7/18/2011 1 Clinical Use of Antiepileptic Drugs and Clinical Use of ...

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7/18/2011Electroclinical syndromesarranged by age at onset• Neonatal period• Infancy• Childhood• Adolescence – Adult• Less specific age relationship19Electroclinical syndromesOnset at adolescence – adult• Juvenile absence epilepsy (JAE)• Juvenile myoclonic epilepsy (JME)• Epilepsy with generalized tonic–clonicseizures alone• Progressive myoclonus epilepsies(PME)• Autosomal dominant epilepsy withauditory features (ADEAF)• Other familial temporal lobe epilepsies20Distinctive constellations• Mesial temporal lobe epilepsy withhippocampal sclerosis• Rasmussen syndrome• Gelastic seizures with hypothalamichamartoma• Hemiconvulsion–hemiplegia–epilepsySeizures not diagnosed as epilepsy• Conditions with epileptic seizures that aretraditionally not diagnosed as a form ofepilepsy per se• Febrile seizure• Benign neonatal seizures (BNS)2122EXAMPLE23Example• ชาย อายุ 52 ปี มีอาการกระตุกที่แก้มข้างขวาก่อนแล้วจึงกระตุกทั ้งตัว หมดสติขณะที่กระตุกทั ้งตัว CT scan ofbrain พบ right frontal lobe tumor• Seizure type• Focal motor seizure at right faceevolving to a bilateral, convulsiveseizure• Epilepsy type• Epilepsy attributed to right frontal lobetumor244
7/18/2011Clinical use of AEDs• How correct diagnosis is important!• Indication for starting antiepileptic drug• AED selection• Maintenance therapy• Strategies when treatment failsHOW CORRECT DIAGNOSIS ISIMPORTANT !!!2625Why correct diagnosis is important?• Etiology management• Prognosis• AED selection• AED-induced seizure• Non-epileptic attack disordersAED choice according toepilepsy syndrome• Infantile spasm• Vigabatrin, nitrazepam, valproate, B 6,adrenocorticotropic hormone, surgery• Juvenile myoclonic epilepsy• Valproate, lamotrigine, topiramate,levetiracetam2728AED choice according toepilepsy type• Epilepsy with focal seizure• Many AEDs• Epilepsy with generalized seizure• Many AEDs• Epilepsy syndrome with generalized seizureprefer valproate, phenobarbital, lamotrigine,topiramate, levetiracetam, zonisamide• Some AEDs may induce seizure !!29AED choice according toseizure type• Generalized tonic-clonic seizure• Any AED• Focal seizure• Any AED• Absence• Valproate, lamotrigine, topiramate,levetiracetam• Myoclonic seizure• Phenobarbital, valproate, lamotrigine,topiramate, levetiracetam305
Page 1 and 2: 7/18/2011Clinical Use ofAntiepilept
Page 3: 7/18/2011Focal seizureFOCAL SEIZURE
Page 7 and 8: 7/18/2011Indication for starting AE
Page 9 and 10: 7/18/2011ครูหญิง อ
Page 11 and 12: 7/18/2011Drug-drug interaction• B
Page 13 and 14: 7/18/2011Valproate in pregnancy•
Page 15: 7/18/2011Strategies when treatment

7/18/2011 1 Clinical Use of Antiepileptic Drugs and Clinical Use of ...

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