Epilepsy carbamazepine

Phenobarbitone was the first AED and was introduced in 1912. It was largely replaced in 1932 by phenytoin for the management of tonic-xilonic seizures and partial and secondary epilepsy. Carbamazepine followed, then ethosuximide for absence seizures and valproic acid. These remained, apart from the introduction of the benzodiazepines, the mainstay of therapy until the last decade. They were introduced solely on their ability to control experimentally induced seizures. Their mechanisms of action were unknown and no thought was given to the possibility of NT modification and in fact subsequent research has shown that with the exception of the benzodiazepines none of them work primarily through NT manipulation. They act directly on neuronal excitability. 

Carbamazepine is an effective agent for the treatment of partial seizures and generalized tonic-clonic seizures its use is contraindicated in absence epilepsy. Carbamazepine is also useful in the treatment of trigeminal neuralgia and is an effective agent for the treatment of bipolar disorders (see Chapter 33). 

In 10 children with rolandic epilepsy, carbamazepine impaired memory and possibly visual search tasks (122). Evaluation of individual data suggested that some children were especially vulnerable to the adverse effects of carbamazepine on cognition. The authors did not comment on the fact that rolandic epilepsy is regarded as a syndrome for which treatment in most cases is not indicated. 

Levy, R. H. et ah, Pharmacokinetic interactions of chronic drug treatment in epilepsy carbamazepine, in The Effects of Disease State on Drug Pharmacokinetics, Benet,... 

Mr. Parks, age 32 years, has recently received a diagnosis of epilepsy. He has been taking the anticonvulsant carbamazepine, but his seizures are not yet under control. Mr. Parks asks you how long it will take to cure his epilepsy. Determine how you would respond to Mr. Parks. 

Epilepsy is a clinical disorder characterized by spontaneous, recurrent seizures arising from excessive electrical activity in certain parts of the brain [51]. Currently available drugs, such as phenytoin, carbamazepine, valproic acid, lamotrigine, and topiramate (for molecular structures see Fig. 6), provide symptomatic seizure suppression in only 60-70% of those receiving treatment [52-54]. These drugs are also associated with unwanted side... 

Carbamazepine therapy is initiated at 200-400 mg/day in two divided doses, and the typical daily dose is often in the 1000-2000 mg/day range. There are no established plasma levels for carbamazepine specifically established for BEAD, so the levels used in monitoring the drug in the treatment of epilepsy (i.e., 4-12 ig/mL) are typically used. 

Epilepsy, monotherapy Indicated for conversion to monotherapy in adults with partial seizures who are receiving treatment with carbamazepine, phenytoin, phenobarbital, primidone, or valproate as the single antiepileptic drug (AED). 

Carbamazepine is a tricyclic iminostilbene derivative and structurally related to the tricyclic antidepressants. It is used as a first-line agent for the management of generalized tonic-clonic epilepsy. It is also highly effective for partial seizures but has no efficacy in patients with absence seizures or atonic seizures. In epilepsy it supposedly has the same mechanism of action as phenytoin. An other well... 

At present, phenobarbital and primidone are considered as alternative drugs for the treatment of partial seizures and for generalized tonic-clonic epilepsy. They are judged to be less effective than carbamazepine and phenytoin. 

Rowan AJ, Ramsay RE, Collins JF, et. al. New onset geriatric epilepsy a randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology 2005 64 1868-1873. 

Brodie MI, Overstall PW, Giorgi L, The UK Lamotrigine Elderly Study Group. Multicentre, double-blind, randomized comparison between lamotrigine and carbamazepine in elderly patients with newly diagnosed epilepsy. Epilepsy Res 1999 37 81-87. 

Carbamazepine has been shown to be better tolerated as long-term monotherapy than DVP in children with epilepsy or febrile convulsions (Herranz et ah, 1988). Nevertheless, a comparison of the adverse effect profile in the Kowatch sample (Kowatch et ah, 2000) shows that nausea (46%), rash (8%), and dizziness (8%) were more prevalent in youngsters taking CBZ, compared to children on DVP, who experienced overall less nausea (20%), rash (0%), and dizziness (0%). 

Evans, O.B., Gay, H., Swisher, A., and Parks, B. (1989) Hematologic monitoring in children with epilepsy treated with carbamazepine. / Child Neurol 4 286-290. 

Mattson, R.H., Ctamer, J.A., and Collins, J.F. (1992) A comparison of valproate with carbamazepine for the treatment of complex partial seizures and secondarily generalized tonic-clonic seizures in adults. The Department of Veterans Affairs Epilepsy Cooperative Study No. 264 Group [see comments]. N Engl J Med 327 765-771. 

Rattya, J., Vainionpaa, L., Knip, M., Panning, P., and Isojarvi, J.I. (1999) The effects of valproate, carbamazepine, and oxcarbaze-pine on growth and sexual maturation in girls with epilepsy. Pediatrics 103 588-593. 

Semah, F, Gimenez, F, Longer, E., Laplane, D., Thuillier, A., and Baulac, M., (1994) Carbamazepine and its epoxide an open study of efficacy and side effects aftet catbamazepine dose incte-ment in refractory partial epilepsy. Ther Drug Monit 16 537-340. 

Steardo L, Barone P, Hunnicutt E Carbamazepine lowering effect on CSF somatostatin-like immunoreactivity in temporal lobe epilepsy. Acta Neurol Scand 74 140-144, 1986... 

Weiss SRB, Post RM, Sohn E, et al Cross tolerance between carbamazepine and valproate on amygdala-kindled seizures. Epilepsy Res 16 37-44, 1993 Weiss SRB, Clark M, Rosen JB, et al Contingent tolerance to the anticonvulsant effects of carbamazepine relationship to loss of endogenous adaptive mechanisms. Brain Res Brain Res Rev 20 305-325, 1995 Weissman MM Panic disorder impact on the quality of life. J Clin Psychiatry 52 [suppl) 6-8, 1991... 

Carbamazepine is effective in both acute and prophylactic treatment of mania (Weisler et al. 2005). An extended-release formulation of carbamazepine, available since 1997 for treatment of epilepsy, was approved in 2004 under the brand name Equetro. Extended-release preparations are preferred because simplified dosage schedules facilitate patient adherence. Other extended-release carbamazepine preparations include Tegretol XR and Carbatrol, although neither has been specifically indicated for the treatment of bipolar disorder. The longer-acting preparations are also of benefit because they tend to have fewer gastrointestinal side effects. 

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