SLIDE 1
DR.RAHUL ANAND YADAV MD DM(NEONATOLOGY) HOD KKCTH When to us use? - - PowerPoint PPT Presentation
DR.RAHUL ANAND YADAV MD DM(NEONATOLOGY) HOD KKCTH When to us use? - - PowerPoint PPT Presentation
DR.RAHUL ANAND YADAV MD DM(NEONATOLOGY) HOD KKCTH When to us use? Whic ich type of se seiz izur ures? es? How much(d (dose ose of d drug) g) to us use? Ho How lo long g to us use? MANDAN MISHRA SANKARACHA CHARY
SLIDE 2
SLIDE 3
When to us
use?
Whic
ich type of se seiz izur ures? es?
How much(d
(dose
- se of d
drug) g) to us use?
Ho
How lo long g to us use?
SLIDE 4
MANDAN MISHRA SANKARACHA CHARY RYA
SLIDE 5
1)Eye witness 2)Logic 3)Guidelines by authority in subject
SLIDE 6
SLIDE 7
SLIDE 8
SLIDE 9
Normal Neonatal Brain Neonatal convulsions Drug Action Conclusions
SLIDE 10
SLIDE 11
Disturbed balance
between excitatory and inhibitory neurotransmitters
Excitatory:Glutamat
e
Inhibitory:Gaba
Glutamate tamate Gaba
SLIDE 12
SLIDE 13
Subtle seizures Multi focal clonic Generalized tonic Myoclonic
SLIDE 14
- Depends upon levels of
cytosolic calcium levels.
- When cytosolic calcium levels
are high, signal to noise ratio is altered resulting in seizures.
- Levetiracetam inhibits the
release and influx of calcium into cytosol thereby reducing the signal to noise ratio
- Synaptotagmin is a calcium
sensor for exocytosis in pre synaptic vesicle leading to excitatory NT release into synaptic junction.
- SV2A regulates the activity of
synaptotagmin leading to inhibition of calcium mediated exocytosis.
- Levetiracetam acts as an
agonist of synaptic vesicle protein 2A
Signal
al to noise ratio
SV2A
2A agonist ist
SLIDE 15
SLIDE 16
SLIDE 17
Can be used in neonates Do not use in subtle and generalized tonic
seizures
“Use in Myocloni
- nic seizur
ures, es, especi cial ally ly stimulus ulus sen ensi siti tive ve thalamocort mocortical ical myoclonus
- nus”
SLIDE 18
“DOES NOT EXIST”
SLIDE 19
When to use? Which type of seizure to use? How much to use? How long to use?
SLIDE 20
DIAZEPAM
Status Epilepticu s LEVETIRACET AM
4 hours NOT REDUCED
EPILEPSY RISK
SLIDE 21
LEVETIRACETAM PHENOBARBITONE
Respiratory depressant
action absent
Myocardial depressant
action absent
Metabolic demand:? Multifocal clonic
seizure:use unknown
Myocloni
clonic: c:more more useful ul
Drug
g interac acti tions
- ns
ab absent ent
Respiratory depressant
action present
Myocardial depressant
action present
Metabolic
demand:Decreased
Multifocal clonic
seizure:useful
Myocl
clonic
- nic: less useful
Drug interact
ractions ions present ent
SLIDE 22
LEV EVETIR ETIRAC ACETA ETAM VALPR LPROAT OATE
Liver dysfunction
absent
In instances where
there is increased levels of ammonia,it is safe
Pharmacoresistance
not seen(MDR protein)
Liver dysfunction
present
In instances where
there is increased levels of ammonia,it is unsafe
Pharmacoresistance
seen
SLIDE 23
- Loading dose :40mg/kg(some units start
with 20mg/kg)
- 1cc=100mg…
- “Accidental overdose reported but non fatal!”
- Maintainance dose
< 7 days-10mg/kg q8h > 7 days-20mg/kg q12h
- Can use higher doses in exceptional
circumstances
SLIDE 24
SLIDE 25
Dentate gyrus is a part of Hippocampus Involved in episodic memory formation and
exploration of new environment
LEV ,on prolonged use has potential side
effects due to effect on dentate gyrus
Manifestations include
Hyperactivity,psychosis ,tremors
SLIDE 26
Routinely don’t use Can be used in stimulus sensitive myoclonic
convulsions
Higher doses tolerated better Stop as soon as primary etiology is better