Used to Treat Epilepsy

Even in the absence of drug therapy, individual seizures are usually self-limiting. Brain neurons are unable to sustain a high level of synaptic activity for more than a few minutes, and the seizure ends spontaneously. However, the uncontrolled recurrence of seizures is believed to cause further damage to the already injured neurons, and can be potentially harmful to healthy cells.15,36 In particular, seizures can cause structural and functional changes in neuronal pathways, resulting in impaired cerebral activity and increased susceptibility to additional seizures.22,36 

Certain types of seizures will also be harmful if the patient loses consciousness or goes into convulsions and injures himself or herself during a fall. Certain types of convulsions are potentially fatal if cardiac irregularities result and the individual goes into cardiac arrest. Even relatively minor seizures may be embarrassing to a person, and social interaction may be compromised if the individual is afraid of having a seizure in public. Consequendy, a strong effort is made to find an effective way to control or eliminate the incidence of seizures. 

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Phenobarbitone A barbiturate sedative-hypnotic used to treat epilepsy. It is a potent inducer (stimulator) of cytochrome P-450 activity. 

The EEG effects of valerian are most concordant with those of tiagabine, a GABA uptake inhibitor used to treat epilepsy. Tiagabine also increases slow-wave sleep, but unlike valerian has little or no effect on REM (Lancel et al. 1998). GABAA agonists also tend to have this effect. 

Barbiturates. The hrst barbiturate, barbital, was introduced in 1903 and was followed a few years later by phenobarbital. The barbiturates effectively relieve anxiety, but they are never used as anxiolytics today due to toxicity and abuse concerns. However, several barbiturates, including phenobarbital (Luminal), secobarbital (Seconal), and pentobarbital (Nembutal), remain available and are occasionally used to treat epilepsy and rarely to manage acute alcohol withdrawal. 

Benzodiazepines have a wide array of clinical uses. In addition to relieving anxiety, they can be used to treat epilepsy, alcohol withdrawal, insomnia, agitation, and perhaps impulsivity. They can also be used as muscle relaxants or to produce conscious sedation during certain medical procedures such as cardiac catheterization and colonoscopy. 

In addition to treating insomnia, gabapentin has been used to treat epilepsy, anxiety disorders, and bipolar disorder. It is generally well tolerated with sedation and headaches being the only prominent side effects. Because gabapentin is excreted unchanged in urine, it does not require metabolism by the liver. It is therefore easily eliminated by elderly patients and those with liver disease, although it should be used with caution in those with poor renal (kidney) function. 

Phenobarbitone is used to treat epilepsy, migraine headache, dental infections, pregnancy vomiting, tetanus, enuresis, chorea, pre and post operative sedation, hypertension, anxiety states, neurosis, and in the treatment of drug and alcohol addiction. This drug is also called phenobarbital. 

Topiramate is used to treat epilepsy in both children and adults. In children it is also indicated for... 

The discovery of benzodiazepines is a story of serendipity and certainly one that is difficult to predictably reproduce as part of a drug discovery program. Regrettably (or fortuitously), this story of the benzodiazepines is not an isolated example. Valproic acid, an agent used to treat epilepsy, migraine, chronic pain, and bipolar affective disorder, was also discovered by accident. 

Benzodiazepines used to treat epilepsy include diazepam, clonazepam, clobazam and lorazepam. Of these, diazepam and lorazepam have been most widely used to control status epilepticus, while use of clonazepam is usually restricted to the chronic treatment of severe mixed types of seizures (e.g. Lennox-Gastaut syndrome and infantile spasm). The major problem with most of the benzodiazepines, with the possible exception of clobazam, is sedation. 

Divalproex sodium (Depakote ) is used to treat epilepsy and inhibits the firing of nerve cells. This medication appears to be a promising treatment for migraines, although its precise mechanism of action is unknown. 

Chinese medicine, a dried powder consisting of 1 radish 99 peppercorns is used to treat epilepsy. The effectiveness of the prescription may be due to the anticonvulsant actions of the principal component of pepper, the alkaloid piperine. 

Anticonvulsant Several of the benzodiazepines have anticonvulsant activity and are used to treat epilepsy and other seizure disorders. 

Chapter 15 Update Drugs Used to Treat Epilepsy... 

Drug products with a narrow therapeutic range, such as drugs used to treat epilepsy, asthma, high blood pressure, and heart disease... 

Talampanol (LY300164) is a drug used to treat epilepsy and neurodegen-erative diseases. In an optimized procedure, the first step in its production is enzymatic in nature (Figure 10.4). Zygosaccharomyces rouxii is used to perform a biocatalytic reduction and excellent yields and enantioselectivities have been... 

Jones AL, Proudfoot AT. Features and management of poisoning with modem dmgs used to treat epilepsy. QJM 1998 91(5) 325-32. 

Hartogiella schinoides (Celastraceae) leaves are reported to have similar stimulant activity to C. edulis when chewed (86). Leaves are chewed in southern Africa to relieve thirst, prevent fatigue and are reported to cause weight loss due to lack of appetite (61). Other members of the Celastraceae with psychoactive uses are Maytenus senegalensis and M. heterophylla which are used to treat epilepsy in Zimbabwe and East Africa respectively (87,88), however little is know about their chemistry. 

Another barbiturate (phenobarbitone (Luminal)) and a newer drug lamotrigine (Lamictal) are used to treat epilepsy. Trazodone (Molipaxin) is a useful anti-depressant with fewer side-effects than some of the older drugs. The action of varenicline (Champix), used to treat smoking withdrawal, has a straightforward mechanism, being a nicotinic partial agonist. 

Diazepam (brand name Valium) A benzodiazepine used to treat anxiety, which may act as a sedative. It provides short-term relief for mild to moderate anxiety and is used to treat epilepsy and alcohol withdrawal symptoms. 

Carbamazepine and valproate can be effective in bipolar depression that is unresponsive to lithium and appear to exert their action by depressing the limbic system. Both these drugs are normally used to treat epilepsy, see page 218. In bipolar depression, this is an unlicensed use. 

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