wrong. You may have periods of unusual behaviors, feelings and sometimes loss of awareness.

1. Presentation- I
Subject- Pharmacology
MMCP,MM(DU)
Presented by-Ms.Sapna Rani
14211011

3. CONTENT
1. Action potential
2. Epilepsy – Introduction
3. Signs and symptoms
4. Types
5. Pathophysiology
6. Antiepileptic drugs

4. ACTION POTENTIAL
ACTION POTENTIAL – This is defined as the change
in electric potential associated with passage of an
impulse along the membrane of a muscle or nerve cell.

5. Resting membrane potential – This is the
potential inside the cell when the cell is at resting phase
and also know as polarized state . RMP is negative 70mV.
Depolarization – When inside of cell membrane
become more positive than outside of cell membrane.
More positive ions inside the cell as compared to outside
. Depolarization state potential is positive 30mV . In this
phase excitation occurs .
Repolarization – When the cell is regaining its
resting potential by moving positive ions outside . This is
a inhibitory stage .

7. What is Epilepsy ?
Epilepsy is a group of neurological disorder , which is
characterized by recurrent and unpredictable
SEIZURES

8. SEIZURE
 Cells in the brain works non synchronously means
not active at the same time but in the case of seizure
cluster of neuron starts sending tons of sudden
excitory signals over and over in a short period of
time this means synchronously .
 Seizure:- Abnormal increase electrical activity
in brain.

9. SIGNS AND SYMPTOMS
OUTWARD SIGNS INWARD SIGNS
i. CONVULSIONS
ii. SALIVATION
iii. LOSE OF
CONSIOUNESS
iv. JAW FREEZE
i. FEAR
ii. UNUSUAL SMELL
AND TASTING
iii. MENTAL CONFUSION

10. FOCAL/PARTIAL SEIZURE GENERALISED SEIZURE
 ONE HEMISPHERE OR
SINGLE LOBE
 SUBTYPES ARE
I. SIMPLE PARTIAL
SEIZURE
II. COMPLEX PARTIAL
SEIZURE
III. PARTIAL SEIZURE
SECONDARILY
GENERALISED
WHOLE BRAIN
SUBTYPES ARE
I. TONIC
II. CLONIC
III. ATONIC
IV. TONIC-CLONIC
V. MYOVLONIC
VI. ABSENSE
TYPES OF SEIZURE

11. PARTIAL SEIZURE
 SIMPLE PARTIAL SEIZURE – Strange sensation ,
tasting something , visual changes and the main
thing that patient knows that something is wrong .
 COMPLEX PARTIAL SEIZURE – loss of awareness ,
convulsions , jaw freeze etc.
 PARTIAL SEIZURESECONDARILY GENERALISED –
Seizure arises as partial and coverts into generalized
tonic clonic seizure .

12. GENERALISED SEIZURE
 TONIC – muscle stiffed and flexed cause backward
fall.
 ATONIC – muscle relaxed and fluffy causes front
fall.
 CLONIC – contraction and relaxation of muscle i.e.
convulsion.
 TONIC-CLONIC – tonic phase followed by clonic
phase.
 MYOCLONIC – small muscle contraction .
 ABSENSE – spaced out.

14. PATHOPHYSIOLOGY
1. Glutamanergic neuron
2. GABAminergic neuron
3. Mitochondrial dysfunction
4. Oxidative stress
5. Brain tumor , toxins and stroke
6. Genetic

15. GLUTAMATE –GABA SYNTHESIS

16. GABA SHUNT
Glucose pyruvate
alpha- Ketoglutarate
L- glutanic acid
GABA
KREBS CYCLE
Oxaloglutarate
transferase
GAD

17. GLUTAMATE
AMPA RECEPTOR NMDA RECEPTOR MET RECEPTOR
Na ion influx Ca/Na ion influx IP3 / DAG

18. Binds to
endoplasmic
reticulum
RELEASES THE
CALCIUM
STORED IN ER
HYPER
DEPOLARIZATION
ROS
INCREASES
ACTIVITY OF
PROTEASE
CELL
DEATH

19. GABA RECEPTOR

20. OXIDATIVE STRESS
ROS binds with
mitochondrial
complex , leads to
• Decease ATP production
DNA mutation and damage
Lipid peroxidation
Proteolysis
CELL
DAMAGE
AND
DEATH

21. GENETIC
 Genetics is believed to be involved in most of the
cases either or indirectly . If identical twins, if one is
affected there is a 50-60% chance that the other will
also be affected . In non identical twins the risk is
15%. If both the twins are affected most of time they
have same epileptic syndrome 60-70%.

22. BRAIN TUMOUR ,STROKE AND TOXINS
 Brain tumor - A cancerous or non-cancerous mass or
growth of abnormal cells in the brain. These cells
interfere with the chemical balance of neighboring cells
and may cause cell damage .
 Stroke - Damage to the brain from interruption of its
blood supply . This leads to less supply of nutrients and
oxygen to brain and causes cell death .
 Toxins – Domoic acid is a marine toxin and have high
affinity to NMDA receptor .

23. ANTIEPILEPTIC DRUG
CLASSIFICATION
1. Barbiturate Phenobarbitone
2. Deoxybarbiturate Primidone
3. Hydantoin Phenytoin Fosphenytoin
4. Iminostilbene Carbamazepine Oxcarbazepine
5. Succinimide Ethosuximide
6. Aliphatic carboxylic Valproic acid acid (sodium valproate) Divalproex
7. Benzodiazepines Clonazepam Diazepam Lorazepam Clobazam
8. Phenyltriazine Lamotrigine
9. Cyclic GABA analogue Gabapentin
10. Newer drugs Vigabatrin Topiramate Tiagabine Zonisamide

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