医学课件抗癫痫药_1

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1、抗癫痫药AntiepilepticDrugs北京协和医学院基础医学院药理学系叶菜英Definitionsinepilepsy:Epilepsycomprisesrecurrentepisodesofabnormalcerebralneuronaldischarge.Theresultingseizuresareusuallyclinicallyobviousandvaryinpatternaccordingtowhichpartsofthebrainareaffected.Epilepsycanbecausedbymanyneur

2、ologicaldiseases,includinginfection,trauma,infarctionandneoplasia.Heredityhasanimportantrole(especiallyintheidiopathicgeneralisedepilepsies).NormalbraincellAbnormalhigh-frequencydischargeFocusDrugactionInhibitdischargeStabilizemembrane,inhibitthediffusionofdischarge(p

3、rimary)CommonseizuretypesofEpilepsy:Generalisedseizures.Absence(petitmal).Tonic/clonic(grandmal).Partialseizures.Simplepartialseizures.Complexpartialseizures(temporallobeepilepsy).Generalisedseizures:Absence(petitmal):Theseseizureshaveabruptonsetandcessation,withimpai

4、redconsciousness,butwithnormalpostureoftenretained.TheEEGshowsatypical‘spikeandwave’pattern.Tonic/clonic(grandmal):Consciousnessisimpairedandthepatientusuallyfallstothefloor.Aphaseofmusclecontraction(‘tonic’)isfollowedbyirregularmuscleclonusandthenbysleep.Injurymayocc

5、ur.Partialseizures:Simplepartialseizures:featuresdependonthepartofthebrainaffected,resultfromdischargeintheprecentralgyrus.Consciousnessisunimpaired.Complexpartialseizures(temporallobeepilepsy):Consciousnessisimpairedwithcomplex,oftenrepetitive,action.TheEEGinseizureo

6、fEpilepsy3HzParadoxicaldischargeSpikewaveEpilepsyPathogenesis:Theneuroninbrainlesiondepolarizestogethersuddenly,andthenproducthigh-frequency,out-breakdischarge.Thedischargecandiffusetosurroundingnormaltissue→extensiveexcitation→thebrainfunctiontransientaberration.Norm

7、albraincellAbnormalhigh-frequencydischargeFocusDrugactionInhibitdischargeStabilizemembrane,inhibitthediffusionofdischarge(primary)EpilepsyTherapeuticprinciple:ChangethepermeabilityofNa+,Ca2+andK+innervecellmembrane,degradeexcitementstage,extendrefractoryphase.Directly

8、orindirectlyincreaseCNSlevelsofGABA.Theprimaryanimalmodelsusedinanti-epilepticdrugsresearchMaximalelectroshockseizure(MES)mo