EPILEPSY
Joan Mae L. Garbin, RPh
CEU-School of Pharmacy
EPILEPSY
Epilepsy is defined by the
occurrence of at least two
unprovoked seizures separated by
at least 24 hours.
EPILEPSY
Some people with epilepsy
simply stare blankly for a few
seconds during a seizure, while others
repeatedly twitch their arms or legs.
EPILEPSY
• Seizures result from excessive excitation or
from disordered inhibition of a population of
neurons.
• Initially, a small number of neurons fire
abnormally. Normal membrane conductance
and inhibitory synaptic currents then break
down, and excitability spreads locally (focal
seizure) or more widely (generalized seizure).
EPILEPSY
• Local imbalances between the main
neurotransmitters (glutamate, GABA) and
neuromodulators (acetylcholine,
norepinephrine, and serotonin)
CLASSIFICATION OF EPILEPTIC
SEIZURES
1. Partial (focal) seizures
• Seizures that result from abnormal
activity in just one area of the brain
• In attacks, may manifest as a sensation or
abnormal feeling and is called the aura.
CLASSIFICATION OF EPILEPTIC
SEIZURES
1. Partial (focal) seizures
If there is no loss of consciousness, the
seizures are called simple partial.
They may alter emotions or change the way
things look, smell, feel, taste or sound. They may
also result in involuntary jerking of a body part,
such as an arm or leg, and spontaneous sensory
symptoms such as tingling, dizziness and flashing
lights.
CLASSIFICATION OF EPILEPTIC
SEIZURES
1. Partial (focal) seizures
If there is loss of consciousness or
awareness, the seizures are called complex partial.
During this seizure, you may stare into space
and not respond normally to your environment or
perform repetitive movements, such as hand
rubbing, chewing, swallowing or walking in
circles, grimacing and undressing.
CLASSIFICATION OF EPILEPTIC
SEIZURES
2. Generalized seizures
Seizures that appear to involve all
areas of the brain are called generalized
seizures.
CLASSIFICATION OF EPILEPTIC
SEIZURES
Types of generalized seizures:
a. Tonic seizure
Presence of sudden stiffening of the
body, arms and legs
b. Clonic seizures
Clonic seizures are associated with repeated or
rhythmic, jerking muscle movements.
These seizures usually affect the neck, face and arms.
CLASSIFICATION OF EPILEPTIC
SEIZURES
c. Tonic clonic seizures (‘grand mal’)
Without warning, the patient suddenly goes
stiff, falls and convulses, with labored breathing
and salivation.
Cyanosis and tongue biting may occur. The
convulsion ceases after a few minutes and may often
be followed by a period of drowsiness, confusion &
headache .
CLASSIFICATION OF EPILEPTIC
SEIZURES
d. Atonic seizures - also known as drop
seizures, that may be described as a head drop,
dropping of a limb, or slumping to the ground,
loss of muscle control, which may cause you to
suddenly collapse or fall down.
Tonic clonic seizures
Atonic seizures
CLASSIFICATION OF EPILEPTIC
SEIZURES
e. Absence seizures
Often called ‘petit mal’; happen almost
exclusively in childhood and early adolescence.
It is characterized by staring into space,
involunatry body movements(hands), eye
blinking or possibly a brief upward rotation of
the eyes and lip smacking. These seizures may
occur in clusters and cause a brief loss of awareness.
CLASSIFICATION OF EPILEPTIC
SEIZURES
f. Myoclonic seizures
Myoclonic seizures usually appear as sudden
brief jerks or twitches of your arms and legs.
They usually happen in the morning,
shortly after waking. They may sometimes cause
the person to fall, but recovery is immediate.
Myoclonic seizures
Absence seizures
CAUSES
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Genetic influence
Head trauma
Brain conditions
Infectious diseases
Prenatal injury
Developmental disorders
DIAGNOSIS
1. Blood tests
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CBC
Chemistry panel (Ca, Mg, K, Na )
Kidney function test
Liver function test
FBS
DIAGNOSIS
2. Neurological exam
Use to assess behavior, motor abilities,
mental function and other areas to
diagnose your condition and determine
the type of epilepsy you may have.
DIAGNOSIS
3. Electroencephalogram (EEG)
This is the most common test used to
diagnose epilepsy. In this test, doctors attach
electrodes to your scalp with a paste-like
substance. The electrodes record the electrical
activity of your brain.
DIAGNOSIS
3. Electroencephalogram (EEG)
Your doctor may monitor you on video
while conducting an EEG while you're
awake or asleep, to record any seizures you
experience.
DIAGNOSIS
4. Computerized tomography (CT) scan
- CT scans can reveal abnormalities in
your brain that might be causing your seizures,
such as tumors, bleeding and cysts.
5. Magnetic resonance imaging (MRI)
- An MRI uses powerful magnets and
radio waves to create a detailed view of your
brain.
DIAGNOSIS
6. Positron emission tomography (PET)
PET scans use a small amount of lowdose radioactive material that's injected into a
vein to help visualize active areas of the brain
and detect abnormalities.
TREATMENT
Epilepsy surgery
When medications fail to provide
adequate control over seizures, surgery may
be an option. With epilepsy surgery, a
surgeon removes the area of your brain that's
causing seizures.
TREATMENT
Vagus nerve stimulation
In vagus nerve stimulation, an
implanted pulse generator and lead wire
stimulate the vagus nerve, which leads to
stabilization of abnormal electrical activity in
the brain.
TREATMENT
1. Phenytoin: treatment of tonic-clonic
seizures and partial (focal) seizure
Dosing: 3-6mg/kg/day
2. Carbamazepine is a DOC in tonic clonic and
partial seizures
Dosing: 200-1200mg/day
TREATMENT
Chronic side effects of Phenytoin include:
• Gingival hyperplasia
• Impaired cognition
• Hirsutism
• Vitamin D deficiency
• Osteomalacia
• Carbohydrate intolerance
• Hypothyroidism
• Peripheral neuropathy
TREATMENT
3. Phenobarbital is the DOC for neonatal
seizures; use also in tonic-clonic and focal
(partial) seizures
Adult dosing: 1-4mg/kg/day
4. Valproic acid is a DOC for the treatment of
generalized absence seizures, myoclonic seizures and
generalized tonic clonic seizures
Dosing: 750-2000mg/day given BID-QID
TREATMENT
5. Ethosuximide is a DOC for generalized
absence seizures, and has no useful effect
against any other seizure type.
Dosing: 750-1250mg/day
TREATMENT
6. Lamotrigine – used for focal (partial) seizures,
tonic clonic seizures & myoclonic seizures.
It considered the first-line option in women of
child-bearing potential who have idiopathic generalized
epilepsy
Dosing: 25-2000mg/day given BID
7. Pregabalin is a second-line agent for partial
seizures that have failed initial treatment
Dosing: 75mg-150mg/day, max: 600mg/day
TREATMENT
8. Levetiracetam is indicated as adjunctive
treatment for focal (partial) seizures.
Dosing: 500-2000mg/day given BID
9. Oxcarbazepine- indicated for focal (partial)
seizures.
Dosing: 600-2400mg/day given BID
TREATMENT
* Diazepam – used mainly in the treatment
of status epilepticus and for febrile seizure
Tonic clonic
(Grand mal)
seizures
Phenytoin
Phenobarbital
Valproic acid
Carbamazepine
Lamotrigine
Focal
(partial)
seizures
Carbamazepine
Lamotrigine
Oxcarbazepine
Phenytoin
Phenobarbital
Absence
(petit mal)
seizures
Myoclonic
seizures
Valproic acid
Ethosuximide
Valproic
acid
Lamotrigine