Anticonvulsant drugs appeared only 100 years ago. In recent decades, scientists and manufacturers have been discovering new compounds and launching new drugs on the market. How to make the right choice?
Cramps are involuntary muscle contractions. They can also occur in healthy people after overloading certain muscles, for example, in athletes, violinists, with hypothermia in water. When falling asleep and during sleep, convulsive involuntary twitching is not uncommon. But also convulsions of various types can be symptoms of epilepsy.
Epilepsy
Epileptic seizures that occur two or more times without any apparent cause can be considered epilepsy. An epileptic seizure is an abnormal or excessive discharge of neurons in the brain with visible manifestations. Visible manifestations are not always convulsions and loss of consciousness, it can be:
- Only changes in consciousness;
- Mental manifestations;
- Motor changes;
- Vegetative manifestations.
For a particular person, these symptoms can be in the form of ringing in the ears, flashes of light or flame, redness of the face, short-term speech disorders, memory, and many others. It depends on the place where the nerve impulse broke out of control and activated a particular area of the brain. Moreover, these changes may be the first to be noticed by another person, and not by the patient himself. This may be the case, for example, with episodes of fading for a few seconds. If these symptoms have a clear cause, a head injury, a brain tumor, it is not an epilepsy.
There are many forms of epilepsy, depending on the type of epileptic seizures, types of epilepsy and epileptic status (an epiprime lasting more than 30 minutes at a time or a series of seizures without full recovery of consciousness).
Convulsions
You might think that seizures occur only in epilepsy. Therefore, when they appear, anticonvulsants are necessarily needed. In addition to epilepsy, there may be many other conditions that have nothing to do with it, but which can be accompanied by convulsions:
Diseases of the blood vessels of the brain, the age of more than 75 years and hemorrhagic strokes often cause the onset of acute symptomatic convulsive attacks.
- Traumatic brain injuries.
- Infectious diseases of the central nervous system (meningitis, encephalitis, HIV infection).
- Oxygen starvation of the brain.
- Intoxication of the body.
- Taking medications.
- Acute metabolic disorders, for example, hypoglycemia in the treatment of diabetes mellitus, electrolyte balance disorders.
- Withdrawal syndrome when you stop drinking alcohol.
- Taking large doses of alcohol.
- Taking psychotropic drugs (psychotropic stimulants-cocaine, crack, “ecstasy”).
- The temperature above 38.5°C in children under 7 years can give febrile seizures.
- Liver failure.
- Parkinson’s disease.
- Therefore, self-administration of anticonvulsants without a doctor’s prescription is prohibited. First, you need to determine the cause of the problem and only then treat it.
Approaches to taking anticonvulsant medications
If earlier the main goal of therapy for epilepsy and taking anticonvulsant drugs was to prevent new attacks, today an integrated approach takes the first place, taking into account the quality of life of the patient, maintaining his performance against the background of treatment
Selecting an effective therapy can be difficult. This is influenced by factors such as compliance with the medication regimen, side effects. Changing drugs by trade name, but with the same active substance, can also lead to an aggravation of problems.
Usually, at the beginning of treatment for epilepsy, one drug is used, but the dosage and medication may change. If the desired result is not achieved, only then connect the second tool and use different combinations.
Anticonvulsant medications
For the treatment of epilepsy, 3 main mechanisms are used:
Stabilization of the membrane potential of nerve cells by affecting the ion channels. Due to this, the K+ ions remain in the cell, and the Na+ ions remain outside. The effect can also be carried out through Ca2+channels. This keeps the” rest ” on the membrane of the nerve cells.
Suppression of the processes involved in arousal.
Strengthening of braking mechanisms.
Many drugs act on several mechanisms at once and it will not be possible to divide them into groups on this basis.
Medicines:
Depakin Chronosphere, Convulex, Encorat chrono. Preparations of valproic acid. They have a muscle relaxant effect and enhance inhibitory processes in the brain. The absorption of the drug may slow down when taken with food. Side effects include: weight gain, hair loss, problems with the gastrointestinal tract, tremor.
Finlepsin retard, Tegretol CR, Carbatol. They belong to carbamazepine preparations, are used for large convulsive seizures and mixed forms of epilepsy. Contraindications absentee and myoclonic seizures. Side effects: dizziness, drowsiness, headache, but discontinuation of the drug is more often caused by a skin rash.
Phenobarbital, Benzonal, Maysolin. They belong to the group of barbiturates. They can be used for all types of epilepsy attacks. It is often used in infants. Pronounced slowing of mental processes. Children have a reverse reaction and develop hyperreactivity. They reduce motor activity, can cause drowsiness. The anticonvulsant effect is realized by preventing the occurrence and propagation of the impulse from the focus of activity. An absentee form of idiopathic epilepsy will be a contraindication to taking it.
Frisium, Relanium, Merlith. They belong to the group of benzodiazepines. Especially often used in progressive myoclonic epilepsy. But over time, the effect may decrease and addiction may develop.
Lamiktal, Pamolen. The active substance is lamotrigine. It is effective for all types of seizures, but it is recommended to avoid myoclonia. The main side effect is a rash, the severity of which increases sharply when combined with valproates and carbamazepine.
Topamax (topiramate). It acts on different mechanisms in preventing seizures, and is effective in adults and children. Start taking with minimal doses and slowly increase. It is used with caution in children with speech disorders, as well as with sleep problems. One of the side effects is weight loss, so it should not be used in “thin” patients.
Keppra – the active substance is levetiracetam. Optimal action in epileptic myoclonia, does not interact with other drugs. It should not be used in patients prone to agitation and sleep disorders.
Suxilep. Previously, it was the drug of choice in the treatment of absentee seizures, now it has given way to valproic acid. Contraindicated in mental problems. Side effects: headache, drowsiness, gastrointestinal symptoms.
Tebantin, Neurontin, Gabapentin. Structurally similar to GABA, they are not transformed in the liver, so they can be used with many other drugs and in liver diseases. Side effects: weakness, dizziness, weight gain.
Since the treatment of epilepsy in many cases involves lifelong use of drugs, the ratio of their effectiveness and toxicity is important. The pathways of drug metabolism (in the liver), interaction with other drugs in concomitant diseases also play a role. The selection of anticonvulsant therapy is a joint work of the doctor and the patient.