神经系统药理-魏尔清-抗癫痫药.ppt

Part9

AntiepilepticandAnticonvulsantDrugs

PsychomotorseizuresPetitmal(absence)Grandmal(tonic-clonic)Epilepsyisnotasingleentity;itisafamilyofdifferentrecurrentseizuredisordersthathaveincommonthesudden,excessiveanddisorderlydischargeofcentralneurons.Thisresultsinabnormalmovementorperceptionsthatareofshortdurationbutthattendtorecur.

Classificationofepilepsy(older)Generalizedseizures(全身发作）1Grandmal（大发作）：2tonic-clonicseizures（强直－阵挛）3Petitmal（小发作）：4absenceseizures（失神发作）5Partialseizures(部分性发作)6Pshychomotor（精神运动性）：7temporallobeseizures（颞叶癫痫）8Partial（部分发作）：9motor,sensory,ANS,etc.（局限性发作）10

Classificationofepilepsy

AbsenceEEGNormalEEG

Thepathwaysforseizurepropagationinpartialseizuresandprimarygeneralizedseizures

Stereotypicalcomplexpartialseizures

MechanismsofantiepilepticdrugsElectrophysiologicalInhibitingexcessivedischargesInhibitingspreadofdischargesMolecularPotentiatingGABAneuronalfunctionsModulatingNa+,Ca2+,K+channelfuctions

A.AntiepilepticdrugsSpecialdrugsPhenytoinSodium苯妥英钠

PharmacologicaleffectsandthemechanismInhibitinginfluxofNa+andCa2+InhibitingspreadofabnormaldischargesAntiepilepticdrugs

2.Clinicaluses(1)AntiepilepsyGrandmal,statusepilepticus;Partialseizures(simpleandcomplex);Ineffectiveforpetitmal(absenceseizures)(2)Trigeminalandrelatedneuralgia(3)AntiarrhythmiaA.Antiepilepticdrugs

ADMELargerdoses:non-linearkinetics（plasmaconcentration10?g/ml）NecessarytomonitorplasmaconcentrationsInductionofhepaticdrug-metabolizingenzymesAntiepilepticdrugs

A.AntiepilepticdrugsAdverseeffectsGIreactions;gingivalhyperplasiaParticularlyinthecerebellumandvestibularsystems:nystagmus(眼球震颤),ataxia(共济失调),etc.LocalreactionsCNSreactionsBehavioralchanges:confusion,hallucination123456

(3)HemologicalreactionsMegaloblasticanemia(4)AllergicreactionsSkinreactions;bloodcellabnormality(includingth