Definition

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Definition

• The epilepsies are a group of disorders
  characterized by chronic recurrent paroxysmal
  changes in neurologic function caused by
  abnormalities in the electrical activity of the
  brain

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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.
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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

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• Status
• A pathological state different from a single
  seizure by the Epilepticus (absence or
  reduction of inhibitory processes to terminate
  the seizure).
• Applies to any seizure type. The length of
  time required to differentiate seizure from
  status is both empirical and practical.
• Convulsive, myoclonic status 10-30 minutes.

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Differential diagnosis of seizures

• Syncope
• Drop attacks
• Narcolepsy-Cataplexy
• Pseudoseizures
• Panic attacks
• Hypoglycemia
• Migraine

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Epidemiology

• Incidence
• Developed countries 40-70 per one lakh
• Developing countries 100-190 per one lakh
• Prevalence
• Developed countries 4-10 per 10,000
• Developing countries 57 per 10,000
• Partial seizures with or without generalization
  is most common

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• Bimodal age distribution
• lt 1 and gt 60. Less sharp in developing
  countries
• Common causes Perinatal disorders associated
  with cerebral palsy mental retardation, Head
  trauma, CNS infections, Stroke, Brain tumours,
  Alcohol and other drugs
• Men affected 1-2.4 times compared
  to women

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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)
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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)
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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.
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Antiepileptic drug (AED)

• A drug which decreases the frequency and /or
  severity of seizures in people with epilepsy.
• Treats the symptom of seizures, not the
  underlying epileptic condition.
• Improves quality of life by minimizing seizures.

Gitanjali-2
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History of Antiepileptic Drug Therapy

• 1857 - Bromides
• 1912 - Phenobarbitone
• 1937 - Phenytoin
• 1944 - Trimethadione
• 1954 - Primidone
• 1960 - Ethosuximide

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History of AED therapy

• 1974 Carbamazepine, Oxcarbazepine
• 1975 - Clonazepam
• 1978 - Valproate
• 1993 - Felbamate, Gabapentin
• 1995 Lamotrigine, Levetiracetam
• 1997 - Topiramate, Tiagabine

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Principles of AED Selection

• Correct diagnosis of the type of epilepsy
  influences treatment, prognosis and genetic
  counseling.
• One best drug to fit the fit, fit the patient
  Sequential monotherapy
• Use the least expensive AED (all things being
  equal, like efficacy).
• Prefer AEDs which can be taken od over bid / tid.
• AEDs almost never need qid dosing

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Principles of AED Selectioncont.

• Newer is not better, and almost certainly more
  expensive
• Start with one AED and push the dose to clinical
  toxicity or seizure control.
• Withdraw AEDs that are not effective.
• Never have a patient on more than three (3)
  AED's.

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Principles of AED Selectioncont.

• Don't use combination medications (e.g.,
  phenytoin with phenobarbital).
• No proof that multiple AEDs are synergistic in
  the treatment of epilepsy.
• Polypharmacy is expensive, increases side effects
  and increases the complexity of adjusting AEDs in
  the refractory patient.

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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.