Part9AntiepilepticandAnticonvulsantDrugsPsychomotorseizuresClassificationofepilepsy(older)ClassificationofepilepsyNormalEEGThepathwaysforseizurepropagationinpartialseizuresandprimarygeneralizedseizuresStereotypicalcomplexpartialseizuresMechanismsofantiepilepticdrugsA.Antiepilepticdrugs1.PharmacologicaleffectsandthemechanismInhibitinginfluxofNa+andCa2+Inhibitingspreadofabnormaldischarges2.Clinicaluses(1)AntiepilepsyGrandmal,statusepilepticus;Partialseizures(simpleandcomplex);Ineffectiveforpetitmal(absenceseizures)(2)Trigeminalandrelatedneuralgia(3)Antiarrhythmia3.ADMELargerdoses:non-linearkinetics（plasmaconcentration>10g/ml）NecessarytomonitorplasmaconcentrationsInductionofhepaticdrug-metabolizingenzymes3.Adverseeffects(1)LocalreactionsGIreactions;gingivalhyperplasia(2)CNSreactionsParticularlyinthecerebellumandvestibularsystems:nystagmus(眼球震颤),ataxia(共济失调),etc.Behavioralchanges:confusion,hallucination(3)HemologicalreactionsMegaloblasticanemia(4)AllergicreactionsSkinreactions;bloodcellabnormality(includingthrombocytopenia,agranulocytosis);hepatictoxicity;ect.(5)SkeletalreactionsOsteomalaciabyabnormalvitaminDmetabolismandcalciumabsorption4.Druginteractions(1)Increasesplasmaconcentrationsofdrugsbydisplacementofplasmaproteinbinding(salicylates)andinhibitionofinactivation(isoniazid,chloramphenicol)(2)Decreasesplasmaconcentrationsofdrugs(phenobarbital,carbamazepine)byenhancingmetabolism(3)PhenytoinenhancesthemetabolismofcorticosteroidsandvitaminDInhibitingbothformationandspreadofdischargesEffectiveforgrandmal,partialsimpleseizures,statusepilepticusEffectiveforpsychomotorseizures,andgrandmalEffectiveformania,depression,andneuralgiaBroadspectrumofantiepilepsyHepatictoxicityOtherantiepilepticdrugsPrimidone扑米酮：analoguesofphenobarbital,usedforphenobarbital-andphenytoin-ineffectivepatientsMephenytoin美芬妥英,Ethotoin乙苯妥英：analoguesofphenytoinEthosuximide乙琥胺：peptitmalDiazepam:statusepilepticus(i.v.)Nitrozepam硝西泮,Clonazepam氯硝西泮：pept