Course Name: Introduction To Pharmacology

Course Code: MLT BA 801

Teacher Introduction:
Hassan Imran
M.Phil. Pharmacology
Lecturer, UIMLT
Faculty of Allied Health Sciences (FAHS)
The University of Lahore
ANTIEPILEPTICS/ANTICONVULSANTS

Learning Objectives:
 Introduction of Epilepsy.
 Etiology & Precipitating Factors Epilepsy.
 Classification of Antiepileptic Drugs.
 Mechanism of Action of Antiepileptic
Drugs.
 Adverse Effects of Antiepileptic Drugs.
 Epilepsy
The word epilepsy is derived from Greek
word epilepsia, which means to attack or
seizure.
Seizure:
A seizure may be defined as:
“A transient alteration of behavior caused by
disordered, synchronous and rhythmic firing
of population of brain neurons”.
 Epilepsy

The term epilepsy refers to disorder of brain

function characterized by unpredictable
occurrence of seizures, resulting from
uncontrolled neuronal discharges.
Epilepsy is a disorder, not a disease and it is
not contagious.
These electrical discharges produce seizures
which vary from one person to another in
frequency and form. Sometimes the
electrical signal only reaches part of the
brain from where a part of the body, like an
arm or a leg that may move on its own.
 If the signal goes through all the brain, the
person may shake all over, fall and lose
consciousness.
The particular symptoms produced in
epilepsy depend on the site of primary
discharge and extent of its spread in the
brain.
Etiological and Precipitating Factors
In approximately 50% of the cases of
childhood epilepsy, seizures disappear
completely. In 50-60% of cases, the cause of
epilepsy is unknown. In the remaining cases,
the following causes are most often
identified:
i. Genetic mutations – (30%)
ii. Developmental anamolies.
iii. Trauma and surgery (Brain injury)
iv. Pyrexia ( convulsions in children under 5
year of age due to high fever).
v. Poisoning from substance abuse or
environmental contaminants e.g. lead
poisoning.
vi. Encephalitis and other inflammatory
condition of the brain.
vii. Metabolic abnormalities, hypoglycemia,
hyponatraemia, acute hypoxia, uraemia.
viii. Degenerative brain disorders (Alzheimer's
disease).
ix. Sleep deprivation and stress.

Uraemia:
A raised level in the blood of urea and other
nitrogenous waste compounds that are
normally eliminated by the kidneys.
Diagnosis:
i. Abnormal electrical activity during and
following a seizure can be detected by
“electroencephalography (EEG)” recording
from electrodes distributed over the surface
of the scalp.
Various types of seizure can be recognised
on the basis of the nature and distribution of
the abnormal discharge.
Diagnosis: (Continue)

ii. Modern brain imaging techniques, such

as magnetic resonance imaging (MRI).
iii. Positron emission tomography (PET scan),
are now routinely used in the diagnosis of
epilepsy (to identify structural
abnormalities (e.g. lesions, tumours) that
cause certain epilepsies.
 Important Note to Understand PET
In epilepsy, brain needs more energy stores
which is provided in the form of glucose. In
epileptic attack, blood flow to the affected
areas increases and glucose metabolism also
increases to provide energy to the
hyperactive neurons.
Positron emission tomography is modern
analytical technique to diagnose epilepsy.
 HOW PET WORKS

PET scanning is done by injecting small

amounts of radionuclides (radioactive
isotopes) labeled molecules intravenously.
The molecules are picked up by specific
cellular or molecular targets to be
investigated. By detecting the gamma rays
emitted from the radiochemicals injected,
the cellular function is measured and the
location of abnormality detected.`
 HOW PET WORKS (Continue)
For PET scan, several radiochemicals have
been studied for imaging brain function. The
one used currently is FDG (Fluoro-
deoxyglucose), which is radio-labeled
glucose. Brain metabolizes glucose as major
source of energy. Normal brain picks up FDG
in a large amount.
 HOW PET WORKS (Continue)

In epilepsy, the brain cells (neurons) do not

function right or the neurons are lost due to
variety of reasons. FDG-PET scan will detect
the regions of the brain where the glucose
uptake is low (hypo-metabolism), which is
often associated with the site of seizure
origin.
 Classification Of Epilepsy

The nomenclature developed by the

International League Against Epilepsy (ILAE)
is considered the standard way to classify
seizures and epilepsy syndromes. Seizures
have been classified into two broad groups:
1. Partial Seizures
2. Generalized seizures
 Classification Of Epilepsy

A. Partial Seizures
Partial seizures are those in which the
discharge begins locally and often remains
localized. The symptoms depend on the
region of the brain involved include
involuntary muscle contractions.
 Partial Seizures (Continue)

There is repetitive jerking of a particular

muscle group, beginning on one side of the
body, often in the thumb, big toe or angle of
the mouth, which spreads and may involve
much of the body within about 2 min before
dying out. The patient loses voluntary
control of the affected parts of the body but
does not necessarily lose consciousness.
 Partial Seizures (Continue)

The seizure usually lasts for a few minutes,

after which the patient recovers with no
recollection of the event. The behaviour
during the seizure can be bizarre and
accompanied by a strong emotional
response.
The EEG discharge in this type of epilepsy is
normally confined to one hemisphere.
 Generalized seizures

Generalized seizures may begin locally and then

progress to include abnormal electrical discharges
throughout both hemispheres of the brain.
 Generalized seizures

1.Tonic-clonic Seizures (Grand Mal Seizures)

A tonic–clonic seizure consists of an initial
strong contraction of the whole
musculature, causing a rigid spasm and an
involuntary cry. Respiration stops, and
defaecation (discharge of faeces) ,
micturition (the action of urinating) and
salivation often occur.
 Tonic-clonic Seizures (Cont)

This tonic phase lasts for about 1 min, and

is followed by a series of violent,
synchronous jerks that gradually die out in
2–4 min. The patient stays unconscious for a
few more minutes and then gradually
recovers, feeling ill and confused. Injury may
occur during the convulsive episode.
Strategy: Require First Aid treatment . Immediate medical
attention is required if the seizure lasts more than 5 minutes.
 First Aid for Tonic-Clonic Seizure

1. Keep calm. seizures usually only last a few

minutes.
2. Protect from injury-ease the person to the
floor, move away any objects, protect the
person’s head with a pillow or rolled up
coat.
3. Loosen any tight neckwear.
 First Aid for Tonic-Clonic Seizure

4. Do not restrain the person.

5. Do not insert anything into the person’s
mouth.
6. After the seizure, roll the person on to
their side.
7. Be reassuring, talk calmly to the person.
* If a seizure lasts longer than five minutes,
seek medical attention
 2. Absence Seizures (Petit Mal)

Absence seizures occur in children; they are

much less dramatic but may occur more
frequently (many seizures each day) than
tonic–clonic seizures. The patient abruptly
ceases whatever he or she was doing,
sometimes stop speaking in mid-sentence,
and stares vacantly for a seconds, with little
or no motor disturbance.
2. Absence Seizures (Petit Mal) (Continue)

Patients are unaware of their surroundings

and recover abruptly with no after effects.
Strategy: Talk gently to the person, be comforting as it
may take time for the person to become re-oriented.
 3. Clonic Seizures

These seizures consist of short episodes of

muscle contractions. Consciousness is more
impaired with clonic.
4. Status Epilepticus:
It is a type of epilepsy in which continuous
uninterrupted seizures occur that require
emergency treatment.
OR
A life-threatening condition in which
epileptic seizures occur almost without a
break.
5. Atonic /Akinetic Seizures:
These seizures are also known as drop
attacks and are characterized by a sudden
loss of muscle tone.
This is observed in children in which child
suddenly falls to ground.
Epilepsy is treated mainly by drugs, although
brain surgery may be used for suitable
severe cases.
Antiepileptic drugs are sometime called
anticonvulsants because the drugs are used
to treat or prevent convulsions caused by
brain diseases (e.g. trauma, infection,
tumour, stroke etc.).
(Continue PART 2)
 Learning Outcomes:

The students will learn about:

 Epilepsy and different types of epilepsy.
 Etiology & Precipitating Factors Epilepsy.
 Drugs used for the management of
epilepsy.
 Therapeutic uses, drug interactions and

adverse effects of these drugs.

 References

1. Lippincott, Illustrated Reviews

Pharmacology

2. Basic and Clinical Pharmacology 12

Edition Katzung