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ANTIEPILEPTICS Dr: Samah Gaafar Hassan
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a periodic recurrence of seizures with or without convulsions. A convulsion implies violent, involuntary contraction(s) of the voluntary muscles. A seizure results from an excessive discharge of cortical neurons and is characterized by changes in electrical activity as measured by the electroencephalogram (EEG).
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The goal of treatment is to control or reduce the frequency of seizures and ensure compliance, allowing the patient to live as normal a life as possible. Complete suppression of seizures must be balanced against tolerability of side effects, and the patient should be involved in defining the balance.
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The mechanism of action of most AEDs includes effects on ion channels (sodium and calcium), inhibitory neurotransmission (GABA), or excitatory neurotransmission (glutamate and aspartate).
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Blocks voltage-gated sodium channels. Partial seizures, generalized tonic clonic, trigeminal neuralgia. An enzyme inducer. (own induction) Has active metabolite carbamazepine-10,11- epoxide. S.E Neurosensory side effects (e.g., diplopia, blurred vision, nystagmus, ataxia. Hyponatremia. Drug interaction valporic acid, clarithromycin, errythromycin.
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inhibits type T- Ca channels. Only for absence seizures. FELBAMATE: Broad spectrum antiepileptic. glycine receptor antagonist. Aplastic anaemia & hepatitis.
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second-line agent for patients with partial seizures. Less side effect & less drug interaction In elderly. Renal excretion. LAMOTRIGINE: Broad spectrum. Drug interaction enzyme indution & inhibition. Eldery.
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Enhances the GABA effect. Choice in neonatal seizures. In SE. PHENYTOIN: Partial, generalized tonic clonic & SE. 90% binding to plasma protein. Is an enzyme inducer. Zero-order elimination. S.E: ataxia, nystagmus, gengival hypertrophy. Folic acid deficiency.
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Partial & primary generalized. >90% is plasma protein bound. Is an enzyme inhibitor. S.E: hepatotoxicity, pancytopenia, POS, hair loss, menstrual irregularities.
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2-5 yrs. Compliance. Barbiturates and phenytoin are associated with congenital heart malformations and facial clefts. Valproic acid and carbamazepine are associated with spina bifida.
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