tailieunhanh - EPILEPSY: GLOBAL ISSUES FOR THE PRACTICING NEUROLOGIST- part 7

Trong khi lập kế hoạch các chương trình điều trị cho những người bị động kinh ở các nước đang phát triển, điều quan trọng là để đảm bảo rằng đây là những đơn giản, chi phí-hiệu quả, và cũng có thể đưa vào tài khoản các quan điểm truyền thống và thái độ đối với bệnh động kinh | CHAPTER 6 ANTIEPILEPTIC DRUGS Most people with newly diagnosed and chronic epilepsy in the developed countries will be treated with one or another antiepileptic drug AED and followed up at regular intervals. AEDs are the mainstay in the long-term management of people with epilepsy. The usual practice of initiating treatment with AEDs in the developed countries does not necessarily apply in the developing nations especially among the people with epilepsy living in rural and far-flung areas. The neurologists responsible for treating people with epilepsy in developing countries certainly need to know about the state-of-the-art approaches to the management of individual cases of epilepsy. On the other hand it is equally important for them to be able to modify the ideal treatment schedules to suit their own socioeconomic milieu. While planning treatment programs for people with epilepsy in developing countries it is important to ensure that these are simple cost-effective and also take into account the traditional views and attitudes toward epilepsy. Further the treatment programs need to be tailored as per the regulations and resources of an individual country so that the AEDs recommended are actually available to the population with provisions that allow facilities for long-term follow-up counseling and education about the role of early treatment of people with epilepsy. This chapter reviews the important aspects of currently available conventional and new AEDs and the basic principles of choosing AEDs the most suitable AED for a specific condition with contingency solutions and examples of a few typical situations. MECHANISMS OF ACTION OF AEDs Most AEDs work through different multiple mechanisms while the exact mechanism of action of a few of the drugs is not known. Some AEDs act on sodium channels others potentiate the effect of y-aminobutiric acid GABA a naturally occurring inhibitory neurotransmitter while AEDs that are effective against absence seizures act by .