DƯỢC LÍ Goodman & Gilman's The Pharmacological Basis of Therapeutics 12th, 2010

therapy. More detailed information is presented in
Table 21–1.
Apart from this epileptic seizure classification, an additional
classification specifies epileptic syndromes, which refer to a cluster
of symptoms frequently occurring together and include seizure
types, etiology, age of onset, and other factors (Commission on
Classification and Terminology, 1989). More than 50 distinct epileptic
syndromes have been identified and categorized into partial versus
generalized epilepsies. The partial epilepsies may consist of any
of the partial seizure types (Table 21–1) and account for roughly
60% of all epilepsies. The etiology commonly consists of a lesion in
some part of the cortex, such as a tumor, developmental malformation,
or damage due to trauma or stroke. Such lesions often are evident on
brain magnetic resonance imaging (MRI). Alternatively, the etiology
may be genetic. The generalized epilepsies are characterized
most commonly by one or more of the generalized seizure types
listed in Table 21–1 and account for ~40% of all epilepsies. The etiology
is usually genetic. The most common generalized epilepsy is
referred to as juvenile myoclonic epilepsy, accounting for ~10% of
all epileptic syndromes. The age of onset is in the early teens, and the
condition is characterized by myoclonic, tonic-clonic, and often
absence seizures. Like most of the generalized-onset epilepsies,
juvenile myoclonic epilepsy is a complex genetic disorder that is
probably due to inheritance of multiple susceptibility genes; there is
a familial clustering of cases, but the pattern of inheritance is not
Table 21–1
Classification of Epileptic Seizures
CONVENTIONAL RECENTLY DEVELOPED
SEIZURE TYPE FEATURES ANTI-SEIZURE DRUGS ANTI-SEIZURE DRUGS
Partial Seizures
Simple partial
Diverse manifestations determined by the
region of cortex activated by the
seizure (e.g., if motor cortex representing
left thumb, clonic jerking of left thumb
results; if somatosensory cortex representing Carbamazepine,
left thumb, paresthesia of left thumb results), phenytoin,
lasting approximating 20-60 seconds. valproate Gabapentin,
Key feature is preservation of consciousness.
lacosamide,
Complex partial Impaired consciousness lasting 30 seconds to lamotrigine,
2 minutes, often associated with purposeless levetiracetam,
movements such as lip smacking or
rufinamide,
hand wringing.
tiagabine,
Partial with Simple or complex partial seizure evolves topiramate,
secondarily into a tonic-clonic seizure with loss of Carbamazepine, zonisamide
generalized consciousness and sustained contractions phenobarbital,
tonic-clonic (tonic) of muscles throughout the body phenytoin,
seizure followed by periods of muscle contraction primidone,
alternating with periods of relaxation
valproate
(clonic), typically lasting 1-2 minutes
Generalized Seizures
Absence seizure Abrupt onset of impaired consciousness Ethosuximide, Lamotrigine
associated with staring and cessation of
valproate,
ongoing activities typically lasting less
clonazepam
than 30 seconds.
Myoclonic A brief (perhaps a second), shocklike Valproate, Levetiracetam
seizure contraction of muscles that may be restricted clonazepam
to part of one extremity or may be generalized.
Tonic-clonic As described earlier in table for partial with Carbamazepine, Lamotrigine,
seizure secondarily generalized tonic-clonic phenobarbital, levetiracetam,
seizures except that it is not preceded phenytoin, topiramate
by a partial seizure.
primidone,
valproate