Bijoy Thomas

Pharm D

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Definition
Epidemiology
Etiology
Pathophysiology
classification
laboratory tests
Treatment
Reference

Epilepsy implies a periodic recurrence

of seizures with or without convulsions.
Epilepsy is a disorder that is best
viewed as a symptom of disturbed
electrical activity in the brain caused
by a wide variety of etiologies.

incidence of epilepsy is 44 per 100,000

person-years.
Each year, about 125,000 new epilepsy
cases occur
one peak occurring in newborn and
young children and the second peak
occurring in patients older than age 65.

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Anything that disrupts the normal homeostasis of the neuron

and disturbs its stability
Patients with mental retardation and cerebral palsy
idiopathic epilepsy include cerebrovascular disease (both
ischemic and hemorrhagic stroke), neurodegenerative
disorders, tumor, head trauma, metabolic disorders, and CNS
infections, sleep deprivation, sensory stimuli, and emotional
stress may initiate seizures.
Hormonal changes
AEDs in toxic concentrations

The seizure originates from the gray

matter

. Normal membrane conductances and inhibitory synaptic currents

break down, and excess excitability spreads, either locally to produce
a focal seizure or more widely to produce a generalized seizure.

An abnormality of potassium conductance, a defect in the voltagesensitive ion channels, or a deficiency in the membrane ATPases
linked to ion transport may result in neuronal membrane instability
and a seizure.

Systemic pH

During a seizure, there is a large increase in the demand for blood

flow to the brain to carry off CO2 and to bring substrates for neuronal
metabolic activity.

The more prolonged the seizure, the more likely the brain is to suffer
ischemia that may result in neuronal destruction and brain damage

I. Partial seizures
II. Generalized seizures
III. Unclassified seizures
IV. Status epilepticus

No specific diagnostic laboratory tests for

epilepsy.
serum prolactin levels may be transiently
elevated.
EEG(may be normal in some patients
who still have the clinical diagnosis of
epilepsy)
MRI is very useful (especially imaging of
the temporal lobes)

DESIRED OUTCOME
The ultimate goal of treatment for
epilepsy is no seizures and no side
effects with an optimal quality of life.

identification of goals, assessment of seizure type

and frequency, development of a care plan, and a
follow-up evaluation.
Patient characteristics such as age, medical
condition, ability to comply with a prescribed
regimen, and insurance coverage also should be
explored
If the therapeutic goal is not achieved with maximal
monotherapy, a second drug may be added
withdrawal of AEDs include a seizure-free period of 2
to 4 years, complete seizure control within 1 year of
onset

Diet
Surgery
vagal nerve stimulation (VNS)

Seizure Type
Partial seizures

First-Line Drugs
Carbamazepine
Phenytoin
Lamotrigine
Valproic acid
Oxcarbazepine

Generalized seizures

Absence

Myoclonic

Valproic acid, ethosuximide

Lamotrigine, levetiracetam

Valproic acid, clonazepam

Lamotrigine, topiramate, felbamate,

zonisamide, levetiracetam

Tonic-clonic

Alternative Drugs
Gabapentin
Topiramate
Levetiracetam
Zonisamide
Tiagabine
Primidone, phenobarbital
Felbamate

Phenytoin, carbamazepine,
valproic acid
Lamotrigine, topiramate,
phenobarbital, primidone,
oxcarbazepine, levetiracetam

clinical monitoring,
drug utilization review
quality-of-life assessments.
Patients should be questioned regularly
to determine whether they are seizurefree.

DAVIDSONS PRINCIPLE AND PRACTICE

OF MEDICINE 6TH EDITION
PHARMACOTHERAPY A
PATHOPHYSIOLOGIC APPROACH BY
JOSEPH T.DIPIRO5TH EDITION