Professional Documents
Culture Documents
Epilepsy: DR - Sasmoyohati Sps (K)
Epilepsy: DR - Sasmoyohati Sps (K)
dr.Sasmoyohati
SpS(K)
Definition
Pathogenesis
The 19th century neurologist Hughlings
Jackson suggested a sudden excessive
disorderly discharge of cerebral neurons
as the causation of epileptic seizures.
Recent studies in animal models of focal
epilepsy suggest a central role for the
excitatory neurotransmiter glutamate
(increased in epi) and inhibitory gamma
amino butyric acid (GABA) (decreased)
Definition of epilepsy by
cause
Epilepsy
is a symptom of numerous disorders, but in the majority
of
sufferers the cause remains unclear despite careful
history
taking,examination and investigation!
Epilepsy - Classification
The modern classification of the epilepsies
is based upon the nature of the seizures
rather than the presence or absence of an
underlying cause.
Seizures which begin focally from a single
location within one hemisphere are thus
distinguished from those of a generalised
nature which probably commence in a
deeper structures (brainstem? thalami)
and project to both hemispheres
simultaneously.
Epilepsy - Classification
Focal seizures
account for
80% of adult epilepsies
Simple partial seizures
Complex partial seizures
Partial seizures secondarilly
generalised
Generalised seizures
Unclassified seizures
Usually originates in TL
Generalized seizures
(convulsive or non-convulsive)
Absences
Myoclonic seizures
Clonic seizures
Tonic seizures
Atonic seizures
Generalized seizures
Absences
Myoclonic seizures
Clonic seizures
Tonic seizures
Atonic seizures
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)
Epilepsy Investigation
Epilepsy
Differential
Diagnosis
The following should be considered in the diff. dg. of epilepsy:
Epilepsy - Treatment
Epilepsy Treatment
(cont.)
Treatment Goals
No seizures
No side effects
Monotherapy
Once daily dosing
No blood tests
70%
20%
Principals of pharmacological
treatment 1
Use the right drug for the seizure type
Use one drug and increase the dose until a
therapeutic effect is gained or toxicity
appears (maximum tolerated dose)
Monitor treatment including blood levels
If required add a second drug.
Principals of pharmacological
treatment 2
Modes of action
1 Suppress action potential
Sodium channel blocker or modulator
Potassium channel opener
2 Enhance GABA transmission
GABA uptake inhibitor
GABA mimetics
3 Suppression of excitatory transmission
Choice of antiepileptic 1
Seizure type
Drug of choice
Alternatives
Carbamazepine
Phenytoin
Valproate
Lamotrigine
Gabapentin
Levetiracetam
Topiramate
Tiagabine
Oxcarbazepine
Phenobarbital
Choice of antiepileptic 2
Seizure type
Drug of choice
Alternatives
Lamotrigine
Topiramate
Phenobarbital
Lamotrigine
Clonazepam
Clonazepam
Aminophylline
Amphetamines
Analgesics
Antibiotics
Antidepressants
Antimuscarinics
Antipsychotics
Baclofen
Bupropion
Donepezil etc
Cyclosporin
Cocaine
Isoniazid
Lignocaine
Mefloquine
NSAIDs
Opioids
Oral contraceptives
Vincristine
Epilepsy Surgical
Treatment
Status Epilepticus