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Antiepileptic drugs - pharmaceutical drugs with anticonvulsant action, used to treat epilepsy, relieve muscle cramps of various origins (epilepsy, eclampsia, intoxication, tetanus).
Antiepileptic drugs are also used to treat bipolar disorder (manic-depressive psychosis), as some of the drugs in this group are normotimics and have the ability to stabilize mood.
Many tranquilizers - benzodiazepine derivatives (diazepam, nitrazepam, clonazepam) - have an anticonvulsant effect. Moreover, clonazepam in many pharmaceutical classifications is designated primarily as an anticonvulsant.
The principle of operation common to antiepileptic drugs is to reduce the frequency of neuronal firing. Modern drugs of this group show selective inhibition of the activity of pathologically active neurons. This action is usually achieved in three main ways:
increasing the activity of inhibitory neurons, for example, by stimulating the activity of GABA receptors
inhibition of excitatory neuronal receptors, for example, by reducing the activity of NMDA receptors.
direct influence on the conduction of electrical impulses, for example, by regulating the ion channels of neurons.
The effectiveness of drug therapy for epilepsy is determined not only by the fact of confirming the diagnosis of epilepsy, but also by determining the specific form of the disease - whether it is a manifestation of hereditary or acquired pathology, whether the seizures are generalized or focal. Most of the antiepileptic drugs available today do not have a universal effect, the result depends on the selection of the drug that is most effective for this type of seizure. It should be borne in mind that the patient may have not one, but several types of seizures.
Factors that provoke seizures (alcohol, lack of sleep, etc.) are taken into account. The effectiveness of treatment increases if, in parallel with drug therapy, the influence of possible provoking factors is limited. Previously, it was traditionally necessary to have at least 2 unprovoked seizures to start treatment. It is now believed that treatment can be initiated after the first seizure if additional data (neurological status, EEG, MRI) indicate a high likelihood of a second seizure.
The choice of an antiepileptic drug depends not only on the form of the disease and the type of seizures, the patient's age, gender (reproductive age in women), concomitant diseases, the time of onset of seizures, existing medical contraindications to a particular drug, possible side effects, drug interactions are taken into account.
It is considered good practice to focus on monotherapy - the doctor seeks to achieve an effect on one drug, since polytherapy (a combination of different drugs) increases the risk of side effects. To control side effects, the increase in dosage occurs gradually, usually over 2-4 weeks, depending on the specific drug. If the first drug is not effective enough, a decision is made to gradually replace it with another drug that is effective for this type of seizure. If monotherapy with the second drug is also ineffective, a combination of the two drugs (duotherapy) is tried. Given the relatively large selection of AEDs, more than two antiepileptic drugs are considered appropriate in a very small number of cases.
In case of insufficient effectiveness of drug therapy, or the occurrence of side effects, it is often used to determine the level of the drug in the blood (pharmacomonitoring) with subsequent dosage adjustment. It is necessary to strictly follow the prescribed interval of taking the drug.
The goal of drug therapy is complete cessation (complete control) of seizures in the absence of unacceptable side effects. For this, the following rule is usually used: the absence of seizures for a period exceeding 3 times the average interictal interval before the start of therapy, but not less than a year. Even when a complete cessation of seizures is achieved, it is necessary to continue antiepileptic therapy for a long time (usually at least 3-5 years). The period during which it is necessary to continue taking medications depends on the form of epilepsy in the patient, the assessment of the likelihood of a resumption of seizures, the decision is made individually, in each case.
Unfortunately, in about 30 percent of cases, drug therapy is not effective enough. Then the epilepsy is considered pharmacoresistant (refractory) and other, non-drug methods of treatment, in particular, surgical treatment, should be considered.