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Inhibition
Excitation
GABA
glutamate
aspartate
Department of Pharmacology & Pharmacotherapy, Fac. Medicine UGM
Clinical Factors Associated With Genetic Versus
Symptomatic Epilepsy
250 Alcohol
Other provoked
Epilepsy
200 Single
150 Total
100
50
0
0 20 40 60 80 100
Age
Hauser, W. A. et al. (1995). Epilepsia, 34(3), 453-458.
• New
• Very Old – Clobazam (FrisiumR)
– Bromides (1861) – Lamotrigine (LamictalR)
– Topiramate (TopamaxR)
– Vigabatrin (SabrilR)
• Old • Even Newer
– Phenobarbital (1912) – Levetiracetam (KeppraR)
– Phenytoin (DilantinR)(1936) – Oxcarbazepine (TrileptalR)
– Diazepam (ValiumR)(1960’s) • The Newest
– Lacosamide (VimpatR)
– R
Carbamazepine (Tegratol ) (1974)
– Rufinamide (Banzel R)
– Valproic Acid (DepakoteR) (1978) – Ezogabine (PotigaR)
– End Point:
• seizures controlled or side-effects occur
• Decreasing medication
• Discontinuing medication
• Advantages • Disadvantages
– Well tolerated – Weight gain
– Broad spectrum – Tremor
– No effect on BCP – Hair thinning
– Platelet dysfunction
– Drug interactions
– “allergic” reactions
– Avoid in Pregnancy
• Advantages • Disadvantages
– Effective – Allergic Rash
– Well-tolerated – Titrate Slowly
– Twice daily
• Blood
– Symptoms:
• Bleeding, bruising, persistent infections
• Advantages • Disadvantages
– Effective – Dizziness/unsteady
– Well tolerated – “allergic” reaction
– Drug Interactions
– May exacerbate seizures
• Myoclonic, absence
• Advantages • Disadvantages
– Effective – Therapeutic levels
– Broadspectrum – Drug interactions
– Chew tabs, capsules – “Allergic” reactions
– Intravenous
– Inexpensive
– Once daily
• Advantages • Disadvantages
– Effective – Cognitive effects
– “off label” – Kidney Stones
• Migraine – Weight Loss
– No “allergic” reactions
– Twice daily
• Advantages • Disadvantages
– Effective – Mild fatigue
– No drug interactions – Psychosis (0.6%)
• Including OCP – Cost
– Well tolerated
• No “allergic” reactions
– Can titrate fast
• Folic Acid
– 0.4mg/day all women of child baring age
– Higher dose (4-5mg/day): women with epilepsy of
child baring age
Standard Therapy
AED Initial Dose Maintenance Dose Route