抗癫痫药物的选择.ppt

* * * * * * * * * * * * * * * * Effect of non-AEDS on newer AEDs Rifampicin decrease the blood level of lamotrigine; INH increases it. Anti HIV agents increases the level of Lamotrigine, Levitiracetum gabapentin AED oral contraceptives Topiramate,oxcarbazepine, and felbamate are weak inducers can reduce the oral contraceptive effect. AEDs that are safe to use in the presence of oral contraceptives include valproate, gabapentin, lamotrigine, levetiracetam, and zonisamide. NEWER DRUGS IN STATUS: i/v Valproate: i/v Levetiracetum; Oral Clobazam Oral Topiramate NEWER DRUGS IN STATUS:I/V valproate CSF penetration is similar to I/V diazepam Good alternative to phenytoin. Seizure control in 80% of patients More effective than Phenytoin (66% vs 42%) No significant side effect: No sedation, No hypotension. NEWER DRUGS IN STATUS:I/V valproate Dose: I/V bolus: adult dose: 15-30 mg/kg Children; 20-40 mg/kg At the rate of 50mg /mt Adverse effects: Hyperammonemic encephalopathy Pancreatitis Thrombocytopenia Contraindication Children with acute liver failure Patients with inherited metabolic diseases NEWER DRUGS IN STATUS:I/V Levetiracetum Advantages: Rapid titration. No drug interaction Good safety profile Excellent choice in hepatic failure I/V dose; 1000 mg i/v Efficacy: 100% efficacy in BZD resistant SE NEWER DRUGS IN STATUS:Topiramate Oral loading Topiramate: 10mg/kg followed by 5mg/kg/day USE SIDE EFFECT PROFILE OF NEWER AEDS CLOBAZAM Highly effective as an add-on Antiepileptic effect: Broad spectrum; Partial, secondarily generalised, Absences, myoclonus LGS, ESES Alcohol withdrawal seizures Benign childhood partial epilepsies Intermittent therapy in catamenial epilepsy CLOBAZAM Side effects; Behavioral disturbances, irritability Sedation Tolerance Topiramate Broad spectrum\: Partial, secondarily generalised Primary generalised LGS Childhood epilepsy syndromes Infantile spasms SMEI Atypical a