Chpt 16 Antiepileptic Drugs1抗癫痫和抗惊厥药.pptVIP

Chapter 16Antiepileptics and Anticonvulsants抗癫痫和抗惊厥药 Epilepsy a common chronic neurological disorder characterized by recurrent seizures. Seizure a transient symptom of excessive or synchronous neuronal activity in the brain. It can manifest as an alteration in mental state, tonic or clonic movements, convulsions, and various other psychic symptoms. Convulsion a medical condition where body muscles contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of the body Types of epilepsy Focal or partial seizure(部分性发作) 1) Simple partial seizure(单纯部分性发作) Involuntary muscle contraction or abnormal sensory experience without loss of consciousness. 2) Complex partial( psychomotor ) seizure(复杂部分性发作,精神运动性发作) Consciousness disturbance and psychiatric symptoms with often involuntary movement. B) Generalized seizure-Immediate loss of consciousness 1) Tonic- clonic seizures.(grand mal, 强直-阵挛发作,大发作)Patient falls in convulsion may bite his tongue may lose control of his bladder or bowel. 2) Status epilepticus ( 癫痫持续状态). Continuous seizure without intervening return of consciousness for more than 30 minutes 3) Absence seizure(失神小发作 ). Patient stares vacantly for a few seconds with loss of consciousness. Most common in children ( 4-12 yrs ). 4) Myoclonic seizure(肌阵挛性发作). Sudden, brief shock like contraction which may involve the entire body or be confined to the face, trunk or extremities. Pathophysiology of Seizures Paroxysmal阵发性，synchronic , high-frequency depolarization of populations of CNS neurons. Membrane depolarization (ion channels) Decreased inhibitory (GABA) input Increased excitatory (EAA, glutamate) input Action mechanism of antiepileptics Inhibition of sodium channel function: Prolongation of the inactive state of Voltage-dependent Na+ channels Characteristic: use (frequency)-dependent inhibition Phenytoin苯妥英, carbamazepine卡马西平，and lamotrigine拉莫三嗪 Inhibition of calcium channels: Reduction of T-type calcium current A low-thresh