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Part9Part9AntiepilepticandAntiepilepticandAnticonvulsantDrugsAnticonvulsantDrugsPsychomotorseizuresPsychomotorseizuresPetitmal(absence)Petitmal(absence)Grandmal(tonic-clonic)Grandmal(tonic-clonic)EpilepsyisnotasingleEpilepsyisnotasingleentity;itisafamilyofentity;itisafamilyofdifferentrecurrentseizuredifferentrecurrentseizuredisordersthathaveindisordersthathaveincommonthesudden,commonthesudden,excessiveanddisorderlyexcessiveanddisorderlydischargeofcentralneurons.dischargeofcentralneurons.ThisresultsinabnormalThisresultsinabnormalmovementorperceptionsmovementorperceptionsthatareofshortdurationbutthatareofshortdurationbutthattendtorecur.thattendtorecur.Classificationofepilepsy(older)Classificationofepilepsy(older)Generalizedseizures(Generalizedseizures(全身发作全身发作））GrandmalGrandmal（（大发作大发作）：）：tonic-clonicseizurestonic-clonicseizures（（强直－阵挛强直－阵挛））PetitmalPetitmal（（小发作小发作）：）：absenceseizuresabsenceseizures（（失神发作失神发作））Partialseizures(Partialseizures(部分性发作部分性发作))PshychomotorPshychomotor（（精神运动性精神运动性）：）：temporallobeseizurestemporallobeseizures（（颞叶癫痫颞叶癫痫））PartialPartial（（部分发作部分发作）：）：motor,sensory,ANS,motor,sensory,ANS,etc.etc.（（局限性发作局限性发作））ClassificationofepilepsyClassificationofepilepsyNormalEEGNormalEEGAbsenceEEGAbsenceEEGThepathwaysforThepathwaysforseizurepropagationinseizurepropagationinpartialseizuresandpartialseizuresandprimarygeneralizedprimarygeneralizedseizuresseizuresStereotypicalcomplexpartialseizuresStereotypicalcomplexpartialseizuresMechanismsofantiepilepticdrugsMechanismsofantiepilepticdrugsElectrophysiologicalElectrophysiologicalInhibitingexcessivedischargesInhibitingexcessivedischargesInhibitingspreadofdischargesInhibitingspreadofdischargesMolecularMolecularPotentiatingGABAneuronalfunctionsPotentiatingGABAneuronalfunctionsModulatingNaModulatingNa++,Ca,Ca2+2+,K,K++channelfuctionschannelfuctionsA.A.AntiepilepticdrugsAntiepilepticdrugsSpecialdrugsSpecialdrugsPhenytoinSodiumPhenytoinSodium苯妥英钠苯妥英钠CONNHC6H5C6H5NaO1.1.PharmacologicaleffectsandthemechanismPharmacologicaleffectsandthemechanismInhibitinginfluxofNaInhibitinginfluxofNa++andCaandCa2+2+InhibitingspreadofInhibitingspreadofabnormaldischargesabnormaldischargesA.A.AntiepilepticdrugsAntiepilepticdrugs2.2.ClinicalusesClinicaluses(1)Antiepilepsy(1)AntiepilepsyGrandmal,statusepilepticus;Grandmal,statusepilepticus;Partialseizures(simpleandcomplex);Partialseizures(simpleandcomplex);Ineffectiveforpetitmal(absenceseizures)Ineffectiveforpetitmal(absenceseizures)(2)Trigeminalandrelatedneuralgia(2)Trigeminalandrelatedneuralgia(3)Antiarrhythmia(3)AntiarrhythmiaA.A.AntiepilepticdrugsAntiepilepticdrugs3.3.ADMEADMELargerdoses:non-linearkineticsLargerdoses:non-linearkinetics（（plasmaplasmaconcentration>10concentration>10g/mlg/ml））NecessarytomonitorplasmaconcentrationsNecessarytomonitorplasmaconcentrationsInductionofhepaticdrug-metabolizingInductionofhepaticdrug-metabolizingenzymesenzymesA.A.AntiepilepticdrugsAntiepilepticdrugs3.3.AdverseeffectsAdverseeffects(1)Localreactions(1)LocalreactionsGIreactions;gingivalhyperplasiaGIreactions;gingivalhyperplasia(2)CNSreactions(2)CNSreactionsParticularlyinthecerebellumandvestibularsyst...