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Anticonvulsant Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Patients should be counseled that anticonvulsant therapy during pregnancy is associated with risks of serious birth defects. For example, with valproic acid and carbamazepine, the risk for neural tube defects, spina bifida in particular, is increased with exposure during the first trimester (Table 9.6). Risks for other congenital anomalies are increased when associated with exposure to other anticonvulsants during embryogenesis (Table 9.8). Risk for valproic acid-associated neural tube defects is increased at (1) high doses (>800 mg/day) and (2) polytherapy. Interestingly, recent analyses indicate that the risk for neural tube defects with exposure to oxcarbazepine or to lamotrigine is not different from the risk with carbamazepine (Perucca, 2005).
Nonopioid and Adjuvant Analgesic Agents
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Gabapentin and pregabalin are the two anticonvulsants commonly recommended as first-line treatment for the management of neuropathic pain (Finnerup et al, 2015). This is in part due to their well-documented efficacy but also because the incidence and severity of adverse effects is significantly less than with other anticonvulsants. These medicines have been used successfully in a wide variety of neuropathic pain conditions and have also been used in the acute pain setting.
Control of neuronal activity by electrical fields: in vitro models of epilepsy
Published in Hans O Lüders, Deep Brain Stimulation and Epilepsy, 2020
Dominique M Durand, Marom Bikson
Epilepsy is a devastating disease affecting approximately 1 per cent of the world’s population. Anticonvulsant drug therapy is an effective tool to suppress seizures but 25 per cent of the patients are either not responsive or suffer major side effects. For some patients, surgical resection is a potential treatment, but can also be associated with serious complications. Recently, electrical stimulation has proved to be an effective alternative to resection in specific cases. Over the past two decades, numerous electrical stimulation protocols have been developed using animal models of epilepsy that can reduce or completely suppress electrographic seizures. In this chapter, several methods to generate suppression of abnormal neural activity with electrical fields are discussed. The review is focused on those stimulation paradigms that have been tested in vitro in order to assess their underlying mechanisms. In particular, the anticonvulsant effects of direct cortical (DC) electrical fields, low frequency, high frequency, chaos control and desynchronization protocols are discussed. The effect of electrical fields was tested on a variety of in vitro animal epilepsy models including low calcium, high potassium, penicillin, and picrotoxin. Both the underlying mechanisms and the potential for clinical implementation are discussed.
Veratramine ameliorates pain symptoms in rats with diabetic peripheral neuropathy by inhibiting activation of the SIGMAR1-NMDAR pathway
Published in Pharmaceutical Biology, 2022
Yu Zhang, Guangyao Ye, Yuebo Chen, Chaoxu Sheng, Jianlin Wang, Lingsi Kong, Liyong Yuan, Chunyan Lin
At present, tricyclic drugs (TCA), serotonin-norepinephrine reuptake inhibitors (SNRIs), or anticonvulsants (gabapentin or pregabalin) are used as first-line drugs for DPN treatment, followed by opioids and local therapy (Spallone 2012). Although these drugs have been the subject of formal clinical trials, they do not prevent the progression of the disease, and long-term use can bring a variety of toxic side effects. For example, opioids can cause nausea, itching, dizziness, inhibition of the pituitary axis, immunological changes, and the possibility of dependence and abuse. Anticonvulsants can cause mood disorders, peripheral edema, and even seizures (Javed et al. 2015). Therefore, it is urgent to better understand the pathogenesis of DPN and develop more effective drugs to treat it.
The state-of-the-art pharmacotherapeutic options for the treatment of chronic non-cancer pain
Published in Expert Opinion on Pharmacotherapy, 2022
Ryan S. D’Souza, Brendan Langford, Rachel E. Wilson, Yeng F. Her, Justin Schappell, Jennifer S. Eller, Timothy C. Evans, Jonathan M. Hagedorn
The most commonly reported side effects of anti-convulsant agents include somnolence, dizziness, difficulty with concentration, and nausea [55]. Black box warning for serious rashes such as Steven-Johnson Syndrome (SJS) or Toxic epidermal necrolysis (TEN) have been placed for carbamazepine and lamotrigine. Even though phenytoin, levetiracetam, and gabapentin do not have a black box warning for dermatologic rash, there is a small risk for SJS/TEN [55]. Phenytoin carries a black box warning for severe hypotension and cardiac arrhythmia with its intravenous formulation [55]. Hyponatremia is a side effect unique to carbamazepine and oxcarbazepine, and warrants close monitoring with interval laboratory workup. Metabolic acidosis is associated with topiramate and zonisamide use due to its carbonic anhydrase inhibition property. Lastly, development of withdrawal symptoms is associated with discontinuation of any anti-convulsant medication [55].
Effects of Multiple Detoxifications on Withdrawal Symptoms, Psychiatric Distress and Alcohol-Craving in Patients with an Alcohol Use Disorder
Published in Behavioral Medicine, 2021
Martha Ooms, Hendrik G. Roozen, Juul H. Willering, Wobbe P. Zijlstra, Ranne de Waart, Anna E. Goudriaan
In previous studies, it has been suggested that specific pharmacological interventions may ameliorate the withdrawal pathology and counteract the kindling phenomenon. For instance, anticonvulsants may reduce withdrawal symptoms and due to their putative neuroprotective properties they may be capable of halting the underlying allostatic neuroadaptative effects and clinical symptom severity associated with multiple withdrawals.65 Several promising therapeutic agents are currently available (e.g. carbamazepine, gabapentin, topiramate) that potentially may be valuable to stop the progress of withdrawal severity and reduce post-detoxification alcohol consumption.65–69 Carbamazepine, in particular is widely used and one of the most studied agents for the treatment of alcohol withdrawal.65 A recent review demonstrated that in general the effects are inconclusive in favor of anticonvulsants treating alcohol withdrawal,69 but carbamazepine may hold promise in treating alcohol withdrawal symptoms.67 That said, it is unclear whether agents such as carbamazepine are capable of dampening, preventing or even reinstating the underlying withdrawal-relapse induced sensitization. More studies are needed to address the kindling phenomenon by examining the efficacy and tolerability of pharmacological agents in order to prevent the cumulative neuroadaptations that progressively worsen treatment outcomes.