1

E

PRESENTED BYMOHIT KUMAR VERMAMO (PHARMACOLOGY) DEPTT. OF Pharmaceutical Science

P I L E P S Y

08/10/2015

Topic is epilepsy

Topic is epilepsy 2

CONTENTWhat Is Epilepsy ?

Types of epilepsy and sub-types…

Symptoms of Epilepsy...

Causes of Epilepsy...

EPILEPSY : MACHNISM OF ACTION ...

Diagnosis...

Epilepsy Safety...

Epilepsy and Pregnancy...

CLASSIFICION OF ANTI-EPILEPTIC DRUGS...

Choise of anti-epileptic drugs...

Newer Drugs...

Drugs Mode of action...

Reference ...

08/10/2015

3

What Is Epilepsy ?Epilepsy is a defined as disorder of neurological condition and

problem with the brain’s electrical system. Electrical impulses cause

brief changes in movement, behavior, feeling. These events, known

as seizures, may last from a few seconds to a few minutes.

08/10/2015

Topic is epilepsy

TYPES OF EPILEPSY AND SUB TYPES

08/10/2015

08/10/20155 Topic is epilepsy

Topic is epilepsy 6

1. Generalized Tonic-Clonic SeizuresGeneralized tonic clonic seizures are the most easily recognized. They usually begin

with a stiffening of the arms and legs, and are followed by jerking motions. These

convulsions can last up to 3 minutes. After having one, a person may be tired and

confused. This type of seizure involves both sides of the brain.

08/10/2015

Topic is epilepsy 7

PartialSeizuresIn partial seizures, just one side of

the brain is affected. A person having

a simple partial seizure may have

jerking motions or hallucinations.

When having a complex partial

seizure, a person may wonder,

mumble, smack their lips, or fumble

with their clothes. He or she may

appear to be conscious .08/10/2015

Topic is epilepsy 8

Symptoms of Epilepsy

Epilepsy is widely known for causing

convulsions,

• Sudden Un-controlled

movements.

• Loss of consciousness.

•Fainting.

08/10/2015

Topic is epilepsy 9

Causes of Epilepsy•Head injury

•Brain infection

•Oxygen deprivation

•Trauma

•Confussion, depressed

• skull fractures.

•Brain tumors (including tuberculoma),

•Drug withdrawal,

e.g. CNS depressants .

•Fever in children (febrile convulsion).

•Hypoglycemia08/10/2015

10

EPILEPSY : MACHNISM OF ATION SEIZURES Anti -epileptic drug(ESLICARBAZEPINE ACETATE)

1. NEURONS

2. ACTION POTENTIAL ACROSS CELL SURFACE OF Na+ IONS

3. Action potential

4. Active channels

5. INACTIVATED CHANNELS

6. Na+ CHANNEL ACTIONS

7. NEURONE FIRRING

8. Dipolarised Na+ channel

08/10/2015

Topic is epilepsy

Topic is epilepsy 11

Diagnosis: Brain Scan And Diagnosis: EEG

Diagnosis: Brain Scan

Detailed images of the brain from CT: computed tomography or MRI: Magnetic Resonance Imaging scans can help doctors rule out

tumors or blood clots as a cause of seizures. A CT scan is a powerful type of X-ray, and an MRI uses magnets and radio waves to make

pictures. This information will help your doctor come up with the best treatment plan for you.

08/10/2015

Topic is epilepsy 1208/10/2015

Diagnosis: EEG An EEG (Electroencephalogram) can confirm a diagnosis and give more information about your seizures. It’s a painless procedure that records the brain’s electrical activity as wavy lines. The pattern changes during a seizure and may show which part of the brain is affected. That can help guide treatment.

Topic is epilepsy 13

Epilepsy Safety Precautions

Because seizures often strike without warning, certain activities can be dangerous. Losing consciousness while swimming or even taking a bath could be life-threatening. The same goes for many extreme sports, such as mountain climbing. Most states require you to be seizure-free for a certain amount of time before driving a car.

08/10/2015

Topic is epilepsy 1408/10/2015

Treatment: Surgery

If you have partial seizures, surgery may stop them. If the medical team

can determine that your seizures always begin in a single area of the brain,

removing the area may stop them or make them easier to manage. Surgery

may also treat conditions that cause the seizures, such as a brain tumors.

Treatment: Medication- Anti-seizure , anti -epileptic drugs are the most common

treatment for epilepsy.

Topic is epilepsy 15

Epilepsy and Pregnancy

In most cases, it is safe for women with

epilepsy to become pregnant. More than 90% of

babies born to women with epilepsy are

healthy. But if you're planning to get pregnant,

talk to your doctor first. Anti-seizure drugs can

cause risks for infants, and some have more

risks than others. You may need to change or

adjust your medication.

08/10/2015

Topic is epilepsy 16

CLASSIFICION OF ANTI-EPILEPTIC DRUGS

CLASS DRUGSBarbiturate Phenobartitone Deoxybarbiturate PrimidoneHydantoin Phenytoin Iminostilbene Carbamazepine Succinimide EthosuximideAliphatic carboxylic acid Valproic acid Benzodiazepines DiazepamPhenyltriazine Lamotrigine Cyclic GABA analogue GabapentinNewer drugs Zonisamide,Topiramate

08/10/2015

Topic is epilepsy 17

Choise of epileptic drugsDrugs Seizure disorderCarbamazepine or

Valproate orPhenytoin orPhenobarbital

Tonic-clonic (Grand mal)Drug of Choice

Topiramte Lamotrigine (as adjuvant or alone)

Gabapentin (as adjuvant)

Alternatives:

Carbamazepine or Topiramte or Phenytoin or

Valproate

Partial (simple or complex) Drug of choice

Phenobarbital Lamotringine (as adjuvant or alone) Gabapentin (as adjuvant )

Alternatives:

08/10/2015

Topic is epilepsy 18

Treatment cont,d

08/10/2015

Valproate or Ethosuximide

Absence ( petit mal) Drug of choice

ClonazepamLamotrigine

Alternatives:

Valproate Myoclonic, Atonic Drug of choice

Clonazepam Alternatives:

Diazepam, i.v.or Phenytoin, i.v. or Vaproate

Status EpilepticusDrug of choice

Phenobarbital, i.v Alternatives:Diazepam, rectal*Diazepam ,i.vValproate

Febrile Seizures

* Preferred

Topic is epilepsy 19

Topiramate

Vigabatrin,

Levetiracetam, Lamotrigine,

Zonisamide, Lacosamide, Rufinamide

08/10/2015

Newer Drugs

Topic is epilepsy 2008/10/2015

Mode Of Action (MOA)Topiramate: It is a sulphamate substituted monosaccharide, a weak carbonic anhydrase inhibitor has broad spectrum anti-convulsant activity. It appear to act by multiple machanisms:1. Prolongation of Na+ channel inactivation, 2. GABA potentiation,3. Neuronal hyperpolarization through certain

K+ channels.Indications: Topiramate is a useful adjuvant in refractorypartial or generalized epilepsy and other epileptic syndromes

Topic is epilepsy 2108/10/2015

Zonisamide: 1.Weak carconic anhydrase inhibitory action that

modified max. Electroshock seizures and inhibits kindled seizures

2. It has also been found to suppress T-type of Ca+ currents in certain

neurons.

Tiagabine: It’s neuronal inhibitor by depressing GABA trasportor

GAT-1 which remove synapticalliy released GABA into neurones

and glial cells

Topic is epilepsy 22

REFERENCES By-

1. Ferrándiz-Pulido C, García-Fernández D, Domínguez- Sampedro P,

García-Patos V. Stevens-Johnson syndrome and toxic epidermal necrolysis

in children: a review of the experience with paediatric patients in a

university hospital. J Eur Acad Dermatol Venereol.

2. Brunklaus A, Ellis R, Reavey E, Forbes GH, Zuberi SM. Prognostic,

clinical and demographic features in SCN1A mutation-positive Dravet

syndrome. Brain.

3. K.D. Tripathi, Essentials Medical Pharmacology ” seventh edition”-

2013 page no. 411-416.

08/10/2015

Topic is epilepsy 2308/10/2015

Topic is epilepsy 2408/10/2015