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Jerath NU, Lamichhane D, Jasti M, Yarlagadda V, Zilli E, Nazzal Y, Granner M. Treating epilepsy in the setting of medical comorbidities. Curr Treat Options Neurol 2014; 16:298. [PMID: 24861129 DOI: 10.1007/s11940-014-0298-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OPINION STATEMENT Treatment of epilepsy in patients with medical comorbidities can be challenging. Comorbidities can affect medical management and quality of life. In this review, we discuss treatment options in patients with epilepsy and medical comorbidities. In our opinion, the best way to manage patients with medical comorbidities and epilepsy is to accurately recognize and diagnose medical comorbidities, and to have adequate knowledge and familiarity with antiepileptic drug (AED) metabolism, dosing, side effects, and drug interactions. We believe the trend should move toward using the newer generation of AEDs given their generally reduced rate of adverse effects and interactions. The primary goal of therapy is seizure freedom without side effects.
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Affiliation(s)
- Nivedita U Jerath
- Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA,
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Korabathina K, Benbadis SR. Levetiracetam is as effective as carbamazepine in newly diagnosed epilepsy. Expert Rev Neurother 2014; 7:599-601. [PMID: 17563243 DOI: 10.1586/14737175.7.6.599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evaluation of: Brodie MJ, Perucca E, Ryvlin P, Ben-Menachem E, Meencke HJ. Comparison of levetiracetam and controlled-release carbamazepine in newly diagnosed epilepsy. Neurology 6, 402-408 (2007). Despite the emergence of multiple antiepileptic drugs (AEDs) in the past decade, the task of choosing the right drug for monotherapy in patients with newly diagnosed epilepsy remains a precarious task. This is especially true when trying to choose a new AED over a more traditional agent. Much of this uncertainty stems from the fact that there are only a handful of studies that are able to demonstrate efficacy of a new drug over an older AED. While the newer drugs appear more favorable because of better tolerability, safety profiles and simple pharmacokinetics, many do not have an indication for monotherapy. Of course, this is further contingent upon the stringent limitations placed by regulatory bodies, such as the US FDA, who govern approval of AEDs for monotherapy. The current randomized study attempts to evaluate the efficacy of levetiracetam in monotherapy compared with controlled-release carbamazepine, a gold standard in patients with newly diagnosed epilepsy.
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Affiliation(s)
- Kalyani Korabathina
- University of South Florida and Tampa General Hospital, Department of Neurology, Tampa, FL 33612, USA.
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do Couto LL, dos Anjos LC, Araujo MDAF, Mourão CA, Schwartz CA, Ferreira LB, Mortari MR. Anticonvulsant and anxiolytic activity of the peptide fraction isolated from the venom of the social wasp Polybia paulista. Pharmacogn Mag 2012; 8:292-9. [PMID: 24082633 PMCID: PMC3785167 DOI: 10.4103/0973-1296.103657] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 11/21/2011] [Accepted: 11/22/2012] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Arthropod venoms have attracted interest because they represent a source of neuroactive compounds that can be useful tools in neuroscience and pharmacological investigations. OBJECTIVE The purpose of the present work was to evaluate the anticonvulsant, anxiolytic, and behavioral effects of the peptide fraction separated from venom of the social wasp. MATERIALS AND METHODS The low- molecular-weight compounds of the venom were separated by ultrafiltration and the bioassays were performed to test anticonvulsant and anxiolytic effects, as well as alterations in the spontaneous behavior of the animals. RESULTS Intracerebroventricular injections of the compounds induced dose-dependent anticonvulsant effects and a potent anxiolytic activity. Regarding behavioral effects, no significant differences were observed in relation to the saline control group. CONCLUSION The low-molecular-weight compounds of the venom of Polybia paulista include neuroactive peptides that can be used as pharmacological resources for anticonvulsant and anxiolytic drug research.
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Affiliation(s)
- Lucianna Lopes do Couto
- Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - Lilian Carneiro dos Anjos
- Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | | | - Cecília Alves Mourão
- Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - Carlos Aberto Schwartz
- Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | | | - Márcia Renata Mortari
- Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
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Snead OC, Donner EJ. A new generation of anticonvulsants for the treatment of epilepsy in children. Paediatr Child Health 2011; 12:741-4. [PMID: 19030458 DOI: 10.1093/pch/12.9.741] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2007] [Indexed: 11/14/2022] Open
Abstract
Over the past 12 years, a number of new anticonvulsant drugs have been introduced for the treatment of childhood epilepsy. The present article reviews these new agents and provides the considerations one should use in selecting an antiepileptic drug for use in children. While in some cases the newer antiepileptic drugs have a more favourable pharmacokinetic and toxicity profile than the older drugs, there appears to be no objective evidence that any currently available antiepileptic drug is superior in terms of therapeutic efficacy.
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Affiliation(s)
- O Carter Snead
- Division of Neurology and Program in Neurosciences & Mental Health, The Hospital for Sick Children, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
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Elevated endogenous GABA concentration attenuates glutamate-glutamine cycling between neurons and astroglia. J Neural Transm (Vienna) 2009; 116:291-300. [PMID: 19184333 DOI: 10.1007/s00702-009-0186-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 01/13/2009] [Indexed: 10/21/2022]
Abstract
In this study, the relationship between endogenous brain GABA concentration and glutamate-glutamine cycling flux (V (cyc)) was investigated using in vivo (1)H and (1)H{(13)C} magnetic resonance spectroscopy techniques. Graded elevations of brain GABA levels were induced in rat brain after administration of the highly specific GABA-transaminase inhibitor vigabatrin (gamma-vinyl-GABA). The glial-specific substrate [2-(13)C]acetate and (1)H{(13)C} magnetic resonance spectroscopy were used to measure V (cyc) at different GABA levels. Significantly reduced V (cyc) was found in rats pretreated with vigabatrin. The reduction in group mean V (cyc) over the range of GABA concentrations investigated in this study (1.0 +/- 0.3-5.1 +/- 0.5 micromol/g) was found to be nonlinear: Delta V (cyc)/V (cyc) = [GABA (micromol/g)](-0.35 )- 1.0 (r (2) = 0.98). The results demonstrate that V (cyc) is modulated by endogenous GABA levels, and that glutamatergic and GABAergic interactions can be studied in vivo using noninvasive magnetic resonance spectroscopy techniques.
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Abstract
INTRODUCTION: Renal and hepatic diseases cause seizures and patients with epilepsy may suffer from such diseases which change antiepileptic drugs (AEDs) metabolism. OBJECTIVES: To revise how seizures may be caused by metabolic disturbances due to renal or hepatic diseases, by their treatment or by comorbidities and how AEDs choice might be influenced by these conditions. RESULTS: Seizures arise in renal failure due to toxins accumulation and to complications like sepsis, hemorrhage, malignant hypertension, pH and hydroelectrolytic disturbances. Hemodialysis leads to acute dysequilibrium syndrome and to dementia. Peritoneal dialysis may cause hyperosmolar non-ketotic coma. Post-renal transplant immunosupression is neurotoxic and cause posterior leukoencephalopathy, cerebral lymphoma and infections. Some antibiotics decrease convulsive thresholds, risking status epilepticus. Most commonly used AEDs in uremia are benzodiazepines, ethosuximide, phenytoin and phenobarbital. When treating epilepsy in renal failure, the choice of AED remains linked to seizure type, but doses should be adjusted especially in the case of hydrosoluble, low-molecular-weight, low-protein-bound, low apparent distribution volume AEDs. Hepatic failure leads to encephalopathy and seizures treated by ammonium levels and intestinal bacterial activity reductions, reversal of cerebral edema and intracranial hypertension. Phenytoin and benzodiazepines are usually ineffective. Seizures caused by post-hepatic immunosupression can be treated by phenytoin or levetiracetam. Seizures in Wilson's disease may result from D-penicillamine dependent piridoxine deficiency. Porphyria seizures may be treated with gabapentin, oxcarbazepine and levetiracetam. Hepatic disease changes AEDs pharmacokinetics and needs doses readjustments. Little liver-metabolized AEDs as gabapentin, oxcarbazepine and levetiracetam are theoretically more adequate. CONCLUSIONS: Efficient seizures treatment in renal and hepatic diseases requires adequate diagnosis of these disturbances and their comorbidities besides good knowledge on AEDs metabolism, their pharmacokinetic changes in such diseases, careful use of concomitant medications and AEDs serum levels monitoring.
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Mortari MR, Cunha AOS, Ferreira LB, dos Santos WF. Neurotoxins from invertebrates as anticonvulsants: From basic research to therapeutic application. Pharmacol Ther 2007; 114:171-83. [PMID: 17399793 DOI: 10.1016/j.pharmthera.2007.01.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 01/19/2007] [Accepted: 01/19/2007] [Indexed: 12/21/2022]
Abstract
Invertebrate venoms have attracted considerable interest as a potential source of bioactive substances, especially neurotoxins. These molecules have proved to be extremely useful tools for the understanding of synaptic transmission events, and they have contributed to the design of novel drugs for the treatment of neurological disorders and pain. In this context, as epilepsy involves neuronal substrates, which are sites of action of many neurotoxins; venoms may be particularly useful for antiepileptic drug (AED) research. Epilepsy is a chronic disease whose treatment consists of controlling seizures with antiepileptics that very often induce strong undesirable side effects that may limit treatment. Here, we review the vast, but yet unexplored, world of neurotoxins from invertebrates used as probes in pharmacological screening for novel and less toxic antiepileptics. We briefly review (1) the molecular basis of epilepsy, as well as the sites of action of commonly used anticonvulsants (we bring a comprehensive review of the elements from invertebrate venoms which are mostly studied in neuroscience research and may be useful for drug development); (2) peptides from conus snails; (3) peptides and polyamine toxins from spiders and wasps; and (4) peptides from scorpions.
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Affiliation(s)
- Márcia Renata Mortari
- Neurobiology and Venoms Laboratory, Department of Biology, School of Philosophy, Sciences and Literature, University of São Paulo Ribeirão Preto, Brazil
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Abstract
In the last 12 years, 10 new anticonvulsants have been approved by the U.S. Food and Drug Administration and, as a result, the treatment options for children and adults with epilepsy have been expanded considerably. These new generation antiepileptic drugs offer equal efficacy with improved tolerability, pharmacokinetic properties, and side effect profiles compared with the traditional drugs. With many new medications available, the clinician treating children with epilepsy must be well versed in the application of these drugs to their patient population. This manuscript will review the indications, mechanism of action, pharmacokinetics, adverse effects, and dosing of the new generation of anticonvulsant medications.
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Affiliation(s)
- Elizabeth J Donner
- Division of Neurology and Program in Brain and Behavior, Hospital for Sick Children, Department of Pediatrics, Faculty of Medicine, University of Toronto, MSG 1X8 Toronto, Ontario, Canada.
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Affiliation(s)
- Elizabeth J Donner
- Division of Neurology and Program in Brain and Behavior, Hospital for Sick Children, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Affiliation(s)
- Olga Flomin
- School of Medicine, Wayne State University, Detroit, MI 48201, USA
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Prpic I, Vlahovic-Palcevski V, Skarpa-Prpic I, Palcevski G, Boban M. Analysis of antiepileptic drugs use at a university hospital in Croatia. Eur J Neurol 2005; 12:483-5. [PMID: 15885055 DOI: 10.1111/j.1468-1331.2005.00994.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To analyse the consumption rate of new generation antiepileptic drugs (AEDs) compared with traditional AEDs at a university hospital in Croatia. Antiepileptic drugs use was analysed retrospectively for two consecutive years, 2001 and 2002 at Departments of Neurology, Paediatrics, Psychiatry and Neurosurgery at the University Hospital Centre (UHC) Rijeka. The results obtained are expressed as number of defined daily doses (DDDs) per 100 bed days, as proposed by the WHO. The use of new generation AEDs was represented by 2% in 2001 and 5% in 2002. Majority of AEDs administered was taken by the barbiturates in both years. A wide spectrum of AEDs has been used at the Department of Paediatrics. At the Department of Neurology and Psychiatry use of barbiturates and carbamazepine predominated. The use of new AEDs at UHC has increased during the investigation period but it is still rather low compared with traditional AEDs. The similarity of our results with the result of the leading Croatian university hospitals might represent general routine AED prescription in country. Nationally based guidelines may bring more appropriate and rational approach for usage of modern AED. This task should be supported and promoted by international and national neurology associations.
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Affiliation(s)
- I Prpic
- Department of Paediatrics, University Hospital Centre Rijeka, Rijeka, Croatia.
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Abstract
During the past 20 years in pharmacology, a number of innovations have appeared that have resulted in significant changes in the drugs available for people with traumatic brain injury. Among the anticonvulsants, antidepressants, and antipsychotics, new drugs have appeared with fewer cognitive side effects. In these classes of drugs, as well as among central nervous system stimulants, once-daily or other sustained-release preparations have been introduced that make it considerably more likely that the patient will take his or her medication, with smaller fluctuations in drug levels as well. New drugs have also resulted in a greater number of medications for the clinician to choose from. The overall effect has been a dramatic change in pharmacology that has benefited people with traumatic brain injury.
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Affiliation(s)
- Mel B Glenn
- Outpatient and Community Brain Injury Rehabilitation Programs, Harvard Medical School, Boston, MA 02114, USA.
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Abstract
Neonatal seizures are difficult to detect, diagnose, and manage. Infants with a history of seizures often have long-term neurologic sequelae. Controversy exists as to whether neonatal seizures themselves cause damage to the developing brain, and thus, subsequent sequelae; or if these sequelae are due primarily to the underlying cause of the seizures. Treatment of seizures involves identifying and treating the underlying etiology of the seizure and appropriate use of pharmacologic interventions. To provide the context for pharmacological management of seizures in newborns, this article examines the pathophysiology and etiology of seizures and discusses pharmacological agents and issues, short- and long-term outcomes, clinical implications, and directions for future research. Understanding pharmacological issues within this context provides a comprehensive foundation for decision making and management of neonatal seizures.
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Affiliation(s)
- Sheri L P Granelli
- Phoenix Perinatal Associates, Neonatal Division, A Division of Pediatrix Medical Group, Phoenix, AZ, USA.
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Raffo E. Traitements au long cours des épilepsies de l’enfant. Rev Neurol (Paris) 2004. [DOI: 10.1016/s0035-3787(04)71208-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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