This document provides an overview of epilepsy including its etiology, epidemiology, pathophysiology, clinical manifestations, diagnosis, treatment, and management. Some key points include: Epilepsy is characterized by recurrent seizures and can be caused by genetic or acquired factors in approximately 30% of cases. It affects about 50 per 100,000 people. Abnormalities in ion channels or inhibitory/excitatory neurotransmission in the brain lead to seizures. Treatment involves anti-seizure medications to modulate ion channels or inhibitory neurotransmission as well as non-pharmacological options like the ketogenic diet or neurostimulation devices for treatment-resistant cases.

1. PRESENTED BY:
CHALLA.ANITHA, Pharm-D student
Vignan Pharmacy College, Vadlamudi, Guntur
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2. CONTENTS
 INTRODUCTION
 ETIOLOGY
 EPIDEMIOLOGY
 PATHOPHYSIOLOGY
 CLINICAL MANIFESTATIONS
 DIAGNOSIS
 FIRST AID FOR SEIZURES
 TREATMENT
 REFERENCES
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3. INTRODUCTION:
Epilepsy is a common chronic neurological condition characterised by:
• Recurrent seizures
• Loss of consciousness
• With or with out body movements
 It is derived from a greek word Epi – upon, Leptos – seizures.
 It is also known as seizure disorder.
 Seizures are nothing but sudden, excessive, abnormal discharges of cerebral neurons.
 It is usually controlled but not cured.
 World epilepsy day is celebrated on MARCH 26th
every year.
 It is also known as purple day & it was designed to raise awareness on epilepsy.
FIG NO 1: LOGO OF PURPLE DAY
ETIOLOGY:
In 28% cases cause can be determined, rest 72% are idiopathic ( of unknown cause)
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4. CATEGORIES DETERMINED CAUSES
Inherited / genetic Single gene mutation (< 2%), multiple genes + environmental factors,
genetic disorders ( down, dravet, etc ), > 200 genes have the
capability of causing epilepsy.
Acquired Head trauma, neurosurgery, cerebrovascular disease, infections
(meningitis, influenza, toxoplasmosis, mumps, measles, syphilis),
metabolic disorders (such as hypoglycemia and hypocalcemia),
Intracranial neoplasms
Congenital Inborn error of metabolism
Withdrawal of drugs Alcohol, benzodiazepines, barbiturates, antiepileptics
Drugs that induce
seizures
Some of the antibiotics, antidiabetics, anesthetics, antimalarials,
antispastics, antidepressants, antipsychotics, mood satbilisers
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TABLE NO: 1 DETERMINED CAUSES

5. AGE AT SEIZURE ONSET PROBABLE CAUSE OF SEIZURE
Birth to 1 month
1–6 months
6 months to 2 years
3–10 years
10–18 years
18–25 years
35–60 years
> 60 years
Birth injury or anoxia, congenital hereditary diseases,
and metabolic disorders
As above, plus infantile spasms
Infantile spasms, febrile convulsions, birth injury or
anoxia, meningitis, and head trauma
Birth injury or anoxia, meningitis, cerebral vessel
thrombosis, and idiopathic epilepsy
Idiopathic epilepsy and head trauma
Idiopathic epilepsy, trauma, neoplasm, and
withdrawal from alcohol or drugs
Trauma, neoplasm, vascular disease, and withdrawal
from alcohol or drugs
Vascular disease, neoplasm, degenerative disease,
and trauma
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TABLE NO: 2 PROBABLE CAUSES OF SEIZURE IN DIFFERENT AGE GROUPS

6. EPIDEMIOLOGY:
Incidence of epileptic seizures is around 50 cases per 100,000 of the population.
PATHOPHYSIOLOGY:
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Abnormalities in ion channel ( Na+, K+, Ca+ )
(or)
Decreased INT activity / inactivation of INT activity
Rhythmic & repetitive hypersynchronus discharge of neurons
Seizures focus
Seizures
Repeated seizures
Epilepsy
Increased ENT activity
FIGURE NO 2: PATHOPHYSIOLOGY OF EPILEPSY

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FIG NO:3 NEURO HUMORAL TRANMISSION, MOA OF ANTIEPILEPTIC DRUGS

8. INTERNATIONAL CLASSIFICATION OF EPILEPTIC SEIZURES
I.) Partial / Focal seizures (seizures begin locally)
A. Simple (without impairment of consciousness)
B. Complex (with impairment of consciousness)
C. Secondarily generalized (partial onset evolving to generalized tonic-clonic
seizures)
II.) Generalized seizures (bilaterally symmetrical and without local onset)
A. Absence
B. Myoclonic
C. Clonic
D. Tonic
E. Tonic-clonic
F. Atonic
G. Infantile spasms
III.) Unclassified seizures
IV.) Status epilepticus
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CLINICAL MANIFESTATIONS

9. TYPE OF GENERALISED SEIZURE CLINICAL MANIFESTATIONS
Absence / petit mal Happen exclusively in childhood and early adolescence
The child goes blank & stares; fluttering of the eyelids and
flopping of the head may occur.
The attacks last only few seconds & often go un recognized.
Myoclonic Involuntary shock-like jerks, which may involve the whole body,
or the arms or the head.
Tonic-clonic / grand mal Commonest of all epileptic seizures.
Without warning the patient suddenly goes stiff, falls and
convulses
Laboured breathing and salivation, cyanosis, incontinence and
tongue biting may also occur.
The convulsion ceases after a few minutes and may often be
followed by a period of drowsiness, confusion, headache and sleep.
Atonic / falling out The patient looses consciousness, muscle tone. No muscle
movements are typically noted, & the patient will fall when they
are not lying down or sitting in chair.
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TABLE NO 3:GENERALIZED SEIZURES (BILATERALLY SYMMETRICAL AND WITHOUT LOCAL ONSET):

10. TYPE OF PARTIAL SEIZURE CLINICAL MANIFESTATIONS
Simple partial seizures The patient will have a sensation of uncontrolled
muscle movement of a portion of their body
without an alteration in consciousness
Complex partial seizures Alteration in the patients level of consciousness
Secondarily generalized Partial onset evolving to generalized tonic-clonic
seizures
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TABLE NO 4: PARTIAL / FOCAL SEIZURES (SEIZURES BEGIN LOCALLY)
Status epilepticus: If it lasts ≥ 5 min ongoing / without returning to normal

11. DIAGNOSIS:
 Neurological examination / neuropsychological tests - Doctor tests for behavior, motor
abilities, mental function & other symptoms.
 Medical history
 Electroencephalogram (EEG) – Tracks electrical signals from the brain.
 CT scan, MRI scan – Used to detect abnormalities in brain ( tumors, bleeding, cysts)
 fMRI – Used to measure the changes in blood flow
 PET ( Positron Emission Tomography) – Used to visualize active areas of brain & detect
abnormalities
 SPECT ( Single Photon Emission Computerized Tomography) – Used when MRI & EEG
didn’t pinpoint the location in brain where the seizures are originating.
 SISCOM ( Substraction Ictal SPECT Coregistered to MRI ) – A form of SPECT test
which may provide even more detailed results.
 Genetic testing
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FIG NO 4: EEG OF PARTIAL SEIZURES FIG NO 5: EEG OF GENERALISED SEIZURES

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VIDEO NO : 1 FIRST AID FOR SEIZURES

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TREATMENT
Pharmacological / drug
therapy.
Non pharmacological
treatment / non drug therapy.
1.) MODULATION OF VOLTAGE GATED ION
CHANNELS:
a.) Na+ channel blockers:
Phenytoin, Carbamazepine,Valproicacid, Lamotrigine,
Topiramate, Zonisamide.
b.) Calcium channel blockers:
Ethosuximide, Topiramate, Gabapentin
2.) ENHANCEMENT OF SYNAPTIC INHIBITION:
a.) Increased GABA activity:
•Barbiturates , Benzodiazepines
•Vigabatrin – GABA transaminase inhibitor
•Tigabine – GABA reuptake inhibitor
3.) INHIBITION OF SYNAPTIC EXCITEMENT:
a.) Decreased glutamate activity
4.) Levitriacetam
a) Ketogenic diet
b) Surgery
1) Lobe resection
2) Lesionectomy
3) Corpus callosotomy/ split brain surgery
4) Functional hemispherectomy
5) Multiple subpial transection (MST)
6) Vagus nerve stimulation (VNS)
7) Responsive neurostimulation device (RNS)
c) Avoiding of precipitating factors:
1) Stress
2) Sleep deprivation
3) Ingestion of excessive amount of
caeffine (or) alcohol
d) Promotion of emotional wellbeing
( yoga)
e) Reduction of psychiatric
co-morbidities (anxiety or depression)

14. Seizure type First line drugs Alternative drugs
Partial seizures Carbamazepine, phenytoin,
lamotrigine, valproic acid,
oxcarbazepine
Gabapentin, Topiramate,
levetriacetam, zonisamide,
tigabine, primidone,
phenobarbital,
felbamate
Generalised seizures
Absence
Myoclonic
Tonic- clonic seizures
Valproicacid,
Ethosuximide
Valproicacid,
Clonazepam
Phenytoin,
Valproic acid
Lamotrigine,
Levetriacetam
Lamotrigine,
Levetriacetam
Topiramate, zonisamide
Lamotrigine, Topiramate ,
Oxacarbazepine
Levetriacetam,
oxcarbazepine
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TABLE NO: 5 CHOICE OF TREATMENT

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DRUGS BRAND NAME DOSE ADVERSE EFFECTS
Phenobarbitone GARDENAL 1-3 mg/kg/day Hyperactivity, sedation, behavior
changes, metabolic bone disorders,
ataxia, blood dyscrasias,
unsteadiness.
Phenytoin DILANTIN 3-5 mg/kg Ataxia, nystagmus, behavior
changes, hirsutism, gingival
hyperplasia, visual blurring, blood
dyscrasias
Carbamazepine TEGRETOL 400mg/day Hyponatremia, rash, drowsiness,
unsteadiness, blood dyscrasias
( diseased state in which there are
abnormal blood components)
Ethosuximide ZARONTIN 500mg/day Drowsiness, unsteadiness, ataxia,
behavioral changes, blood
dyscrasias, hiccoughs.
Valproic acid DEPAKENE
DEPAKOTE
DEPACON
15 mg/kg Thrombocytopenia, GI upset, tremor,
acute hepatic failure, acute
pancreatitis, alopecia
TABLE NO: 6 TREATMENT

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DRUG BRAND NAME DOSE ADVERSE EFFECTS
Clonazepam KLONOPIN 1.5 mg/day Drowsiness, loss of appetite,
constipation
Lamotrigine LAMICTAL 25 mg qod if on
VPA
25-50mg/day if not
on VPA
Ataxia ( inability to coordinate
voluntary muscle movements),
diplopia, unsteadiness, skin
rash ( Steven Johnson
Syndrome)
Gabapentin NEURONTIN 900mg/day Pedal edema, weight gain,
dizziness, ataxia, Somnolence (
state of being drowsy), fatigue
Tigabine GABITRIL 4-8 mg/day Dizziness, fatigue, difficulty in
concentrating, spike wave
stupor, blurred vision, tremor.
Topiramate TOPAMAX 25-50mg/day Psychomotor slowing , Acute
angle, glaucoma , Weight loss
Oligohydrosis, Somnolence
( state of being drowsy),
kidney stones
TABLE NO: 7 TREATMENT

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DRUG BRAND NAME DOSE ADVERSE EFFECTS
Diazepam VALIUM PO - 4-40 mg
IV - 5-10 mg
Shakiness, unsteady walk,
unsteadiness
Vigabatrin SABRIL 250 mg twice daily Drowsiness, dizziness,
tremor
Lorazepam ATIVAN PO - 10 mg/day
IV – 0.044 mg/kg/day
Sleepiness,
abdominal/stomach pain,
aggressive black tarry stools
etc
Levitriacetam KEPPRA 3000 – 4000 mg Sedation, behavioral
disturbances
Zonisamide ZONEGRAN 600 mg Sedation, Kidney stones
Dizziness, Rash, Weight
loss, Cognitive impairment
Oligohydrosis
TABLE NO: 8 TREATMENT

18. STATUS EPILEPTICUS:
1.) Initial management of status epilepticus is supportive and may include:
 Positioning the person to avoid injury
 Supporting respiration
 Maintaining blood pressure
 Correcting hypoglycaemia
2.) First line agents Intravenous lorazepam or diazepam.
3.) Alternative medicines Midazolam
NON PHARMACOLOGICAL TREATMENT:
KETOGENIC DIET:
Ketogenic diet containing high content of fats, followed by proteins, cabohydrates
was found to reduce seizures in some children
FIG NO 6: KETOGENIC DIET
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19. Side effects: Constipation, slow growth because of nutritional deficiencies, build
up of uric acid in blood , kidney stones
SURGERIES:
 Medications can control seizures in most people with epilepsy, but they don’t
work for everyone.
 About 30% of people taking the drugs can’t tolerate the side effects. In such
cases, brain surgery may be an option.
1) Lobe resection
2) Lesionectomy
3) Corpus callosotomy/ split brain surgery
4) Functional hemispherectomy
5) Multiple subpial transection (MST)
6) Vagus nerve stimulation (VNS)
7) Responsive neurostimulation device (RNS)
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20. VAGUS NERVE STIMULATION (VNS):
A device implanted under your skin sends an electronic jolt to the vagus nerve,
which
controls activity between your brain & major internal organs.
FIG NO 7: VAGUS NERVE STIMULATOR
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GOALS
Remove the area of
the brain that causes
seizures.
Disrupt the nerve
pathways that seizure
impulses take through
your brain.
Implant a device to
treat epilepsy.

21. REFERENCES:
 RODGER WALKER, CATE WHITTLESEA; Epilepsy ; Clinical pharmacy &
Therapeutics; 5th
Edition; p.g.no: 489 - 506
 ERIC. T. HERFINDAL, DICK R. GOURLEY, HART; Epilepsy ; Clinical
pharmacy & Therapeutics; 8h
Edition; p.g.no: 1608 - 1645
 JOSEPH T. DIPIRO et.al; Epilepsy ; Pharmacotherapy A Pathophysiologic
approach; 6th
edition; p.g.no: 1023 – 1048
 Comprehensive pharmacy review for NAPLEX, Leon shargel, Alan H.
Mutnick etal; hepatic disorders; 8th
edition pg.no:- 743 - 773
 www. medicinet. com
 www. healthline. com
 www. emedicinehealth.com
 www. medical newstoday. com
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