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CLINICAL PHARMACOLOGY 2003 (PART 22)

Antiepilepsy drugs: principles of management; withdrawal of therapy; pregnancy; teratogenic effects; epilepsy in children; status epilepticus • Individual drugs: carbamazepine, phenytoin, sodium valproate, lamotrigine, vigabatrin, gabapentin, clonazepam, topiramate, levetiracetam. • Parkinsonism Objectives of therapy Drug therapy; problems of long-term treatment • Other disorders of movement • Tetanus cortical neurons simultaneously (primary generalised seizure). Bromide (1857) was the first drug to be used for the treatment of epilepsy, but it is now obsolete. Phenobarbital, introduced in 1912, controlled patients resistant to bromides. The next success was the discovery in 1938 of phenytoin (a hydantoin) which is structurally related to the. | SECTION 4 Epilepsy parkinsonism and allied conditions SYNOPSIS Antiepilepsy drugs principles of management withdrawal of therapy pregnancy teratogenic effects epilepsy in children status epilepticus Individual drugs carbamazepine phenytoin sodium valproate lamotrigine vigabatrin gabapentin clonazepam topiramate levetiracetam. Parkinsonism Objectives of therapy Drug therapy problems of long-term treatment Other disorders of movement Tetanus cortical neurons simultaneously primary generalised seizure . Bromide 1857 was the first drug to be used for the treatment of epilepsy but it is now obsolete. Phenobarbital introduced in 1912 controlled patients resistant to bromides. The next success was the discovery in 1938 of phenytoin a hydantoin which is structurally related to the barbiturates. Since then many other drugs have been discovered but phenytoin still remains a drug of choice in the treatment of major epilepsy. Over the past ten years there has been a dramatic increase in the number of new anticonvulsant drugs vigabatrin gabapentin lamotrigine topiramate oxcarbazepine levetiracetam but none has been shown to be superior to the major standard anticonvulsants phenytoin carbamazepine and sodium valproate . Antiepilepsy drugs Epilepsy affects 5-10 per 1000 of the general population.1 It is due to sudden excessive depolarisation of some or all cerebral neurons. This may remain localised focal seizure or may spread to cause a secondary generalised seizure or affect all 1 Some people with epilepsy make pilgrimages to Terni Italy to seek intercession from Saint Valentine to relieve their condition. There was more than one Saint Valentine and it is unclear if he was also the patron saint of lovers. MODE OF ACTION Antiepilepsy anticonvulsant drugs inhibit the neuronal discharge or its spread and do so in one or more of three ways 1. Reducing cell membrane permeability to ions particularly the voltage-dependent sodium channels which are responsible for the inward current .