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Biological Approaches
Published in Tricia L. Chandler, Fredrick Dombrowski, Tara G. Matthews, Co-occurring Mental Illness and Substance Use Disorders, 2022
Tricia L. Chandler, Mary C. Hoke, Tara G. Matthews, Elizabeth Reyes-Fournier
Tiagabine is an anti-convulsive medication primarily used in the treatment of panic disorder. Although the exact mechanism by which Tiagabine exerts its effect on the human body is unknown, it does appear to operate as a selective GABA reuptake inhibitor, enhancing the activity of gamma aminobutyric acid (GABA), the major inhibitory neurotransmitter in the central nervous system. Tiagabine binds to recognition sites, permitting more GABA to be available for receptor binding on the surfaces of post-synaptic cells. Tiagabine has shown efficacy in modifying cocaine-using behavior and reducing opiate withdrawal symptoms, including reducing aggressive behavior (Gowin et al., 2011).
Epilepsy
Published in Hani Ts Benamer, Essential Revision Notes in Clinical Neurology, 2017
➤ Other antiepileptic drugs (AEDs) such as tiagabine, ethosuximide, piracetam and benzodiazepines (clobazam, clonazepam) are occasionally used in clinical practice. Tiagabine is used as an adjunctive treatment in patients with partial-onset epilepsy not controlled with other anticonvulsants. The only use of ethosuximide is for children with absence seizures, while piracetam is used as an adjunctive treatment in adults with refractory myoclonus. Benzodiazepines can be used in treating patients with learning difficulties and refractory epilepsy.
Neurotransmitters and pharmacology
Published in Mark J. Ashley, David A. Hovda, Traumatic Brain Injury, 2017
Ronald A. Browning, Richard W. Clough
Because the major mechanism for terminating the action of GABA following its release from nerve endings is reuptake into GABAergic neurons and glial cells, drugs that block this process will enhance and prolong the action of released GABA, just as the SSRIs do for 5-HT. Currently, tiagabine (Gabitril®) is the only GABA reuptake inhibitor available for clinical use. Tiagabine blocks the uptake of GABA in both neurons and glial cells via its selective blockade of GAT-1 rather than GAT-2 or GAT-3. This effectively prolongs the inhibitory action of synaptic GABA. Tiagabine is an antiepileptic drug used for the adjunctive treatment of complex partial seizures.
National assessment of anti-epileptic drug exposures among pre-teens and adolescents, 2000–2020
Published in Clinical Toxicology, 2022
Michael S. Toce, Joel D. Hudgins, Christopher J. Yuskaitis, Michael C. Monuteaux, Florence T. Bourgeois
The population-adjusted rate of epilepsy diagnoses remains relatively unchanged, indicating that the rise in AED exposure cases may be related to increased prescribing of AEDs for psychiatric indications as opposed to epilepsy [25]. This is consistent with known increases in the use of AEDs for psychiatric conditions [16,26,27]. AEDs have been shown to be effective in treating a variety of psychiatric conditions, including major depressive disorder, generalized anxiety disorder, and bipolar disorder [10–14]. For example, lamotrigine’s primary psychiatric indication is the treatment of bipolar disorder, which is FDA-approved for this indication in adults and supported by strong evidence for efficacy in the treatment of the depressive phase of bipolar disorder [28]. Carbamazepine has a number of well-established psychiatric uses, including for bipolar disorder, mania, post-traumatic stress disorder, and behavioral dysregulation [10,29]. Tiagabine, the AED with the highest risk of adverse outcomes in our analysis, does not have any FDA-approved psychiatric indications, but is used off-label in the treatment of anxiety [30,31]. However, in 2005, the FDA added a boxed warning to the label stating that use of tiagabine in non-epileptic patients has been associated with seizures [32].
Pharmacological treatment of focal epilepsy in adults: an evidence based approach
Published in Expert Opinion on Pharmacotherapy, 2021
LTG and LEV showed to be effective and well-tolerated representing the best choice again in adjunctive treatment [35,36]. Psychiatric side effects in predisposed patients should be considered especially for LEV [37]. The use of OXC is based on low-quality findings and safety data suggest a high risk of treatment withdrawal due to side effects [38]. LCM seems to be effective and well tolerated but not at high doses (>400 mg per day) [39]. Perampanel (PRP) seems to be effective from 4 mg but data on seizure response suggest minimum benefits from high doses (>10 mg) [40]. Data on GBP suggest a minimum effective dose of 900 mg per day with a target dose of 1800 mg [41] while for tiagabine (TGB) the optimal dose seems to be around 30 mg per day [42]. Despite meta-analyses do not seem to disfavor TGB, the association with cases of status epilepticus [43] made this drug less and less popular. There are three trials comparing pregabalin (PGB) to LTG, LEV, and GBP, showing that PGB has higher response rates than LTG (RR 1.47; 95%CI 1.03–2.12) but not higher than LEV or GBP [44].
Brain circuits and neurochemical systems in essential tremor: insights into current and future pharmacotherapeutic approaches
Published in Expert Review of Neurotherapeutics, 2018
Sara M Schaefer, Ana Vives Rodriguez, Elan D Louis
Progabide is a GABAA receptor agonist that has shown not to work in ET [62,63]. It is not clear which subunits progabide may or may not act upon, as it has not been explored in ET since the 1980s. Tiagabine is a GABA reuptake inhibitor (rather than a GABA receptor agonist) that is also ineffective for the treatment of ET [64]. Zolpidem has high affinity for α1–3 and γ subunits, like benzodiazepines, but does not act on α5 subunits as benzodiazepines do [20]. It has not been studied in ET. Baclofen, a selective GABAB receptor agonist, has shown an effect in harmaline-induced tremor in rats, but has not been studied in ET patients [65].