Epilepsy

Seizure disorder

 Epilepsy is a brain disorder involving

recurrent seizures
 Epilepsy is a disorder involving repeated
seizures of any type. Seizures ("fits") are
episodes of disturbed brain function that
cause changes in attention and/or
behavior. They are caused by abnormal
electrical excitation in the brain.
 Seizure disorders affect about 0.5% of the
population. Approximately 1.5 to 5.0% of
the population may have a seizure in their
lifetime. Epilepsy can affect people of any
age.
 Risk factors include a family history of
epilepsy, head injury, or other condition
that causes damage to the brain.
 The following factors may present a risk for
worsening of seizures in a person with a
previously well-controlled seizure disorder:
 Pregnancy
 Lack of sleep
 Skipping doses of epilepsy medications
 Use of alcohol or other recreational drugs
 Certain prescribed medications
 Illness
 Symptoms
 The severity of symptoms can vary greatly
from simple staring spells to loss of
consciousness and violent convulsions. For
many patients, the event is stereotyped (the
same thing over and over) while some
patients have many different types of
seizures that cause different symptoms each
time.

 The type of seizure a person experiences

depends on a variety of factors, such as the
part of the brain affected, the cause, and
individual response
SYMPTOMS OF GENERALIZED
SEIZURES
Generalized seizures affect all or most of the brain.
They include petit mal and grand mal seizures.
Petit mal seizures:
 Minimal or no movements (usually, except for "eye
blinking") -- may appear like a blank stare
 Brief sudden loss of awareness or conscious
activity -- may only last seconds
 Recurs many times
 Occurs most often during childhood
 Decreased learning (child often thought to be day-
dreaming)
 Tonic-clonic (grand mal) seizures:
 Whole body, violent muscle contractions
 Rigid and stiff
 Affects a major portion of the body
 Loss of consciousness
 Breathing stops temporarily, then "sighing"
 Incontinence of urine
 Tongue or cheek biting
 Confusion following the seizure
 Weakness following the seizure (Todd's
paralysis)
 SYMPTOMS OF PARTIAL
SEIZURES
Partial seizures affect only a portion of the brain.
Simple partial (focal) seizures:
 Muscle contractions of a specific body part
 Abnormal sensations
 May have nausea, sweating, skin flushing and
dilated pupils
 May have other focal (localized) symptoms
 Partial complex seizures:
 Automatism (automatic performance of complex
behaviors without conscious awareness)
 Abnormal sensations
 May have nausea, sweating, skin flushing and dilated
pupils
 May have other focal (localized) symptoms
 Recalled or inappropriate emotions
 Changes in personality or alertness
 May or may not lose consciousness
 Olfactory (smell) or gustatory (taste) hallucinations or
impairments -- if the epilepsy is focused in the temporal
lobe of the brain.
 Bazetol XR is a specially designed
formulation that minimizes the sudden rise
in peak concentration (cmax), maintains it
within the therapeutic range, avoiding the
peak concentration – related troublesome
side –defects. It also offers convenient BID
dosage schedule because of sustained
action. Thus Bazetol XR is a major
breakthrough in carbamazepine therapy.
 Mode of Action:
 Exact mechanism of action is not clearly
understood. It is believed that carbamazepine
produces differential inhibition of high frequency
discharges in and around epileptic foci with
minimal disruption of normal neuronal traffic by
inhibiting voltage –sensitive sodium channels.
 Carbamazepine also alters most of the classical
neurotransmitters such as dopamine,
noradrenalin, serotonin and noradrenalin
explains its usefulness in a complex disorder
known as manic depressive or depression
(swinging between two extreme poles of mania
and depression).
PHARMACOKINETICS
 Absorption:
 Bazetol-XR is slowly absorbed from the gastrointestinal
tract, in such a manner that the peak levels achieved are
within therapeutic range and are maintained for 12
hours. Consequently, the side effects due to high plasma
levels are reduced.
 Metabolism:
 Bazetol XR is metabolized in the liver and it induces its
own metabolism. As a result the half life which is long
(50 to 60 hours) after the first dose is reduced to 5 to 24
hours at steady state levels .The metabolite of Bazetol
XR is active.
 Distribution:
 Bazetol XR is distribution rapidly in all tissues.
 Excretion:
 Mainly by kidney (72%) and also in the faeces (28%).
 INDICATIONS
 All types of epilepsy except absence seizures
 Trigeminal neuralgia (Pain in the trigeminal
nerve, which sends intense pain shooting across
the face)
 Manic depressive psychosis (Bipolar
depression)
 Diabetic Neuropathy (Degeneration of tissues
of the nervous system due to diabetes).
 Schizophrenia, in combination with other anti-
psychotics
 Alcohol withdrawal syndrome.
 ADVERSE EFFECTS

 Adverse effects are much less as compared to

plain carbamazepine formulation. However side
effects may occur in the initial period of starting
the treatment and they disappear spontaneously
within 7 to 14 days or following a temporary
reduction in dosage. The following adverse
effects are considered to be dangerous and
requires stoppage of treatment. These are
aplastic anemia, agranulocytosis, bone marrow
depression, and thrombocytopenia.
 CONTRAINDICATION
Hypersensitivity to Carbamazepine, AV block,
Severe Cardiovascular, Hepatic and renal
disorders are the contraindications to the use of
Bazetol XR.

 USE IN PREGNANCY AND LACTATION

Bazetol XR is not administered routinely in
pregnant women as well as lactating women. If
need arise, Carbamazepine is considered to be
the safest anti- epileptic drug in pregnant or
lactating women.
OVER DOSAGE

 Over dosage may produce tremor, excitation

convulsion changes in blood pressure and
coma. Over dosage is seen after ingestion of 30
to 60 gm of carbamazepine . There is no specific
antidote and the patient is treated with
supportive treatment consisting of gastric
lavage, activated charcoal and if necessary
administration of benzodiazepine.
DRUG INTERACTION
 Combination with phenytoin, phenobarbitone or
primidone causes lowering of blood levels of
carbamazepine resulting in relapse of the disease unless
the dose of carbamazepine is increased. (These drugs
induce the liver enzymes which result in more
metabolism of carbamazepine).
 Carbamazepine increase the metabolism of warfarin,
doxycycline, and theophylline. (This is so because it
induces the liver enzyme which is involved in metabolism
of these drugs).
 Blood levels of co administered haloperidol are reduced.
 Concomitant administration of carbamazepine with
erythromycin, cimetidine, propoxyphen and isoniazide
cause elevated plasma levels of carbamazepine and its
side effects. ( Since these drugs inhibit the metabolizing
enzyme).
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