DRUGS

USED FOR PARTIAL SEIZURES

Mentor: Dr. Yogeeta Walke
• Carbamazepine
• Lamotrigine
• Valproate
• Phenytoin
 GROUP MEMBERS
•  Rea Fernandes
•  Ritz Alfonso
•  Reshma Salunkhe
•  Samantha Pinto
•  Rajashwini Sarnaik
•  Saumya Pal
•  Siddhi Savoiverekar
•  Sharon Thomas
•  Shefali Gauns
•  Shiara Afonso
 PARTIAL SEIZURES
1.  Simple parPal seizures
•  Convulsions -group of muscles or localized sensory disturbance
depending on area of cortex involved lasPng 1/2–1 min
•  without loss of consciousness.
2. Complex parPal seizures (CPS, temporal lobe epilepsy, psychomotor)
•  aZacks of bizarre and confused behaviour, purposeless movements,
emoPonal changes lasPng 1–2 min
•  with impairment of consciousness.
•  Aura o[en precedes.
•  seizure focus-temporal lobe.
3. Simple parPal or complex parPal seizures secondarily generalized
•  parPal seizure evolves into GTCS
•  with loss of consciousness.
 PHENYTOIN
MECHANISM
!  Stabilizing influence on neuronal membrane
Blocks Na+ channels

Prolongs inacPvated state of voltage sensiPve neuronal Na+ channel

Prevents repePPve detonaPon of normal brain cells during

‘depolarizaPon shi[’
!  TherapeuPc concentraPons
•  High frequency discharges inhibited
•  LiZle effect on normal low frequency discharges
•  Which allow Na+ channels to recover
!  Has no effect on resPng membrane potenPal: normal synapPc
transmission is not impaired.
!  Does not interfere with kindling
 INDICATIONS

•  Simple parPal seizures

•  Complex parPal seizures –added to
carbamazepine
•  DOSE 100mg BD maximum 400mg/day
 CARBAMAZEPINE
MECHANISM OF ACTION
•  Na+ channels- prolongaPon of inacPvated
state
•  Inhibits high frequency neuronal discharges
and presynapPc acPon -decreased transmiZer
release
•  Inhibits kindling
 INDICATIONS
•  Most effecPve for CPS
•  GTCS
•  SPS
•  Preferred in young girls -cosmePc side
effects of phenytoin (hirsuPsm)
•  Dose:
! 200–400 mg TDS
!  Children 15–30 mg/kg/day
 LAMOTRIGINE
MECHANISM OF ACTION
! New anPconvulsant -carbamazepine-like acPon :
•  Prolongs Na+ channel inacPvaPon and suppression of
high frequency firing
•  Directly blocks voltage sensiPve Na+ channels thus
-stabilizing the presynapPc membrane
-prevenPng release of excitatory neurotransmiZers
(glutamate and aspartate) -broader-spectrum of
anPseizure efficacy.
•  Does not antagonize PTZ seizures or block NMDA type
of glutamate receptors.
 INDICATION
•  Simple parPal seizures-add-on therapy in
cases with incomplete/poor response
•  Complex parPal L-added in refractory cases.
•  Dose: 50 mg/day iniPally, increase upto 300
mg/day as needed; not to be used in children.
 VALPROATE
MECHANISM OF ACTION
MulPple mechanisms:
•  Frequency-dependent prolongaPon of Na+
channel inacPvaPon
•  Weak aZenuaPon of Ca2+ mediated ‘T’ current
•  AugmentaPon of release of inhibitory transmiZer
GABA by
" inhibiPng its degradaPon (by GABA-
transaminase)
" increasing its synthesis from glutamic acid.
•  Responses to exogenously applied GABA are not
altered
 INDICATION
•  AlternaPve/adjuvant drug for GTCS, SPS and
CPS
•  Used with cauPon young children -hepaPc
toxicity
•  Dose: Adults—
start with 200 mg TDS,
maximum 800 mg TDS
Type of seizure First choice drugs Second choice Add-on drugs
Alterna9ve Add-on drugs
drugs

simple parPal with Carbamazepine, Valproate, Lamotrigine,

or without Phenytoin Phenobarbitone GabapenPn,
generalizaPon Topiramate,
Primidone,
LevePracetam

Complex parPal Carbamazepine, GabapenPn, Clobazam,

with or without Valproate, Lamotrigine, Zonisamide,
generalizaPon Phenytoin LevePracetam Topiramate