Epileptic seizures, treatment

Epileptic seizures treatment of Erectile dysfunction treatment of Ergot alkaloids Estrogenic preparations... 

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. 

Whether there is any other connection between anticonvulsant activity and camosine s antiaging actions is obviously highly speculative. It may be relevant to note that epileptic seizures and a shortened life span, together with altered protein accumulation, are consequences of PIMT-deficiency in mice, while treatment with valproic acid, an anticonvulsant, partially suppresses these symptoms including effects on life span (Yamamoto et ah, 1998). Conversely, PIMT overexpression can increase life span of Drosophila (Bennet et ah, 2003). Furthermore, the chemistry of some anticonvulsants (ethosuximide) resembles quite closely the structure of the succinimide intermediate formed during both asparagine deamidation and PIMT-mediated repair of isoaspartate residues. One conjectures whether there are any relationships between these... 

Several benzodiazepines are used in the management of epileptic seizures, although only a few are approved for the treatment of seizure disorders in the United States. Since the benzodiazepines share many properties, they will be discussed as a class individual members will be mentioned for specihc indications. 

The apparently quite broad structural requirements for anticonvulsant activity, noted earlier in this chapter, extend to yet another class of five-membered heterocycles that include an imide function. Imidazo-2,4-diones, better known as hydan-toins, have comprised some of the most widely used drugs for treating severe motor and psychomotor epileptic seizures. The general reaction used to prepare this heterocyclic system involves the treatment of a carbonyl compound with ammonium carbonate and potassium cyanide. The first step in the complex sequence can be visualized as the addition of the elements of ammonia and hydrogen cyanide to give an a-aminonitrile (88-2). Addition of ammonia to the cyano group would then lead to an amidine (88-3). Carbon dioxide or carbonate ion present in the reaction... 

Benzodiazepines are used to treat insomnia and for the acute treatment of epileptic seizures, convulsive disorders, and spastic disorders such as cerebral palsy,... 

Seizures Clonazepam [kloe NA ze pam] is useful in the chronic treatment of epilepsy, whereas diazepam is the drug of choice in terminating grand mal epileptic seizures and status epilepticus (see p. 149). Chlordiazepoxide [klor di az e POX ide], clorazepate [klor AZ e pate], diazepam, and oxazepam [ox A ze pam] are useful in the acute treatment of alcohol withdrawal. 

Problem 20.8 Dilantin (5,5-diphenylhydantoin), an anticonvulsant drug used in the treatment of epileptic seizures, is a pyrrole with the molecular formula C 5H 2N202. What is the structural formula for Dilantin ... 

A 49-year-old woman had prominent stuttering before a generalized epileptic seizure and recovered after antiepileptic treatment (73). 

Another field of application for sodium channel blockers is epilepsia. While epileptic seizures are a diverse and complex phenomenon, a key feature consists in bursts of excess excitatory activity of neurons in the brain. Sodium channel blockers will reduce nerve cell excitability, and they are thus one of the mainstays of anti-epileptic treatment. As but one example out of many. Figure 5.10 shows pheny-toin (or diphenylhydantoine). 

Many clinical responses are described in terms of events. An event might be death, a stroke, a myocardial infarction, an epileptic seizure, admission to hospital, need for supplementary treatment, and so on. The occurrence of an event or the time to an event can be modeled using a survival function. The word survival relates most obviously to a death event, but the term is commonly used in a much broader context to describe the probability that the event under study will not occur. 

In a report on the use of albendazole 15 mg/kg/day in two divided doses for 14 days in the treatment of persistent neurocysticercosis (10), adverse reactions were monitored in 43 patients with seizures and a sohtary cysticercal cyst, who had not been treated before. In aU patients CT scans confirmed the presence of a solitary cyst less than 2 cm in diameter. Antiepileptic treatment was continued. In seven patients dexamethasone 8 mg/day in four divided doses was given for the first 5-7 days after the start of treatment. Follow-up CT scans at 4-10 weeks after the start of treatment showed responses in 20 patients, with complete disappearance in seven patients and a reduction to 50% of the pretreatment size in the other 13. There were adverse effects in 15 patients, with a maximum on the fifth day after the start of treatment. Six patients had severe headaches, 11 had partial seizures, and 2 had epileptic seizures and severe postictal hemiparesis that persisted for a week or more. Because of these serious adverse effects treatment was discontinued in seven patients and dexamethasone was added in those patients who were not already taking it, although its use proved questionable. Adverse effects were seen in three of seven patients who took prophylactic steroid therapy and in 12 of 36 patients who did not. 

Appleton R, Sweeney A, Choonaral, etal. Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus. Dev Med Child Neurol 1995 37 682-688. 

Davis et al. found that folate was not the only B group vitamin which was reduced in patients receiving treatment with anticonvulsant drugs (D4). In a study of 68 patients suffering from severe epileptic seizures they found that 18 patients had a low folate, 10 a low serum pyridoxal, and in 15 both the folate and pyridoxal were reduced. Only two patients in this series had a reduced erythrocyte folate, and this is in accord with the infrequency with which a macrocytic anemia is seen in these patients. All the patients in this series had a normal hemoglobin concentration and a normal mean corpuscular volume. However, in a study of 75 epileptic children Maxwell (M3) found both the serum and erythrocyte folate levels to be reduced in 60% and similar observations have been made by other workers (M4, N2). 

Primidone is a potent anticonvulsant which may be chemically regarded as a 2-deoxy analogue of phenobarbital. It is used either in conjunction with other antiepileptics or alone in the treatment and arrest of psychomotor, grand mal and focal epileptic seizures. 

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