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42-401: Trimethadione ( Tridione ) is an oxazolidinedione anticonvulsant . It is most commonly used to treat epileptic conditions that are resistant to other treatments. It is primarily effective in treating absence seizures , but can also be used in refractory temporal lobe epilepsy . It is usually administered 3 or 4 times daily, with the total daily dose ranging from 900 mg to 2.4 g. Treatment

84-479: A class of drugs with hypnotic , anxiolytic , anticonvulsive, amnestic and muscle relaxant properties. Benzodiazepines act as a central nervous system depressant. The relative strength of each of these properties in any given benzodiazepine varies greatly and influences the indications for which it is prescribed. Long-term use can be problematic due to the development of tolerance to the anticonvulsant effects and dependency . Of many drugs in this class, only

126-452: A convulsion may experience several different symptoms, such as a brief blackout, confusion, drooling, loss of bowel or bladder control, sudden shaking of the entire body, uncontrollable muscle spasms , or temporary cessation of breathing. Symptoms usually last from a few seconds to several minutes, although they can last longer. Convulsions in children are not necessarily benign, and may lead to brain damage if prolonged. In these patients,

168-673: A few are used to treat epilepsy: The following benzodiazepines are used to treat status epilepticus : Nitrazepam , temazepam , and especially nimetazepam are powerful anticonvulsant agents, however their use is rare due to an increased incidence of side effects and strong sedative and motor-impairing properties. The following are carboxamides: The following are fatty-acids: Vigabatrin and progabide are also analogs of GABA. Gabapentinoids are used in epilepsy , neuropathic pain , fibromyalgia , restless leg syndrome , opioid withdrawal and generalized anxiety disorder (GAD). Gabapentinoids block voltage-gated calcium channels , mainly

210-415: A number of widely used ones (including lamotrigine and levetiracetam) carried a low risk of adverse neurodevelopmental outcomes (cognitive and behavioral) in children when compared to children born to mothers without epilepsy and children born to mothers taking other anti-seizure medications. Data from several pregnancy registries showed that children exposed to levetiracetam or lamotrigine during pregnancy had

252-474: A person at a greater risk of developing them. Generalized seizures have been broadly classified into two categories: motor and non-motor. A generalized tonic-clonic seizure (GTCS), also known as a grand mal seizure, is a whole-body seizure that has a tonic phase followed by clonic muscle retrenchments. GTCSs can happen in people of all ages. GTCSs are very hazardous, and they increase the risk of injuries and sudden unexpected death in epilepsy (SUDEP). SUDEP

294-436: A side effect or even the actual mechanism of action for some antiepileptic drugs, since GABA can itself, directly or indirectly, act proconvulsively. Another potential target of antiepileptic drugs is the peroxisome proliferator-activated receptor alpha . Some anticonvulsants have shown antiepileptogenic effects in animal models of epilepsy. That is, they either prevent the development of epilepsy or can halt or reverse

336-478: Is a stub . You can help Misplaced Pages by expanding it . Anticonvulsant Anticonvulsants (also known as antiepileptic drugs , antiseizure drugs , or anti-seizure medications ( ASM )) are a diverse group of pharmacological agents used in the treatment of epileptic seizures . Anticonvulsants are also increasingly being used in the treatment of bipolar disorder and borderline personality disorder , since many seem to act as mood stabilizers , and for

378-581: Is a neuronal disorder with multifactorial manifestations. It is a noncontagious illness and is usually associated with sudden attacks of seizures, which are an immediate and initial anomaly in the electrical activity of the brain that disrupts part or all of the body. Various areas of the brain can be disturbed by epileptic events. Epileptic seizures can have contrary clinical features. Epileptic seizures can have long-lasting effects on cerebral blood flow . Various kinds of epileptic seizures affect 60 million people worldwide. The most common type of seizure

420-425: Is a sudden, unexpected, nontraumatic death in patients with epilepsy. Strong convulsions that are related to GTCSs can also cause falls and severe injuries. Not all generalized seizures produce convulsions. For example, in an absence seizure , also known as a petit mal seizure, the brain experiences electrical disturbances but the body remains motionless and unresponsive. A common cause of convulsions in children

462-460: Is associated with adverse neurodevelopmental outcomes (cognitive and behavioral)  in children. On the other hand, evidence is conflicting for carbamazepine regarding any increased risk of congenital physical anomalies or neurodevelopmental disorders by intrauterine exposure. Similarly, children exposed lamotrigine or phenytoin in the womb do not seem to differ in their skills compared to those who were exposed to carbamazepine. There

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504-421: Is called a generalized seizure, also known as a generalized convulsion. This is characterized by a loss of consciousness which may lead to the person collapsing. The body stiffens for about a minute and then jerks uncontrollably for the next minute. During this, the patient may fall and injure themselves or bite their tongue, their eyes roll back, and lose control of their bladder. A familial history of seizures puts

546-401: Is caused by an epileptic seizure. They are also often referred to as antiseizure drugs because they provide symptomatic treatment only and have not been demonstrated to alter the course of epilepsy. The usual method of achieving approval for a drug is to show it is effective when compared against placebo , or that it is more effective than an existing drug. In monotherapy (where only one drug

588-482: Is classified as a "conversion disorder" or Functional Neurologic Symptom Disorder characterized by alterations in behavior, motor activity, consciousness, and sensation. A few neuroimaging (functional and structural) studies suggest that PNES may replicate sensorimotor alterations, emotional regulation, cognitive control, and integration of neural circuits. There is a linkage between infantile convulsion and paroxysmal dyskinesia. Paroxysmal kinesigenic dyskinesia (PKD)

630-518: Is evidence for using gabapentin, lamotrigine, oxcarbazepine or topiramate as monotherapy . Lamotrigine can be included in the options for children with newly diagnosed absence seizures . The first anticonvulsant was bromide , suggested in 1857 by the British gynecologist Charles Locock who used it to treat women with "hysterical epilepsy" (probably catamenial epilepsy ). Bromides are effective against epilepsy, and also cause impotence , which

672-477: Is febrile seizures, a type of seizure associated with a high body temperature. This high temperature is a usual immune response to infection, and in febrile convulsions, the reason for the fever is extra-cranial (such as a body-wide viral infection). In Nigeria, malaria —which can cause sudden, high fevers—is a significant cause of convulsions among children under 5 years of age. Febrile seizures fall into two categories: simple and complex. A simple febrile seizure

714-469: Is generalized, occurs singularly, and lasts less than 15 minutes. A complex febrile seizure can be focused in an area of the body, occur more than once, and lasts for more than 15 minutes. Febrile seizures affect 2–4% of children in the United States and Western Europe, it is the most common childhood seizure. The exact reason for febrile convulsion is unidentified, though it might be the outcome of

756-582: Is inadequate evidence to determine if newborns of women with epilepsy taking anticonvulsants have a substantially increased risk of hemorrhagic disease of the newborn . There is little evidence to suggest that anticonvulsant/ASM exposure through breastmilk has clinical effects on newborns. The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study showed that most blood concentrations in breastfed infants of mothers taking carbamazepine, oxcarbazepine, valproate, levetiracetam, and topiramate were quite low, especially in relationship to

798-699: Is most effective when the concentration of its active metabolite, dimethadione, is above 700 μg/mL. Severe adverse reactions are possible, including Steven Johnson syndrome , nephrotoxicity , hepatitis , aplastic anemia , neutropenia , or agranulocytosis . More common adverse effects include drowsiness, hemeralopia , and hiccups. If administered during pregnancy, fetal trimethadione syndrome may result causing facial dysmorphism (short upturned nose, slanted eyebrows), cardiac defects, intrauterine growth restriction (IUGR), and mental retardation. The fetal loss rate while using trimethadione has been reported to be as high as 87%. This anticonvulsant -related article

840-475: Is not entirely clear. During pregnancy , the metabolism of many anticonvulsants is affected. There may be an increase in the clearance and resultant decrease in the blood concentration of lamotrigine, phenytoin, and to a lesser extent carbamazepine, and possibly decreases the level of levetiracetam and the active oxcarbazepine metabolite, the monohydroxy derivative. In animal models, several anticonvulsant drugs have been demonstrated to induce neuronal apoptosis in

882-449: Is not related to its anti-epileptic effects. Bromide also suffered from the way it affected behaviour, introducing the idea of the "epileptic personality" which was actually a result of medication. Phenobarbital was first used in 1912 for both its sedative and antiepileptic properties. By the 1930s, the development of animal models in epilepsy research led to the development of phenytoin by Tracy Putnam and H. Houston Merritt , which had

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924-435: Is taken) it is considered unethical by most to conduct a trial with placebo on a new drug of uncertain efficacy. This is because untreated epilepsy leaves the patient at significant risk of death. Therefore, almost all new epilepsy drugs are initially approved only as adjunctive (add-on) therapies. Patients whose epilepsy is uncontrolled by their medication (i.e., it is refractory to treatment) are selected to see if supplementing

966-749: The American Academy of Neurology and American Epilepsy Society , mainly based on a major article review in 2004, patients with newly diagnosed epilepsy who require treatment can be initiated on standard anticonvulsants such as carbamazepine , phenytoin , valproic acid / valproate semisodium , phenobarbital , or on the newer anticonvulsants gabapentin , lamotrigine , oxcarbazepine or topiramate . The choice of anticonvulsants depends on individual patient characteristics. Both newer and older drugs are generally equally effective in new onset epilepsy. The newer drugs tend to have fewer side effects. For newly diagnosed partial or mixed seizures , there

1008-577: The American Academy of Neurology and the American Epilepsy Society still recommend a number of these new drugs as initial monotherapy. In the following list, the dates in parentheses are the earliest approved use of the drug. Barbiturates are drugs that act as central nervous system (CNS) depressants , and by virtue of this they produce a wide spectrum of effects, from mild sedation to anesthesia . The following are classified as anticonvulsants: The benzodiazepines are

1050-476: The N-Type , and P/Q -type calcium channels. The following are gabapentinoids: Gabapentinoids are analogs of GABA, but they do not act on GABA receptors. They have analgesic, anticonvulsant, and anxiolytic effects. The following are hydantoins: The following are oxazolidinediones: The following are succinimides: The ketogenic diet and vagus nerve stimulation are alternative treatments for epilepsy without

1092-504: The GABA system, their targets include GABA A receptors , the GABA transporter type 1 , and GABA transaminase . Additional targets include voltage-gated calcium channels , SV2A , and α2δ . By blocking sodium or calcium channels, antiepileptic drugs reduce the release of excitatory glutamate , whose release is considered to be elevated in epilepsy, but also that of GABA. This is probably

1134-583: The brain. Sometimes the convulsion can be caused by genetic defects or brain tumors . Convulsions can also occur when the blood sugar is too low or there is a deficiency of vitamin B6 (pyridoxine). The pathophysiology of convulsion remains ambiguous. Convulsions are often caused by epileptic seizures, febrile seizures, non-epileptic seizures, or paroxysmal kinesigenic dyskinesia. In rare cases, it may be triggered by reactions to certain medications, such as antidepressants, stimulants, and antihistamines. Epilepsy

1176-773: The date their marketing was approved in the US, UK and France. Data for the UK and France are incomplete. The European Medicines Agency approves drugs throughout the European Union. Some of the drugs are no longer marketed. Many of the commonly used anticonvulsant/anti-seizure medications (ASMs), such as valproate, phenytoin, carbamazepine, phenobarbitol, gabapentin have been reported to cause an increased risk of birth defects including major congenital malformations such as neural tube defects. The risk of birth defects associated with taking these medications while pregnant may be dependent on

1218-445: The developing brain. Convulsion Convulsions can be caused by epilepsy , infections (including a severe form of listeriosis which is caused by eating food contaminated by Listeria Monocytogenes), brain trauma, or other medical conditions. They can also occur from an electric shock or improperly enriched air for scuba diving. The word fit is sometimes used to mean a convulsion or epileptic seizure. A person having

1260-545: The distinct advantage of treating epileptic seizures with less sedation. By the 1970s, a National Institutes of Health initiative, the Anticonvulsant Screening Program, headed by J. Kiffin Penry, served as a mechanism for drawing the interest and abilities of pharmaceutical companies in the development of new anticonvulsant medications. The following table lists anticonvulsant drugs together with

1302-517: The dose and on the timing of gestation (how well developed the baby is). While trying to conceive a child and during pregnancy, medical advice should be followed to optimize the management of the person's epilepsy in order to keep the person and the unborn baby safe from epileptic seizures and also ensure that the risk of birth defects due to in utero exposure of anticonvulsants is as low as possible. Use of anticonvulsant medications should be carefully monitored during use in pregnancy. For example, since

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1344-416: The first trimester is the most susceptible period for fetal development, planning a routine antiepileptic drug dose that is safer for the first trimester could be beneficial to prevent pregnancy complications. Valproic acid , and its derivatives such as sodium valproate and divalproex sodium , causes cognitive deficit in the child, with an increased dose causing decreased intelligence quotient and use

1386-556: The frequency of occurrence should not downplay their significance, as a worsening seizure state may reflect the damage caused by successive attacks. Symptoms may include: Most convulsions are the result of abnormal electrical activity in the brain . Often, a specific cause is not clear. Numerous conditions can cause a convulsion. Convulsions can be caused by specific chemicals in the blood, as well as infections like meningitis or encephalitis . Other possibilities include celiac disease , head trauma , stroke , or lack of oxygen to

1428-479: The interchange between environmental and genetic factors. Psychogenic non-epileptic seizures (PNES) are described as neurobehavioral conditions or "psychogenic illnesses" which occur not due to the electrical disturbances in a person's brain but due to mental and emotional stress. PNES are an important differential diagnosis and a common occurrence in epilepsy centers. According to the 5th Edison of Diagnostic and Statistical Manual of Mental Disorders (DSM 5), PNES

1470-578: The involvement of pharmaceuticals. The ketogenic diet consists of a high-fat, low-carbohydrate diet, and has shown good results in patients whose epilepsy has not responded to medications and who cannot receive surgery. The vagus nerve stimulator is a device that can be implanted into patients with epilepsy, especially that which originates from a specific part of the brain . However, both of these treatment options can cause severe adverse effects. Additionally, while seizure frequency typically decreases, they often do not stop entirely. According to guidelines by

1512-500: The lowest effective ASM dosage that will maintain their seizure control while regularly checking medication levels throughout pregnancy. Data from studies conducted on women taking antiepileptic drugs for non-epileptic reasons, including depression and bipolar disorder, show that if high doses of the drugs are taken during the first trimester of pregnancy then there is the potential of an increased risk of congenital malformations. The mechanism of how anticonvulsants cause birth defects

1554-399: The lowest risk of developing major congenital malformations compared to those exposed to other ASMs. The risk of major congenital malformations for children exposed to these ASMs were within the range for children who were not exposed to any ASMs during pregnancy. People with epilepsy can have healthy pregnancies and healthy babies. However, proper planning and care is essential to minimize

1596-461: The medication with the new drug leads to an improvement in seizure control. Any reduction in the frequency of seizures is compared against a placebo. The lack of superiority over existing treatment, combined with lacking placebo-controlled trials, means that few modern drugs have earned FDA approval as initial monotherapy. In contrast, Europe only requires equivalence to existing treatments and has approved many more. Despite their lack of FDA approval,

1638-590: The mother's level and what the fetal level would have been during pregnancy. (Note: valproic acid is NOT a recommended ASM for people with epilepsy who are considering having children.) Infant exposure to newer ASMs (cenobamate, perampanel, brivaracetam, eslicarbazepine, rufinamide, levetiracetam, topiramate, gabapentin, oxcarbazepine, lamotrigine, and vigabatrin) via breastmilk was not associated with negative neurodevelopment (such as lower IQ and autism spectrum disorder) at 36 months. Several studies that followed children exposed to ASMs during pregnancy showed that

1680-455: The progression of epilepsy. However, no drug has been shown in human trials to prevent epileptogenesis (the development of epilepsy in an individual at risk, such as after a head injury ). Many anticonvulsants can cause birth defects in the unborn child if taken while pregnant. Anticonvulsants are more accurately called antiepileptic drugs (AEDs) because not every epileptic seizure involves convulsion , and vice versa, not every convulsion

1722-484: The risk of congenital malformations or adverse neurocognitive outcomes for the fetus while maintaining seizure control for the pregnant person with epilepsy. If possible, when planning pregnancy, people with epilepsy should switch to ASMs with the lowest teratogenic risk for major congenital malformations as well as the least risk of adverse neurodevelopmental outcomes (e.g., lower IQ or autism spectrum disorder). They should also work with their healthcare providers to identify

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1764-447: The treatment of neuropathic pain . Anticonvulsants suppress the excessive rapid firing of neurons during seizures. Anticonvulsants also prevent the spread of the seizure within the brain. Conventional antiepileptic drugs may block sodium channels or enhance γ-aminobutyric acid ( GABA ) function. Several antiepileptic drugs have multiple or uncertain mechanisms of action. Next to the voltage-gated sodium channels and components of

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