Epilepsy secondary

Open-angle glaucoma, secondary glaucoma, preoperatively to lower Intraocular pressure (IOP), edema due to CHF, drug-induced edema, centrencephalic epilepsy Glaucoma... 

Phenobarbitone was the first AED and was introduced in 1912. It was largely replaced in 1932 by phenytoin for the management of tonic-xilonic seizures and partial and secondary epilepsy. Carbamazepine followed, then ethosuximide for absence seizures and valproic acid. These remained, apart from the introduction of the benzodiazepines, the mainstay of therapy until the last decade. They were introduced solely on their ability to control experimentally induced seizures. Their mechanisms of action were unknown and no thought was given to the possibility of NT modification and in fact subsequent research has shown that with the exception of the benzodiazepines none of them work primarily through NT manipulation. They act directly on neuronal excitability. 

National Institute for Clinical Excellence. The Epilepsies The Diagnosis and Management of the Epilepsies in Children and Adults in Primary and Secondary Care http //www.nice.org.uk/ pdf/CG020NICEguideline.pdf. Accessed December 20, 2005. 

Epilepsy Adjunctive therapy in the treatment of partial seizures with and without secondary generalization in patients more than 12 years of age with epilepsy. Also indicated as adjunctive therapy for partial seizures in children 3 to 12 years of age. Postherpetic neuralgia For management of postherpetic neuralgia in adults. 

C. Pyrazinamide is known to cause hyperuricemia and precipitate gouty arthritis. Pyrazinamide-induced gouty arthritis does not respond to uricosuric therapy with probenecid but may respond to acetylsalicylic acid. Cycloserine (A) can cause headaches, confusion, tremors, and seizures, possibly secondary to low levels of magnesium in the cerebrospinal fluid cycloserine should be avoided in patients with epilepsy and mental depression. It is not associated with hyperuricemia. Thiacetazone (B) is an antibiotic that is rarely used in tuberculosis. The most common adverse reactions are general rashes and GI intolerance. Its use is not associated with hy-... 

Valproic acid (Depakene, Depakote, other trade names) is classified as a carboxylic acid, and is used primarily to treat absence seizures or as a secondary agent in generalized tonic-clonic forms of epilepsy. This drug is also used to treat bipolar disorder (manic-depression), especially during the acute manic phase (see Chapter 7). 

Vigabatrin is used as an adjunctive antiepileptic in patients with resistant partial epilepsy with or without secondary generalization, unresponsive to other therapy [2]. Nowadays, vigabatrin is rarely used in the treatment of partial seizures due to several irreversible visual field constrictions associated with its chronic use [57-62], It is regarded by many authorities as a drug of choice in infants with west syndrome (infantile spasms), particularly in cases associated with tuberous sclerosis [62],... 

The epilepsies are estimated to affect 20-40 million individuals worldwide and are more common in children than in adults. They are classified into two broad groups primary or idiopathic epilepsy is the term applied to those types for which no specific cause can be identified, and secondary or symptomatic epilepsy arises when the symptoms are associated with trauma, neoplasm, infection, cerebrovascular disease or some other physically induced lesion of the brain. Seizures that accompany severe metabolic disturbances are not classified as epilepsy. 

Secondary Epileptogenesis, Kindling, and Intractable Epilepsy A Reappraisal from the Perspective of Neuronal Plasticity Thomas P. Sutula... 

Secondary epilepsy A number of reversible disturbances, such as tumors, head injury, hypoglycemia, meningeal infection, or rapid withdrawal of alcohol from an alcoholic, can precipitate seizures. Antiepileptic drugs are given until the primary cause of the seizures can be corrected. Seizures secondary to stroke or trauma may cause irreversible CNS damage. 

Approximately a third of stroke survivors are functionally dependent at one year and stroke is the commonest cause of neurological disability in the developed world (Murray and Lopez 1996 MacDonald et al. 2000). Stroke also causes secondary medical problems, including dementia, depression, epilepsy, falls and fractures. In the UK, the costs of stroke are estimated to be nearly twice those of coronary heart disease (British Heart Foundation Statistics Database 1998 Rothwell 2001), accounting for about 6% of total National Health Service (NHS) and Social Services expenditure (Rothwell 2001). As the population ages over the coming two decades, the total stroke rate will probably increase unless there are substantial decreases in age- and sex-specific incidence (Rothwell et al. 2004a). Stroke deaths are projected to increase from 4.5 million worldwide in 1990 to 7.7 million in 2020, when stroke will account for 6.2% of the total burden of illness (Bonita 1992 Sudlow and Warlow 1997 Menken et al. 2000). 

Epilepsy is not a diagnostic problem unless the seizures are partial. Partial sensory seizures tend to cause positive symptoms such as tingling, and symptoms march across a hand or foot, and up the limb in around a minute and may eventually be accompanied by focal motor seizures or secondary generalization. Sudden speech arrest seems to be more often epileptic, and not necessarily arising in the dominant hemisphere, than caused by ischemia, which is more likely to cause dysphasic speech (Cascino et al. 1991). Transient inhibitory... 

Epilepsy affects 5-10 per 1000 of the general population. 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... 

Gabapentin is effective only for partial seizures and secondary generalised epilepsy (not absence or myoclonic epilepsy), in combination with established agents. It is also used for neuropathic pain. Gabapentin may cause somnolence, imsteadiness, dizziness and fatigue. 

One solitary controlled trial is on record, comparing CBD (200-300 mg daily for up to 4.5 months added to standard therapy) with placebo in a double-blind, parallel-group design in 15 poorly controlled patients with secondary generalised epilepsy (Cunha et al. 1980). Half the CBD patients remained almost free of fits throughout the experiment and all but one of the others showed partial improvement . With a single exception, the placebo patients remained unchanged. Drowsiness in a quarter of the patients was the only unwanted effect associated with CBD. 

---