1. DR.UMA KADAM M.B.B.S. MD ASSOCIATE PROFESSOR PHARMACOLOGY SKNMC

3. SELECTED EPILEPSY TERMS Epilepsy: A clinical paroxysmal disorder of recurring seizures Seizure: A transient dysfunction of brain due to an abnormal firing of cerebral neurons, which may or may not have a clinical manifestation.

4. Myoclonus: A single abrupt shock like extensor movement of a limb. myoclonic seizures. Petit Mal : Used to describe absence seizures as well as atypical absence. Tonic : Sustained contraction of one or more muscle groups, independent of position (i.e. can be flexed, extended, or opisthotonic). Aura: A generic term for a warning. A colloquial term for simple partial seizure. Convulsion: Tonic , clonic or tonic-clonic seizure

9. Revised ILAE (International League Against Epilepsy) Seizure Classification I. PARTIAL (FOCAL, LOCAL) SEIZURES A. Simple partial seizures B. Complex partial seizure C. Partial seizures evolving to generalized tonic-clonic convulsions (GTC)

10. II. GENERALIZED SEIZURES A. 1. Absence seizures 2. Atypical absence B. Myoclonic seizures, Myoclonic jerks (simple or multiple) C. Clonic seizures D. Tonic seizures E. Tonic-clonic seizures F. Atonic seizures (astatic)

11. III. UNCLASSIFIED EPILEPTIC SEIZURES Includes all seizures that cannot be classified because of inadequate or incomplete data and some that defy classification in hitherto described categories. This includes some neonatal seizures, e.g., rhythmic eye movements, chewing, and swimming movements .

15. CLASSIFICATION ON THE BASIS OF CLINICAL USE

21. Therapeutic Drug Monitoring Use AED levels to assess: i. Poor clinical control (compliance, metabolism) ii. Dose-related side effect iii. Drug or disease interaction iv. "Routine" levels on controlled, nontoxic patients are not indicated.

22. Applied Pharmacokinetics of Antiepileptic Drugs (AEDs)

25. Mechanism of action of Antiepileptic Drugs

28. Open Na + Na + Na + Inactivation gate Activation gate Carbamazepine Phenytoin Felbamate Lamotrigine Inactivated channel Blocked channel firing at high frequencies Barbiturates Topiramate Na + Na+ Na+ Na+

32. Ca ++ Ca ++ Voltage regulated Ca ++ current, low threshold “T” current in thalamus Involved in 3 per second spike and wave rhythm Ca ++ Ethosuximide Valproate Reduction in the flow of Ca ++ through T – type Ca ++ channels in thalamus Ca ++ Ethosuximide:

36. GABA metabolites Succinic Semialdehyde Gabapentin GT: GABA transaminase SSD:Succinic semialdehyde dehydrogenase GT SSD Vigabatrin Valproate Benzodiazepines Barbiturates Cl - Gabapentin Tiagabine Topiramate

42. OR Lorazepam - 4 mg IV push (2mg/min) may be repeated. i. Fast acting, medium lasting. ii. Respiratory depression only in the extubated patient.

50. Thank you