ANTICONVULSANTS - ANTICONVULSANTS ANTI-EPILEPTICS OUTLINE 1 Introduction on Epilepsy seizure convulsion 2 Classification of Anticonvulsants 3


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Page 1 ANTICONVULSANTS / ANTI-EPILEPTICS OUTLINE 1. Introduction on Epilepsy, seizure & convulsion 2. Classification of Anticonvulsants 3.Pharmacology of some anticonvulsants a.Phenytoin & Fosphenytoin b.Carbemezepine c.Barbiturates d.Valproic acid 4. Drugs of choices for the different types of seizures INTRODUCTION Some Terms to understand 1. Epilepsy comprises a group of chronic syndromes that involve the recurrence of seizures 2. Seizures are episodes of abnormal electrical activity in the cerebral neuron that manifests as convulsion (involuntary repeated muscular contraction), mood alterations, visual disturbances, unconsciousness… Thus, not all epileptic seizures lead to convulsions, & not all convulsions are caused by epileptic seizures Types of Seizures 1. Partial or Focal onset Seizures: here, a specific locus of the brain shows abnormal electrical discharge. However, this discharge can undergo widespread from the locus to cause Generalized toninseizure a. Simple partial seizure: is the most common. Here, the spread of discharge is minimal. i. Convulsive jerking, paresthesia, Psychic symptoms ( illusions …) and autonomic dysfxn (urinating, “shitting” …) . ii. During these fits, Px is conscious and aware iii. Jacksonian march seizure is one in which the focal discharge originate within the primary motor cortex & “march” in succession from one part of the cortex to another. b. complex partial seizure: where most of the electrical discharge commonly arise from the temporal lobes and become widespread i. Features: Automatism (= lip smacking, swallowing, fumbling, scratching or even walking about). Here, consciousness is altered, during which some Px stare, others stagger or even fall 2. Generalized Seizures: here, there is No focal onset area of electrical discharge & both cerebral hemispheres are widely involved from the onset a. Generalized Tonic-clonic (Grand mal) seizure: is the most dramatic of all seizures i. Loss of consciousness, Followed by Tonic (continuous contraction) and Clonic (rapid contraction and relaxation) phases, followed by a stuporous state (post-ictal depression); all lasting 2-5 min b. Absence (Petit-mal) Seizures i. Consciousness is lost abruptly and for a very brief time (< 45 sec.) ii. usu. Begins in Childhood (until puberty and beyond) or in puberty iii. has a xteristic 2.5-3.5 Hz spike-and wave pattern iv. manifested as Rapid eye blinking, mild clonic jerking of extremities, with postural tone changes & Automatism c. Myoclonic Seizures: is seen in other seizures & xterized by short episodes of muscle contractions that may recur for several minutes d. Atonic seizures i. Px Suddenly loses Postural tone (making them to fall, if standing) ii. it is often refractory to all anticonvulsant medication e. Status Epilepticus: an Emergency situation, where 2 or more seizures occur without recovery of full consciousness btw them. These siezures may be Partial or Generalized, Convulsive or non-convulsive
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Page 2 f. Infantile spasms or Salaam convulsions i. Occurs at 0-2 yrs ii. it is a very brief (1-3 seconds) recurrent muscle spasms, usu. in infants with
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  • Spring '17
  • Seizures, Phenytoin

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