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.

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