Tablets from epilepsy
Epilepsy is a chronic neurological disease that affects the brain. With epileptic seizures, convulsions occur accompanied by a disconnection of consciousness.
Tablets from epilepsy can reduce the strength of impulses that irritate the nerve endings in the brain. As a consequence, epileptic activity decreases, which contributes to the normalization of its functioning.
Indications of the tablets against epilepsy
Medicines are indicated for partial seizures with simple or complex symptoms, psychomotor seizures, convulsive seizures in sleep, diffuse seizures, and mixed types of epilepsy. Also prescribed for such forms of epilepsy - akinetic, JME, submaximal, IGE.
Names of tablets from epilepsy
The most popular drugs for epilepsy are such tablets: carbamazepine, valproate, pyrimidone, clonazepam, phenobarbital, benzodiazepines, pheniton.
Finlepsin is an antiepileptic agent based on carbamazepine, which contributes to the normalization of mood, has an anti-manic effect. It is used as a basic medicine or in combination with other medications, because it can raise the anticonvulsant threshold, thereby simplifying socialization for people who suffer from epilepsy.
Carbamazepine is a derivative of dibenzoazepine. The medicine has antidiuretic, antiepileptic, neuro- and psychotropic effect. It promotes the normalization of the state of membranes of irritated neurons, suppresses serial neuronal discharges and lowers the strength of neurotransmissions of nerve impulses.
Seizar (Phenytoin, Lamotrigine)
Seizar is an anticonvulsant. Affects the Na + channels of the presynaptic membrane, reducing the force of excretion of mediators through the synaptic cleft. Primarily, this suppression of excessive isolation of glutamate - an amino acid that exerts an exciting effect. It is one of the main irritants that create epileptic discharges in the brain.
Phenobarbital has anticonvulsant, hypnotic, sedative and antispasmodic effect. It is used in combination therapy of epilepsy, combining with other medications. Basically, such combinations are selected for each patient individually, based on what is the general condition of the person, and also from the course and form of the disease. There are also ready-made combination medicines based on phenobarbital - this is paglueferal or gluferal, etc.
Clonazepam has a calming, anti-epileptic, anticonvulsant effect on the body. Since this drug anticonvulsant effect is more pronounced than other drugs in this group, it is used in the treatment of convulsive diseases. The use of clonazepam reduces the strength and frequency of epileptic seizures.
Ethosuximide is an anticonvulsant that suppresses neurotransmission into motor regions of the cerebral cortex, thereby increasing the resistance threshold for the occurrence of epileptic seizures.
Valproate sodium is used both for self-treatment and in conjunction with other antiepileptic medicines. The drug itself is effective only for small forms of the disease, but for treatment of more severe types of epilepsy, combined treatment is necessary. In such cases, such drugs as lamotrigine or phenytoin are used as additional agents.
Vigabatrin suppresses exciting impulses in the central nervous system by normalizing the activity of GABA, which is the blocker of spontaneous neuronal discharges.
In more detail, the properties of epilepsy tablets are examined using carbamazepine as an example.
The substance affects the Na + channels of the membranes of overexcited nerve endings, reducing the effects of aspartate and glutamate on them, increasing inhibitory processes, and interacting with central P1-purinergic receptors. The antimanic effect of the drug is due to the suppression of the metabolism of norepinephrine and dopamine. In generalized or partial attacks has an anticonvulsant effect. Effectively reduces aggressiveness and severe irritability in epilepsy.
Absorbs in the digestive tract almost completely, but rather slowly, because food does not affect the strength and speed of the absorption process. The maximum concentration after a one-time tablet is reached after 12 hours. A single-dose or repeated retard tablet gives a maximum concentration (25% below) after 24 hours. The retard tablets, in comparison with other dosage forms, reduce bioavailability by 15%. With blood proteins binds within 70-80%. In the saliva and cerebrospinal fluid there are accumulations that are proportional to the residues of the active component not bound to proteins (20-30%). Passes through the placenta, and also enters the breast milk. Visible volume of distribution is in the range of 0.8-1.9 l / kg. It is biologically converted in the liver (usually through the epoxide route), forming several metabolites - the 10,11-trans-diol source, as well as its compounds, including glucuronic acid, N-glucuronides and monohydroxylated derivatives. The half-life is 25-65 hours, and in case of prolonged use - 8-29 hours (due to the induction of enzymes in the metabolism process). In patients taking MOS inductors (such as phenobarbital and phenytoin), this period lasts for 8-10 hours. After a single dose of 400 mg through the kidneys, 72% of the drug taken out, and the remaining 28% are withdrawn through the intestine. In the urine, 2% of unconverted carbamazepine and 1% of the active substance (10,11-epoxy derivative) enter, and together with this about 30% of other metabolic products. In children, the elimination process is accelerated, so stronger dosages (with conversion to weight) may be needed. An anticonvulsant effect can last at least a few hours, and a maximum of several days (in some cases, 1 month). The antineviral action lasts 8-72 hours, and the anti-manic 7-10 days.
Use of the tablets against epilepsy during pregnancy
Since epilepsy is a chronic disease that requires regular medication, it is necessary to take the pill even during pregnancy.
There was an opinion that AEP could possibly have a teratogenic effect, but it is now justified that the use of these drugs as the sole source of epilepsy treatment helps to reduce the risk of inherited malformations. Studies have shown that over 10 years against the background of the use of AEP, the frequency of inherited malformations has decreased to 8.8% from the initial 24.1%. In the course of studies, monotherapy used drugs such as primidone, phenytoin, carbamazepine, phenobarbital, and valproic acid.
Tablets from epilepsy are forbidden to people suffering from addiction or alcoholism, as well as muscle weakness. In acute form of renal failure, pancreatic diseases, hypersensitivity to the drug, various types of hepatitis, hemorrhagic diathesis. Do not accept those who engage in activities that require physical activity and concentration.
Side effects of the tablets against epilepsy
Preparations for epilepsy have such side effects: vomiting with nausea, shaking and dizziness, reflexive rotation or movement of the eyes, problems with the function of blood circulation, drowsiness, suppression of vital functions of the NS, difficulty with breathing, violations of the blood pressure, disorders of the musculoskeletal system. A prolonged depression can develop, rapid fatigue, irritability is observed. Sometimes there is an allergy or a rash on the skin, which in some cases can go to the Quincke's edema. Possible insomnia, diarrhea, mental disorders, tremors, problems with eyesight, as well as headache.
Dosing and administration
Treatment should begin with the use of a small dose of the drug, which is shown in the patient's form of epilepsy and the type of attack. An increase in dosage occurs if the patient does not experience side effects, and seizures continue.
Carbamazepine (finlepsin and thymonyl, tegretol and carbasan), diphenin (phenytoin), valproates (convullex and depakin), and phenobarbital (luminal) are used to suppress partial seizures. Valproats (average daily dosage of 1000-2500 mg) and carbamazepine (600-1200 mg) are considered to be of primary importance. The dose should be divided into 2-3 uses.
Often used and retard tablets or drugs with prolonged exposure. To consume them you need 1-2 r. / Day (such drugs are tegretol-CR, depakin-chrono, as well as finlepsin-petard).
In case of an overdose, symptoms such as CNS suppression, drowsiness, disorientation in space, an agitated state, the appearance of hallucinations, coma may also occur. Hyperreflexia may also occur, which changes into hyporeflexia, blurred vision, speech problems, reflex repetitive eye movements, dysarthria, impaired motor coordination, dyskinesia, myoclonic cramps, psychomotor disorders, hypothermia, pupillary dilatation.
Possible tachycardia, fainting, lowering or increasing blood pressure, difficulty with breathing, pulmonary edema, gastrostasis, vomiting with nausea, decreased motor activity of the large intestine. There may be a delay in urination, oliguria or anuria, swelling, hyponatremia. Possible consequences of overdose may also be hyperglycemia, an increase or decrease in the number of leukocytes, glycosuria, as well as metabolic acidosis.
Interactions with other drugs
Since lamotrigine is not able to cause a serious slowdown or induction of oxidative hepatic enzymes, the effect of combining with drugs that are metabolized in the cytochrome P450 enzyme system will be low.
Metabolism of drugs that are biologically converted in the liver (microsomal oxidative enzymes are activated), is enhanced when combined with barbiturates. Therefore, the effectiveness of AED (such as acenocoumarol, warfarin, pheninion, etc.) is reduced. In this case, combined use should monitor the level of anticoagulants to adjust dosage. Also, the effect of corticosteroids, digitalis, metronidazole, chloramphenicol and doxycycline is reduced (the half-life of doxycycline is reduced and this effect is sometimes retained for 2 weeks after barbiturate withdrawal). The same effect is also on estrogens, TCAs, paracetamol and salicylates. Phenobarbital reduces the absorption of griseofulvin by lowering its level in the blood.
Unpredictable barbiturates affect the metabolism of anticonvulsants, hydantoin derivatives - the content of phenytoin may increase or decrease, so you need to monitor the plasma concentration. Valproic acid and sodium valproate increase the phenobarbital in the blood, and it in turn reduces the saturation of clonazepam with carbamazepine in plasma.
In combination with other drugs that suppress the functions of the central nervous system (hypnotics, sedatives, tranquilizers and some antihistamines), it can cause additive suppressive effects. Monoamine oxidases prolong the duration of exposure to phenobarbital (presumably because they suppress the metabolism of this substance).
Treatment of epilepsy without tablets
Tablets from epilepsy are not the only way to treat this disease. There are also alternative therapies.
One of the recipes is tincture of mistletoe on alcohol (a week insist in a dark dry place). Use for 10 days for 4 drops in the morning on an empty stomach. After this, do a 10-day break and repeat the course again. An analogue of this medicine is the adjustment of the pink radiolink to alcohol.
Another means of treatment - with the help of the "marjin root". Dig out the plant, cut off about 50 grams, wash, and pour 0.5 liters of vodka. Infuse the mixture for 3 weeks. In the dark. For use, it is necessary to dissolve the tincture in water (1 stack). Dosage: for adults 20 drops in the morning, 25 - in the afternoon, 30 - before bedtime. For children - depending on the age (if the child is 8 years old - 8 drops per stack, daily 3 rubles / day).
In some cases, you have to get rid of epilepsy surgically. This method is used if the patient has a symptomatic disease that has occurred as a result of the appearance of a brain tumor or cavernoma. Removal of pathological focus relieves the patient of seizures in 90% of cases.
Sometimes it is necessary to remove not only the tumor itself, but also a part of the cortex around the malignant formation. To increase the efficiency, the operation is performed using electrocorticography. With its help, the EEG pulses coming from the brain surface are recorded, so that it is possible to determine which areas of the cortex around the lesion are also involved in epileptogenic activity.
Indications for the operative treatment of epilepsy are such factors:
- Medicines do not give the necessary effect;
- Medications are effective, but the patient can not tolerate side effects resulting from the admission;
- The form of epilepsy, which is observed in the patient, can be cured only through surgical intervention.