Antiepileptics

Antiepileptics

Seizure
Seizures are manifestations of electrical disturbances in the brain.
Epilepsy = CNS disorder characterized by brief, chronic seizures with rapid onset. Often associated with focal (localized) brain lesions.

Antiseizure Meds.
Limit repetitive firing of neurons -- by blocking channels that sodium ions flow through & preventing repetitive discharge, which is implicated in seizure activity. (Traditional.)
OR
Enhance GABA-mediated synaptic inhibition by reducing the metabolism of GABA.
(Newer. Also tx. of bipolar.)

Traditional Antiepileptic Drugs.
Barbiturates:
phenobarbitol (generic barb). 1st widely used antiepileptic.
Mebral (mephobarbital). Used occasionally.
Gemonil (metharbital). Used occasionally.

Hydantoins 
Zarontin (ethosuximide)
Mysoline (primidone)
Tegretol (carbamazepine)
Dilantin (phenytoin). Widely used. 

Antiseizure Meds.
Benzodiazepines. Possess antiepileptic properties.
Klonopin, Tranxene
ETOH. Possess antiepileptic properties.

Antiseizure Meds.
GABAergic
Depakine (valproic acid), 1978
Felbatol (felbamate). Rarely used because of toxic effects, including aplastic anemia (serious, failure of bone marrow to produce cells) and liver failure. At first thought to be free of serious side effects.
Neurontin (gabapentin). 1995.Widely used for psych & pain.
Lamictal (lamotrigine). 1995. Used as anti-depressant, anti-manic.
Topamax (topiramate). Also use for anti-manic.
Gabitril (tiagabine). 1998. Also used for anti-manic.

Neurofeedback (NF)
EEG Biofeedback
1972. Case presentation. 23 y.o. woman with 7 yr hx generalized tonic-clonic seizure (w/occ. incontinence) of unknown origin. Meds not helpful, but taking Dilantin 200 mg and Mebarol 200 mg. NF 2x/wk for 3 months; enhance SMR (11-15 Hz) > seizures stopped. Tx. continued (briefly) and she became seizure free without meds.
Neurofeedback (NF)

EEG Biofeedback
Adequate control of epilepsy with medication at best (pts. w/ localized partial seizures -- the most common type) est. as low as 30%.
In 18 published studies (N=174), with different NF protocols: 82% showed significant (>30%) seizure reduction, with an average seizure reduction >50%. Many subjects showed reduction in severity as well. About 5% had complete control for up to 1 year, even when meds were reduced or discontinued. Most patients only responded with SMR reward (not other NF). In studies that looked at pre & post EEG changes, 66% showed significant EEG changes.