第16章-抗癫痫药和抗惊厥药(杨斌)PPT.ppt

第16章 抗癫药及抗惊厥药  Chapter 16  Antiepileptic and Anticonvulsant 多种病因引起的长期反复发作性的大脑功能失调。其特征为发作时大脑局部病灶神经元突发性的异常高频放电并向周围组织扩散，出现短暂的大脑功能失调。表现为突然发作性的短暂的运动、感觉、意识和植物神经功能异常,可伴有脑电图改变。癫的治疗应长期用药，以减少或防止发作，但不能根治。 癫 Table 16-1 (1) Types of Epilepsy and Anti-epileptic Drugs types of epilepsy clinical features anti-epileptic drugs (*preferred) partial seizures 1. simple partial seizures involuntary muscle contraction and abnormal sensory experience without loss of consciousness, seizures lasting for 20~60 sec; carbamazepine*, valproate, clonazepam, phenytoin, phenobarbital, primidone, antiepilepsirine, lamotrigine; 2. complex partial seizures (psychomotor epilepsy) conscious disturbance and psychiatric symptom with often involuntary movement, such as shake head, lasting for 0.5~2min; the same drugs mentioned above; Table 16-1 (2) Types of Epilepsy and Anti-epileptic Drugs types of epilepsy clinical features anti-epileptic drugs (*preferred) 3. partial seizures with following tonic-clonic seizures partial seizures is followed by tonic-clonic seizures without loss of consciousness, lasting for 1~2min; the same drugs mentioned above; generalized seizures 1. tonic-clonic seizures (grandmal) and status epilepticus immediate loss of consciousness with generalized tonic-clonic convulsion, lasting for a few minutes. Seizures lasting for longer time is termed as status epilepticus; carbamazepine*, phenytoin, valproate, phenobarbital, primidone, vigabatrin, lamotrigine, antiepilepsirine; status epilepticus: diazepam* (i.v.);  ethosuximide carbamazepine valproate sodium  phenytoin phenobarbital primidone Fig. 16-1 Molecular structures of antiepileptic drugs 抑制癫病灶神经元的过度放电，或作用于病灶周围正常神经元，抑制异常放电的扩散。这些作用的基础与其增强GABA介导的突触抑制作用有关，如: 1. 苯二氮类(benzodiazepines)和苯巴比妥(phenobarbital)激动GABAA受体、促进GABA介导的氯通道开放。2. 噻加宾(tiagabine)抑制GABA的摄取、增加突触后膜的GABA的浓度。3. 氨己烯酸(vigabatrin)抑制GABA转氨酶活性、减少GABA的灭活。 【抗癫药物的作用