Neurological effects carbamazepine

Monitor for acute and chronic adverse effects of AEDs. Acute adverse effects are best detected by a thorough neurologic examination at clinic visits. Instruct patients to report sedation, ataxia, rash, or other problems immediately. Monitor for chronic adverse effects including a loss of bone mineral density, which should be measured every 2 years in patients taking phenytoin, phenobarbital, carbamazepine, and valproate. 

Rattya J, Turkka J, Pakarinen AJ, Knip M, Kotila MA, Lukkarinen O, Myllyla VV, Isojarvi JI. Reproductive effects of valproate, carbamazepine, and oxcarbazepine in men with epilepsy. Neurology 2001 56(l) 31-6. 

Larson AW, Wasserstrom WR, Felsher BF, Chih JC. Posttraumatic epilepsy and acute intermittent porphyria effects of phenytoin, carbamazepine, and clonazepam. Neurology 1978 28(8) 824-8. 

Carbamazepine is considered a relatively safe antiepileptic drag that is subject to dose-related neurologic toxicities (e.g., drowsiness, vertigo, loss of coordination) in adults and children (80). Since a major route of elimination of carbamazepine is via epoxidation catalyzed by CYP3A4 (81), there are several reports and studies that demonstrate CNS toxic effects of carbamazepine in individuals who also take CYP3A4 inhibitors (82). 

In a 6-week open study of risperidone (mean dosage 4.7 mg/day) in combination with mood-stabilizing treatments (usually lithium, carbamazepine, or valproate) for the treatment of schizoaffective disorder in 102 patients, 95 of whom completed the trial, at week 4 most patients had improved symptom severity and 9.3% were completely symptom-free (35). There were no statistically significant differences between baseline and week 4 in the severity of extrapyramidal symptoms, as measured by the UKU Side-Effect Rating Scale subscale for neurological adverse effects other adverse effects included depressive symptoms (n = 13), exacerbation of mania ( n = 5), drowsiness (n = 3), and impotence (n = 2). 

Meador KJ, Loring DW, Ray PG, Murro AM, King DW, Perrine KR, Vazquez BR, Kiolbasa T. Differential cognitive and behavioral effects of carbamazepine and lamotrigine. Neurology 2001 56(9) 1177-82. 

Therefore, coma, seizures, and apnea may be seen at lower serum levels than in adults. Other manifestations of neurologic toxicity are nystagmus, ataxia, choreoathetoid movements, encephalopathy, absent corneal reflexes, decreased deep tendon reflexes, urinary retention, and dystonias. A cyclic clinical course can be seen, with a waxing and waning of symptoms. This may be due to the presence of a pharmacobezor in the gut or more commonly due to a decrease in gastrointestinal motility produced by the prominent anticholinergic effects of carbamazepine. 

Because antipsychotic therapy has shown only modest efficacy and poses a substantial risk of undesirable side effects, medications traditionally used to treat disruptive behaviors and aggression in other psychiatric and neurologic disorders have been suggested as potential alternatives. These alternatives include benzodiazepines, buspirone, carbamazepine, selegiline, and SSRls. 

A study in epileptic patients found the antiepileptic effects of carbamazepine were enhanced by concurrent Saiko-ka-ryukotsu-borei-to patients experienced fewer seizures and improved neurological symptoms. ... 

Levine M, Jones MW, Sheppard I. Differential effect of cimetidine on serum concentrations of carbamazepine andphenytoin. Neurology (1985) 35, 562-5. 

Gratz ES, Theodore WH, Newmark ME, Kupferberg HJ, Porter RJ, Qu Z. Effect of carbamazepine on phenytoin clearance in patients with complex partial seizures. Neurology (1982)32,A223. 

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