Download Document

Definition
The epilepsies are a group of
disorders characterized by chronic
recurrent paroxysmal changes in
neurologic function caused by
abnormalities in the electrical activity
of the brain
SELECTED EPILEPSY TERMS
Epilepsy A clinical paroxysmal disorder of
recurring seizures
Seizure
A transient dysfunction of brain
due to an abnormal firing of cerebral neurons,
which may or may not have a clinical
manifestation.
Myoclonus
A single abrupt shock like extensor
movement of a limb. myoclonic seizures.
Petit Mal Used to describe absence seizures as
well as atypical absence.
Tonic Sustained contraction of one or more muscle
groups, independent of position (i.e. can be flexed,
extended, or opisthotonic).
Aura A generic term for a warning. A colloquial term
for simple partial seizure.
Convulsion
Tonic, clonic or tonic-clonic seizure
Status

A pathological state different from a single seizure
by the Epilepticus (absence or reduction of
inhibitory processes to terminate the seizure).

Applies to any seizure type. The length of time
required to differentiate seizure from status is both
empirical and practical.
Convulsive, myoclonic status: 10-30 minutes.
Differential diagnosis of
seizures
Syncope
Drop attacks
Narcolepsy-Cataplexy
Pseudoseizures
Panic attacks
Hypoglycemia
Migraine
Epidemiology
Incidence:
Developed countries: 40-70 per one lakh
Developing countries: 100-190 per one lakh
Prevalence:
Developed countries: 4-10 per 10,000
Developing countries: 57 per 10,000
Partial seizures with or without generalization is
most common
Bimodal age distribution:
< 1 and > 60. Less sharp in developing
countries
Common causes: Perinatal disorders
associated with cerebral palsy & mental
retardation, Head trauma, CNS infections,
Stroke, Brain tumours, Alcohol and other
drugs
Men affected 1-2.4 times compared
to women
Revised ILAE (International League Against
Epilepsy) Seizure Classification
I.
PARTIAL (FOCAL, LOCAL) SEIZURES
A. Simple partial seizures
B. Complex partial seizure
C. Partial seizures evolving to generalized
tonic-clonic convulsions (GTC)
II. GENERALIZED SEIZURES
A. 1. Absence seizures
2. Atypical absence
B. Myoclonic seizures, Myoclonic jerks
(simple or multiple)
C. Clonic seizures
D. Tonic seizures
E. Tonic-clonic seizures
F. Atonic seizures (astatic)
III. UNCLASSIFIED EPILEPTIC SEIZURES
Includes all seizures that cannot be
classified because of inadequate or
incomplete data and some that defy
classification in hitherto described
categories. This includes some neonatal
seizures, e.g., rhythmic eye movements,
chewing, and swimming movements.
Antiepileptic drug (AED)
 A drug which decreases the frequency
and /or severity of seizures in people
with epilepsy.
 Treats the symptom of seizures, not the
underlying epileptic condition.
 Improves quality of life by minimizing
seizures.
Gitanjali-2:
History of Antiepileptic
Drug Therapy

1857 - Bromides

1912 - Phenobarbitone

1937 - Phenytoin

1944 - Trimethadione

1954 - Primidone

1960 - Ethosuximide
Gitanjali-3:
History of AED therapy

1974 – Carbamazepine, Oxcarbazepine

1975 - Clonazepam

1978 - Valproate

1993 - Felbamate, Gabapentin

1995 – Lamotrigine, Levetiracetam

1997 - Topiramate, Tiagabine
Gitanjali-4:
Principles of AED Selection
Correct diagnosis of the type of epilepsy
influences treatment, prognosis and genetic
counseling.
One best drug to fit the fit, fit the patient;
Sequential monotherapy
Use the least expensive AED (all things being
equal, like efficacy).
Prefer AEDs which can be taken od over bid / tid.
AEDs almost never need qid dosing
Principles of AED Selection…cont.
Newer is not better, and almost certainly
more expensive
Start with one AED and push the dose to
clinical toxicity or seizure control.
Withdraw AEDs that are not effective.
Never have a patient on more than three (3)
AED's.
Principles of AED Selection…cont.
• Don't use combination medications (e.g.,
phenytoin with phenobarbital).
• No proof that multiple AEDs are synergistic
in the treatment of epilepsy.
• Polypharmacy is expensive, increases side
effects and increases the complexity of
adjusting AEDs in the refractory patient.
Therapeutic Drug Monitoring
Use AED levels to assess:
i. Poor clinical control (compliance,
metabolism)
ii. Dose-related side effect
iii. Drug or disease interaction
iv. "Routine" levels on controlled, nontoxic
patients are not indicated.