Diagnosis

It can be difficult to differentiate seizures from the abundance of other causes of 'funny turns' in the elderly. Syncope, hypoglycaemia, transient ischaemic attacks, transient global amnesia, vertigo and non-specific dizziness afflict up to 10 of the older population. Syncope can have cardiac causes or it may be due to blood pressure changes or impairment of the vascular reflexes linked to posture, and carotid sinus hypersensitivity is also common. Acute confusional states or fluctuating...

Clinical use in epilepsy

Carbamazepine is one of the most widely used antiepileptic drugs in the world, and certainly one of the most widely studied. It is the drug of first choice for partial and secondarily generalized seizures and is effective against the entire range of partial seizure types and in the cryptogenic and symptomatic partial seizure syndromes. In routine practice, it is often the first drug tried in these patients. Carbamazepine is also useful in generalized tonic-clonic seizures associated with...

Renal stones and oligohydrosis

A striking difference that has been noted between Japanese studies and the US and European studies is the occurrence of renal stones. In pre-approval studies in Japan, only two patients 0.2 developed urinary stones, compared with a rate of 2.6 in the early studies in the USA and Europe. Table 3.27 Adverse events of zonisamide in double-blind placebo-controlled studies pooled data events occurred in more than 5 of patients. Table 3.27 Adverse events of zonisamide in double-blind...

Diazepam

Diazepam was the first benzodiazepine to be used in epilepsy. It is highly lipophilic, allowing rapid entry into the brain, but this high lipid solubility also results in rapid subsequent redistribution into peripheral tissues. It is 90 -99 bound to plasma proteins. The volume of distribution for the free component of diazepam i.e. the active, unbound fraction is 1.1 l kg. The initial half-life is 1 hour. Entero-hepatic circulation result in a second peak in blood levels 6 -8 hours after...

Pharmacopoeia

Use of antiepileptic drugs in different seizure types and syndromes. Partial and secondarily Tonic-clonic generalized tonic- seizures primary Absence Myoclonic West Lennox-Gastaut clonic seizures generalized seizures seizurestt syndromettt syndrometttt Reasonable clinical experience of effectiveness. At the time of writing, gabapentin, levetiracetam, pregabalin, tiagabine and vigabatrin are licensed only for use as add-on therapy in most countries. However, there is extensive published...