Seizures epileptic

Simple partial Partial Seizures Carbamazepine, phenytoin, Gabapentin, 

EPINEPHRINE HYDROCHLORIDE (Adrenalin Chloride, AsthmaNefrin, Epifrin, 

The actions of norepinephrine and epinephrine on the cardiovascular systan may be quite different when both drugs are administered in small doses (0.1 to 0.4 ig/kg/min in a slow intravenous infusion), but are essentially the same when given in large doses. The following are the effects of small doses of norepinephrine in humans systolic pressure— increased diastolic pressure— increased mean pressure— increased heart rate—slightly decreased cardiac output—slightly decreased and peripheral resistance— increased. 

Yalrubicin (Valstar) was approved in 1998 for intravesical therapy of bacille Calmette-Guerin-refractory urinary bladder carcinoma in situ in patients for whom immediate cystectomy would be associated with unacceptable morbidity or mortality. Epirubicin (4 -epidoxorubicin, Ellence) was approved by the FDA in 1999 as a component of adjuvant therapy following resection of early lymph-nodepositive breast cancer. 

Eplerenone is a selective aldosterone receptor antagonist that binds to the mineralocorticoid receptor (MR), blocking the binding of aldosterone. It is indicated in the treatment 

Several types of drugs are currently available, and certain compounds work best in specific types of epilepsy. Consequently, the type of epilepsy must be determined by observing the patient and using diagnostic tests such as electroencephalography (EEG).21 The classification system most commonly used in characterizing epilepsy is discussed here. 

Simple partial seizures Limited (focal) motor or sensory signs (e.g., convulsions confined to one limb, specific sensory hallucinations) consciousness remains intact 

Complex partial seizures (needed to differentiate this from absence seizures) Consciousness impaired bizarre behavior wide variety of other manifestations specific electroencephalography (EEG) abnormality 

Partial becoming generalized Symptoms progressively increase until seizure resembles a generalized (tonic-clonic) seizure 

Absence (petit mal) seizures Sudden, brief loss of consciousness motor signs may be absent or may range from rapid eye-blinking to symmetrical jerking movements of entire body 

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Anticonvulsants or antiepileptics are agents that prevent epileptic seizures or modulate the convulsant episodes eflcited by seizure activity. Certain of these agents, eg, the BZs, are also hypnotics, anxiolytics, and sedatives, reinforcing the possibiUty of a common focus of action at the molecular level (1). 

Neuronal excitotoxicity AEA levels are elevated in the hippocampus of mice treated with kainic acid. 2-AG levels are elevated in rats treated with pilocarpine These are two animal models of epileptic seizures, where the endocannabinoids play an anti-convulsant and protective function Inhibitors of cellular re-uptake... 

Excitotoxicity is the over-activity of the glutamatergic system responsible for the large number of dead neurons observed after ischemia (stroke) or epileptic seizures. This neuronal death is due to an overexcitation of the neurons and the massive Ca2+ entry... 

If a carbonic anhydrase inhibitor is being given for absence or nonlocalized epileptic seizures, the nurse assesses the patient at frequent intervals for the occurrence of seizures, especially early in therapy and in patients known to experience seizures at frequent intervals. If a seizure does occur, the nurse records a description of the seizure in the patient s chart, including time of onset and duration. Accurate descriptions of the pattern and the number of seizures occurring each day helps the primary health care provider plan future therapy and adjust drug dosages as needed. 

Lesser RP, Liiders DH, Dinner DS, Morris HH. Epileptic seizures due to thrombotic and embolic cerebrovascular disease in older patients. Epilepsia 1985 26(6) 622-630. 

All such animal procedures suffer from the obvious and basic problem that laboratory animals do not behave like humans and that humans cannot reliably interpret their reactions and behaviour. Thus we know that Parkinson s disease is caused by a degeneration of the dopaminergic nigrostriatal tract but its lesion in animals does not produce any condition which resembles human Parkinsonism, except in primates, even though there are functional tests (e.g. rotational movements) which readily establish that loss of dopamine function and also respond to its augmentation (Chapter 15). By contrast, there are many ways, e.g. electrical stimulation and the administration of certain chemicals, to induce convulsions in animals and a number of effective antiepileptic drugs have been introduced as a result of their ability to control such activity. Indeed there are some tests, as well as animals with varied spontaneous seizures, that are even predictive of particular forms of epilepsy. But then convulsions are a very basic form of activity common to most species and epileptic seizures that are characterised by behavioural rather than motor symptoms are more difficult to reproduce in animals. 

Epileptic seizures are classified broadly as (a) partial or (b) general ... 

Epileptic seizures affect 0.5% of the population, are more common in the young and, except for partial seizures, often decrease with age. Convulsions associated with metabolic disturbances are not considered to be epileptic. 

Figure 16.3 Changes in neuronal function required for the development of epileptic seizures. The factors that may control or induce the changes in neuronal function that turn a normal neuron into a focal one (A) recruit other neurons (focal epileptogenesis) to produce an interictal EEG spike (B) and ensure the spread of activity (general epileptogenesis) to full ictal activity (C) are discussed in the text. They include alterations to various ion channels, especially those for Na, a reduction in local inhibitory activity or an increase in local excitatory drive. The electrophysiological counterparts of some of the events involved are shown in Fig. 16.2...

There is no shortage of AEDs (Fig. 16.7) but it is not appropriate to consider them in detail in this text other than to see how their mechanisms of action comply with and illustrate those proposed above (Fig. 16.6) for the control of epileptic seizures (see Meldrum 1996 Upton 1994). The decision on which drug to use depends not only on their proven efficacy in a particular type of epilepsy (some drugs are inactive in certain forms) but also what side-effects they have—many are sedative — how they interact with other drugs and how often they need to be taken. Compliance is a problem over a long period if dosing is required more than once a day. It is probably acceptable in reality, if not scientifically, to divide the drugs into old-established AEDs and new AEDs. Only the latter have been developed chemically to modify the known synaptic function of the amino acids. 

FIGURE 27-1. International League Against Epilepsy classification of epileptic seizures. Data from reference 16. 

Specific syndromes (epileptic seizures that may complicate many diseases, e.g., Ramsay-Hunt syndrome, Unverricht s disease)... 

The answer is c. (Hardman7 p 408.) Clozapine differs from other neuroleptic agents in that it can induce seizures in nonepileptic patients In patients with a history of epileptic seizures for which they are not receiving treatment, stimulation of seizures can occur following the administration of neuroleptic agents because they lower seizure threshold and cause brain discharge patterns reminiscent of epileptic seizure disorders. 

Apart from this epileptic seizure classification, an additional classification specifies epileptic syndromes, which refer to a cluster of symptoms frequently occurring together and include seizure type, etiology, age of onset and other factors [2]. The epileptic syndromes have been categorized into partial versus generalized epilepsies. The partial... 

Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 22 489-501,1981. 

Zinc is important to the normal functioning of the central nervous system (CNS). At low concentrations, zinc protects mammalian brain neurons by blocking N-methyl-D-aspartate receptor-mediated toxicity. At high concentrations, zinc is a potent, rapidly acting neurotoxicant in the mammalian brain, as judged by zinc-induced neuronal injury of in vitro mature cortical cell cultures (Choi et al. 1988). Increased brain levels of zinc are associated with Pick s disease in certain strains of rodents with inherited epileptic seizures. Intravenous injection of zinc in rats with genetically inherited epilepsy produces seizures a similar response occurs with intracranial injection of zinc in rabbits with inherited audiogenic seizures (Choi et al. 1988). 

The International Classification of Epileptic Seizures (Table 52-1) classifies epilepsy on the basis of clinical description and electrophysiologic findings. 

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