山东大学：抗癫痫和抗惊厥药（PPT课件讲稿）Antiepileptic and Anticonvulsive Drugs

1901 Antiepileptic and Anticonvulsive Drugs Zhang bin Institute of Pharmacology School of medicine Shandong University

1 Antiepileptic and Anticonvulsive Drugs Zhang Bin Institute of Pharmacology School of Medicine Shandong University

一雜0 C门C Section 1 Antiepileptic Drugs

2 Section 1 Antiepileptic Drugs

继脑卒中的第二 Epilepsy位神经系统疾病 r sudden, excessive and synchronous (超同步化) discharge of focal cerebral neuron and diffusion to normal neuronal tissues movement, sensory, autonomIc and psychotic disorders sudden onset(突然发作)、 recurrent attacks(反复发作)

Epilepsy sudden, excessive and synchronous (超同步化) discharge of focal cerebral neuron and diffusion to normal neuronal tissues. movement, sensory, autonomic and psychotic disorders sudden onset (突然发作)、 recurrent attacks (反复发作) 继 脑卒中的第二 位神经系统疾病

Common types of epileptic seizure 1. Partia| sezures(局限性发作)60% ① Simple partia! eIzures(单纯性局限性发作) ② Complex partial seizures(复合性局限性发作) Psychomotor seizures(精神运动性发作) 2 Generalized seizures(全身性发作)40% ① Absence seizures( petit mal,失神性发作,小发作) ② Myoclonic seizures(肌阵挛性发作) ③ Generalized tonic- clonic seizures( grad mal,强直 阵挛性发作,大发作) ④ Status epilepticus(癫痫持续状态)

4 1. Partial seizures (局限性发作) 60% ① Simple partial seizures (单纯性局限性发作) ② Complex partial seizures (复合性局限性发作) Psychomotor seizures (精神运动性发作) 2. Generalized seizures (全身性发作) 40% ① Absence seizures (petit mal, 失神性发作, 小发作) ② Myoclonic seizures (肌阵挛性发作) ③ Generalized tonic-clonic seizures (grad mal, 强直 -阵挛性发作, 大发作） ④ Status epilepticus (癫痫持续状态) Common types of epileptic seizure

局限性发作: 大脑异常放电只局限于局部且只扩散至局部者,只表现大脑局部功能素乱 1.单纯性局限性发作局部肢体运动感觉异常,无意识障碍,持续<1分钟 2.复合性局限性发作相当于颞叶癫痫。阵发性精神失常,无意识运动(如吮 (神经运动性发作)吸、咀嚼、寻找、叫喊、奔跑、挣扎等),有意识障碍, 持续时间<2分钟 全身性发作:异常放电广泛累及全脑导致的突然意识丧失 1.失神性发作 儿童,意识突然丧失,静止、无语、凝视,但无跌倒抽 (小发作) 搐惊厥,持续<30秒 2.肌阵挛性发作分为婴儿、儿童和青春期肌阵挛。肌肉阵挛性抽搐 3.强直阵挛性发作突然意识丧失,继之先强直痉挛后阵挛性抽搐常伴尖叫、 (大发作) 面色青紫、尿失禁、舌咬伤、口吐白沫或血沫、瞳孔散 羊角风 大、呼吸抑制。持续数十秒或数分钟后痉挛发作自然停 止,进入昏睡状态。 4.癫痫持续状态大发作的持续状态,危及生命

5 2分钟 强直痉挛后阵挛性抽搐

Genera| lized tonic-clonic seizure(强直-阵挛性发作) grad mal seizure(大发作) Loss of consciousness (意识丧失) and a strong tonic spasm(强直性痉挛) that is due to violent and continuous contraction 强宜一阵摩发作 of skeletal muscle, tonigsejomie seizure ollowed by a clonic convulsion(阵挛性抽搐) that indicate rapidly alternating contraction and relaxation

6 (意识丧失) and a strong tonic spasm (强直性痉挛) that is due to violent and continuous contraction o f s k e l e t a l m u s c l e , fol lowed by a c loni c convulsion(阵挛性抽搐) that indicate rapidly alternating contraction and relaxation. Generalized tonic-clonic seizure (强直-阵挛性发作) — grad mal seizure (大发作)

迤拨的病因 原发性癫痫 遗传因素 继发性癫痫 一脑血管病、脑外伤、脑炎 脑肿瘤、脑寄生虫、理化因素等

7 Ø原发性癫痫 —— 遗传因素 Ø继发性癫痫 —— 脑血管病、脑外伤、脑炎、 脑肿瘤、脑寄生虫、理化 因素等 癫痫的病因

Pathogenesis of epilepsy l 正常脑细胞 seizure 异常高频放电 病灶 Electrophysiology 1. The initiation of abnormal discharge from the focal area 2. The spread of abnormal discharge to adiacent bI rain areas 1. Unbalanced function of neurotransmitters 2. Instable neuronal membrane

8 Pathogenesis of epilepsy seizure Electrophysiology 1. The initiation of abnormal discharge from the focal area 2. The spread of abnormal discharge to adjacent brain areas 1. Unbalanced function of neurotransmitters 2. Instable neuronal membrane

Pharmacological actions Electrophysiology 1. Block the initiation of abnormal discharge from the focal area 2. Prevent the spread of abnormal discharge to adjacent brain areas 正常脑细胞 异常高频放电 病灶

9 1. Block the initiation of abnormal discharge from the focal area. 2. Prevent the spread of abnormal discharge to adjacent brain areas Pharmacological actions Electrophysiology

Mechanisms of antiepilepsy drugs 1. Balance neurotransmitters(平衡递质) (1)Enhance GABAergic transmission(Cl, k+) 2)Diminish glutamate function(Ca2+, nat 2. Stabilize membrane(膜稳定作用 (1)Decrease activity of voltage-dependent Nat channels 2 Decrease activity of voltage-dependent Ca+ channels N-type(neuronal); L-type(long lasting) T-type(transient)

10 Mechanisms of antiepilepsy drugs (1) Decrease activity of voltage-dependent Na+ channels (2) Decrease activity of voltage-dependent Ca2+ channels N-type (neuronal); L-type (long lasting) T-type (transient) 1. Balance neurotransmitters(平衡递质) (1) Enhance GABAergic transmission (Cl -,K+) (2) Diminish glutamate function (Ca2+ , Na+) 2. Stabilize membrane(膜稳定作用)