Prophylaxis anticonvulsants

The normal body temperature is 36.8°C. Babies under 6 months of age who have a higher temperature than 37.7°C should be referred on the same day. Babies over 6 months should be referred if their temperature is above 38.2°C. Babies who have had a temperature-related convulsion lasting 15 minutes or longer should receive pharmacotherapy in the form of either lorazepam, diazepam or clonazepam. Febrile convulsions in children usually cease spontaneously within 5-10 minutes and are rarely associated with significant sequelae and therefore long-term anticonvulsant prophylaxis is rarely indicated. Parents should be advised to seek professional advice when the child develops fever so as to prevent the occurrence of high body temperatures. 

Lamotngine (Lamictal). Lamotrigine, another anticonvulsant used to treat BPAD, is currently FDA approved for the prevention of both depressive and manic episodes during BPAD maintenance therapy. This represents a shift in the paradigms for BPAD therapy, as medications used to treat acute episodes have also typically been used for antimanic prophylaxis. Lamotrigine is not effective in the acute treatment of mania but has become for many the drug of choice for bipolar depression as well as for prevention of subsequent mood episodes of either polarity. 

Valproate, carbamazepine, and other anticonvulsants pose teratogenic risks. Despite this, treatment should continue during pregnancy, as the potential threat to the fetus by a seizure is greater However, it is mandatory to administer the lowest dose affording safe and effective prophylaxis. Concurrent high-dose administration of folate may... 

Two commonly used anticonvulsant medications for the treatment and prophylaxis of bipolar mood disorder in adults with MR are carbamazepine and valproic acid. Reid et al. (1981) compared carbamazepine to placebo in a double-blind, crossover fashion in 12 overactive adults with severe MR. Those described as having elevated moods and distractibility responded to treatment, while those without mood disturbance did not. Glue (1989) treated 10 adults with MR and rapidcycling bipolar mood disorder with lithium alone, lithium and carbamazepine, and carbamazepine alone. None of the patients treated with carbamazepine alone responded, while half of the patients showed partial or complete improvement with lithium alone or in combination with carbamazepine. 

Belelh D, Lan N, Gee KW Anticonvulsant steroids and the GABA/benzodiazepine receptor-chloride ionophore complex. Neurosci Biobehav Rev 14 315-322, 1990 Bellaire W, Demisch K, Stoll K-D Carbamazepine vs. lithium. Application in the prophylaxis of recurrent affective and schizoaffective psychoses. Muenchener Medizinische Wochenschrift 132 S82-S86, 1990 Belmaker RH Receptors, adenylate cyclase, depression, and lithium. Biol Psychiatry 16 333-350, 1981... 

Several controlled trials have shown that lithium is efficacious in the maintenance treatment of bipolar disorder, with higher serum levels (0.8 1 mol/1) being more indicative of successful prophylaxis (Keck and McElroy. 2002). Valproic acid also appears to have efficacy in maintenance therapy, specifically in bipolar patients with mixed mania and rapid cycling (Bowden et al., 1995). The results concerning carbamazepine s efficacy as a maintenance medication are controversial (Stuppaeck et al., 1994). Other potential agents with some evidence of good maintenance value include clozapine and olanzapine. A combination of lithium and carbamazepine or other anticonvulsants is recommended under certain conditions if an adequate preventive effect cannot be obtained with the substances individually (Bauer et al., 2002). 

It is a anticonvulsant drug and depresses the ventricular automaticity and accelerates the AV conduction. It also reduces the duration of action potential like quinidine. It also shortens the QT interval. It mainly blocks inactivated Na+ channels. It is used for the suppression of ectopic beats and for prophylaxis of recurrent paroxysmal tachycardia and also for the treatment of rapid supraventricular or ventricular tachycardia. 

Propranolol, amitriptyline, and some calcium channel blockers have been found to be effective for the prophylaxis of migraine in some patients. They are of no value in the treatment of acute migraine. The anticonvulsants valproic acid and topiramate (see Chapter 24) have... 

Anticonvulsant, mood stabilizer, migraine prophylaxis, voltage-sensitive sodium channel modulator... 

Lithium salts are ineffective for prophylaxis of bipolar affective disorder in around 35% of patients and cause several unwanted effects. The search for alternatives has produced drugs that are more familiar as anticonvulsants, notably carbamazepine and sodium valproate, and possibly lamotrigine. 

Lithium and valproate are the mainstays of treatment for both acute mania and prophylaxis for recurrent manic and depressive episodes. Anticonvulsants such as lamotrigine, carbamazepine, and oxcarbazepine and atypical antipsy-chotics such as aripizrazole, olanzapine, risperidone, queti-... 

Lamotrigine seems to be more effective than iithium in such cases, especially taking into consideration the proven greater efficacy of iamotrigine in the treatment of bipolar depression.Carhamazepine, an anticonvulsant with known mood-stabilizing capacity, also seems to be superior to lithium in schizoaffective disorder, depressed type, and it may also be used in subsequent prophylaxis. 

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