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Medicine Notes Neurology Notes

Anticonvulsant Drugs Notes

Updated Anticonvulsant Drugs Notes

Neurology Notes

Neurology

Approximately 117 pages

These notes helped me achieve a mark of 76% in my neurology exam, which is the equivalent of a 1st. The notes are based on a series of 49 lectures on the subject. This is a very good, thorough and in depth review of the nervous system. They are very clearly laid out and easy to follow. They cut out unnecessary information on the topic, making the notes very concise, and fast to get through. Anyone studying medicine, or any other subject requiring knowledge of the nervous system (e.g. physiology o...

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Lecture 28

Anticonvulsant drugs

  • What is epilepsy?

    • Definition

      • Group of disorders all of which exhibit episodic seizures

      • Paroxysmal dysfunction of brain neurophysiology (as seen on EEG)

      • Accompanied by paroxysmal dysfunction of brain action (cognitive, behavioural, sensory, experiential)

      • Has a tendency to recur

NB: Not to be confused with febrile convulsions (hyperthermia) in children

  • Major causes

    • Happen at young age

      • Birth & perinatal injuries; congenital malformations

      • Genetic (ion channels)

      • Idiopathic

    • Can happen at any time

      • Vascular insults; head trauma

      • Severe metabolic disturbances

      • Drug/alcohol abuse

      • Neoplasia

      • Infection

    • Epilepsy from some kind of damage

      • EPILEPTIC focus- can be observed for some epilepsies that result from physical injury

        • Some have seizure in one place=localised legion

        • Some have seizure that start in one place and moves=generalised (secondary)

  • Intermittent and precipitated by

    • Altered blood glucose and pH

    • Stress; fatigue

    • Flashing lights and noise

    • No apparent cause

  • Neurones exhibit PAROXYSMAL DEPOLARISING SHIFT (PAD) in epilepsy

    • Intracellular and extracellular events of PAD underlying the interictal epileptiform spoke detected by surface EEG

    • Theories of cause

      • Pre-synaptically driven

        • Presynaptic endings damaged and release lots of glutamate

      • Synaptic

        • Nerves releasing normal amount of glutamate but post synaptic cell=hypersensitive

      • Post-synaptic

        • Crumbly membrane and lets out + ions easily

  • Types of seizure

    • Simple= no loss of consciousness

    • Complex= impairment of consciousness

    • Partial (localised) seizures

      • Most difficult to treat with drugs

      • Includes psychomotor epilepsy (repetitive activity)

    • Generalised seizures

      • Tonic, clonic or atonic (no muscle tone, fall over)

      • Tonic-clonic (muscles alternate between extended and drawn in)

      • Status epilepticus (seizure starts before last finishes)

      • Absence seizures (respond entirely different to drugs)

  • Current therapies

    • Effective in 75% (psychomotor not well controlled)

    • No drugs cure epilepsy, remove symptoms

    • Drugs taken for long period

  • Enhancement of GABAergic transmission

    • GABA-mimetic

    • Potentiate GABA at GABAA receptors (e.g. benzodiazepines- but tolerance to these)

      • Diazepam (tolerance); phenobarbitone

    • Inhibition of GABA breakdown (GABA-T/SSA dehydrogenase- inhibit these)

    • Inhibit GABA reuptake (neuronal and glial)

  • What can we do to dampen down...

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