Types of Epilepsy ± I Generalized

Tonic ± Clonic ± common ± 2 mi8n. Cry-tonic; both hemispheres; clonic- contrac+relax of SK. Muscles. Absence : Children ; 1-2 min.;1 ± directional Atonic: Unconcious; muscel relaxed; loss of posture; sagging head Myoclonic:Isolated jerks; bursts of momem=ntary contraction of muscles; limbs Infantile: Myoclonic jerks; prog.mental det.; epileptic symdrome

Types of Epilepsy ± II Partial
‡ Simple : 20-60 sec., concious ‡ Complex: Temporal lobe ; aura; atutomation;confusion; inpaired conciuosness ‡ Jaksonian- secondary genaralized- partial seizures + T & C ‡ Status Epilepticus: 2/3 times in 30 min; Inc. tone; unconscious; recurrent T & C without recovery

Classes of Anti-Epileptic Drugs
Hydantoins :Phenytoin; phosphophenytoin Barbiturates : Pheno Iminostilbenes : carbamazepine; oxycarba. Succinimides :ethosuximide COOH- aliphatic : valproic acid,; divalp. Benzodiazepines : clanaze,; diaze; loraze New :gabapentin; lamotrignine; tigabine; topiramate; vigabatrin; zonisamide; felbamate

Mech. Of Action
Altered ion conduction Inc. NA++ contrac.- inactivation Dec. CA++ current ± thalamus Inc. GABA Dec. Glutamate- NMDA, AMDA; Kainic Acid Genetic Mech. ECT VNS ; DBS; TMS

VAGUS NERVE STIMULATION
The Pulse Generator (battery) delivers a small amount of electrical current to the vagus nerve intermittently (30 seconds on and five minutes off), 24 hours a day, 7 days a week for up to 10 years. In the study currently being reviewed by the FDA, researchers noted several similarities between epileptic and depressed patients.

DEEP BRAIN STIMULATION
Most important neurosurgical advance of the last decade First used in the 1970s for the treatment of chronic neuropathic pain Thus, if stimulation yields an unwanted side effect, the stimulator may be turned off or repositioned Reversibility: The target nucleus is stimulated and not destroyed, so the effects are reversible. Adjustability: stimulation can be dosed, like a medication, and the dose can be changed as often as is necessary.

Transcranial Magnetic Stimulation
‡ Noninvasive intervention ‡ Stimulation of cortical neurons by inducing magnetic and secondary electric fields ‡ Motor neurophysiological analysis ‡ Established as an investigative tool in cognitive neuroscience

TMS Pharmacology
‡ Repetitive TMS in 14 randomised controlled trials in patients with depression has been prospective. ‡ Regional changes in neurotransmitter/ neuromodulator release. ‡ Trans-synaptic efficiency ‡ Signaling pathways EPILEPCY- Trials in pipeline? ‡ Gene transcription brought about by TMS resembles antidepressant drug therapy.

Limitations of SIT
Widely accepted in Diagnosis and Drug delivery, but treatment?
± Cost ± Patient acceptability ± Restricted clinical trials ± Considered complex by many of the medical practitioners

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