Antiepleptics

• Treatment of epilepsy
• Antiepileptics


  Anticonvulsive drugs
• Spasmolytics


  • Relieve smooth muscle spasm
• Anticonvulsants


  • Resolve skeletal muscle spasms of CNS origin
• Epilepsy


  A chronic disease of nervous system origin with convulsions
• Causes of epilepsy with detectable morphological changes

  • Birth damage
  • Brain tumor
  • Inflammation
  • Trauma
• Causes of epilepsy with no detectable morphological change

  • Metabolic disorder
  • Hypoglycemia
  • Drug side effects
• Epilepsy starts as an extremely intense discharge (focus) of a circumscribed group of neurons in the brain
• The location of the focus and the degree of spread determine the symptoms
• The pathomechanism of epilepsy is still not fully understood
• Imbalances that may cause epilepsy

  • Increase in excitatory effect
  • Reduction of inhibitory effect
  • Increase in the excitability of neurons
• Clinical manifestations of epilepsy

  • Various forms
• Forms of epilepsy


  • Partial, focal epilepsy
  • Generalized epilepsy
  • Status epilepticus
• Partial, focal epilepsy


  • Focus is mostly localized, affecting one brain area at a time, no loss of consciousness
• Generalized epilepsy


  • Process covers several brain areas or the entire brain, accompanied by loss of consciousness
• Grand mal seizure


  • Tonic-clonic jerk develops over the entire body, unconscious patient foams at the mouth
• Petit mal seizure


  • Disturbance of consciousness lasting a few seconds
• Myoclonic seizure


  • Muscle twitching visible only in some muscle groups
• Temporal epilepsy


  • Patient wanders off in a foggy state, may have amnesia
• Status epilepticus


  • Cumulative grand mal seizure, long-lasting convulsive state, consciousness does not clear between seizures
• Status epilepticus is a life-threatening condition that requires immediate intervention
• Diagnostic procedures can find the location of the focus with EEG, CT, and MRI examinations
• The goal of drug treatment is to resolve or prevent seizures
• Long-term medication is required for epilepsy treatment
• Monotherapy


  A single agent used to start treatment
• Some antiepileptic drugs act as enzyme inducers in the liver
• Drug interactions may develop due to enzyme inducers
• Patients should take medication regularly
• After two or three symptom-free years, drug treatment can be slowly and gradually abandoned
• Phenytoin


  Inhibits voltage-dependent Na-channel, primarily reducing high-frequency activity
• Indications for phenytoin


  • Effective for all types of convulsions, except petit mal seizures
• Phenytoin also has an antiarrhythmic effect


  • Can be used during digitalis intoxication
• Phenytoin is metabolized in the liver via the saturable enzyme system
• Plasma level measurement is necessary during long-term treatment of phenytoin
• Side effects of phenytoin

  • Dizziness
  • Double vision
  • Coordination disorders
  • Hyperplasia of the oral mucosa
  • Megaloblastic anemia
• Phenytoin has a teratogenic effect, cleft palate may develop
• Carbamazepine


  Has a similar mechanism of action to phenytoin but also affects normal activity
• Indications for carbamazepine


  • Effective in all types of convulsions, mostly used in partial seizures, suitable for relieving neuropathic and neuralgic pain
• Effective


  For all types of convulsions, except petit mal seizures
• Antiarrhythmic effect


  Can be used during digitalis intoxication