Which anticonvulsant drugs have fewer side effects? Anticonvulsants for children. Basics of anticonvulsant therapy

Let's consider the mechanism of action of anticonvulsants, a list of drugs for epilepsy, neuralgia accompanied by seizures, indications and contraindications for use, side effects medicines.

Classification of antiepileptic drugs

The purpose of anticonvulsants is to eliminate muscle spasms (convulsions), prevent, and relieve an epileptic attack. This is a large group of pharmacological agents that differ in their chemical structure, mechanism of action. Treatment with these medications is carried out until complete recovery or for life ( genetic diseases, chronicity of acute forms).

Based on their chemical composition they are divided into:

• Barbiturates are derivatives of barbituric acid, tablets that depress the central nervous system (for example, Phenobarbital).
• Valproates - contain valproic acid or its salts, stop an attack of epilepsy, migraine (for example, the drug Acediprol).
• Derivatives of hydantoin (imidazolidine) - heterocyclic compounds as a result of double condensation of glycolic acid and urea, stop seizures, are similar in structure to antidepressants (for example, Diphenin tablets).
• Iminostilbenes - have a local effect on the spread of electrical potential along neurons, gently relieve seizures, recommended even for children (for example, the drug Carbamazepine);
• Oxazolidinedione derivatives are rarely used today for the treatment of epilepsy with minor paroxysms, neuralgia trigeminal nerve(for example, Trimethine).
• Succinimides are salts of succinic acid for the treatment of minor forms of epilepsy (for example, the drug Ethosuximide).
• Muscle relaxants - reduce tone and spasms of skeletal muscles, reducing motor activity (for example, Mydocalm).
• Benzodiazepines are universal psychoactive substances that exhibit sedative, anti-anxiety, muscle relaxant, and anticonvulsant effects (for example, the drug Clonazepam).

According to the mechanism of action, all anticonvulsants are divided into:

• Sodium channel blockers: cause modification of ionic currents (correct the conduction of impulses), prolong the inactivation of sodium channels, do not act on open and closed channels, can cause nystagmus, ataxia, demonstrating an anticonvulsant effect (for example, the drug Diphenin).
• Calcium channel blockers: the point of application is the thalamocortical pathway, where the drugs block calcium channels, thereby inhibiting the activity of the emerging pathological focus, at the same time they normalize the heart rhythm, stop seizures, minus - they inhibit hematopoiesis, negatively affect the kidneys (for example, ethosuximide).
• GABA activators: stimulate the processes of GABA synthesis (gamma aminobutyric acid, the most important inhibitory neurotransmitter of the central nervous system), which exhibits anticonvulsant properties (for example, Acediprol).
• Glutamate and aspartate inhibitors: inhibit the transmission of nerve impulses in the chain at the site of these amino acids, relieving seizures (for example, Lamotrigine).
• Combined action: influence amino acid transmission in both ways, plus demonstrate an antispastic, anticonvulsant effect (for example, Felbamate).

This classification is important when developing an optimal treatment regimen for epilepsy or seizures of other etiologies.

Drugs of choice

Prescribing anticonvulsants is the prerogative of the doctor; they are all sold in pharmacies only by prescription, even ordering online will not change the situation. The courier is obliged to ask for the recipe upon delivery, otherwise the legislation of the Russian Federation will be violated.

The most effective and popular anticonvulsants include:

• Phenobarbital is the reference drug of the group. It has a great effect on the central nervous system, but can cause shortness of breath and increased blood pressure. Not compatible with alcohol. Contraindicated for pregnant women.
• Finlepsin - blocks sodium channels, demonstrates the properties of an analgesic, antidepressant, relieves seizures when the trigeminal and glossopharyngeal nerves are damaged.
• Pregabalin - calms, the drug is used as a background or in combination with other anti-seizure drugs.
• Clonazepam – stops myoclonic, involuntary spasms by relaxing the muscles. Provokes discomfort when moving, apathy. The tablets are not compatible with alcohol. Contraindicated during pregnancy, lactation, and renal failure.
• Phenytoin - a drug indicated for epilepsy, is able to inhibit the excitability of nerve receptors, stabilizing cell membranes, can provoke vertigo and nystagmus, but always exhibits anticonvulsant properties.
• Primidone – relieves psychomotor seizures. The tablets locally relieve spasms in the affected area.
• Beclamid - indicated for generalized convulsive attacks, relieves spasticity. The drug is allergic.
• Carbamazepine is effective for prolonged attacks of seizures, improves the mood of patients because it calms the central nervous system, but at the same time causes drowsiness. The tablets are not prescribed to pregnant women.
• Lamotrigine - the medicine stabilizes brain neurons, prolongs remission between epileptic attacks until they stop completely. Reduces concentration and attention. Can cause excitement, therefore it is not used in the elderly and childhood. Contraindicated in case of impaired liver or kidney function.
• Valparin is a drug that relieves muscle spasms in epilepsy.
• Voltaren - capable of stopping seizures resulting from neurological disorders in the spine.
• Ketonal - relieves convulsive syndrome provoked by pain of different localization.
• Benzobamil is minimally toxic, so the drug is used even in children; it gently soothes the central nervous system. Causes nystagmus and is contraindicated in pregnant women.
• Sodium valproate is useful for severe seizures. The drug blocks the generation of electrical impulses in the brain, exhibiting an anticonvulsant effect, and is not recommended for pregnant women, patients with endocrine pathologies, or impaired liver function.
• Keppra is a modern medicine for epilepsy.
• Xanax is a psychotropic, relieves leg cramps, fear, and has a hypnotic effect.
• Actinerval is an antidepressant, eliminates anxiety and convulsions.

Use in childhood

The main requirement for anticonvulsant (antiepileptic) drugs in children is the ability to gently but significantly reduce the excitability of the central nervous system. Unfortunately, almost all remedies have serious negative effects: depress breathing, increase blood pressure, irritate the intestines. In this regard, according to the level of danger, drugs are divided into two groups:

• maximally depressing the respiratory center: for example, tablets of Chloralhydrate, barbiturates, Magnesium sulfate;
• minimally affecting respiratory function: for example, drugs Lidocaine, Droperidol, Sodium hydroxybutyrate.

The main medications of different groups are presented in the table:

Drug name	Properties
Phenobarbital	The drug of choice, acts gently and for a long time (up to two days), relieves seizures, enhances the effect of parallel use of Sibazon
Seduxen, Diazepam, Sibazon	The tablets act quickly, when administered parenterally after 5 minutes, they depress breathing only when a high concentration in the blood is reached, the antidote is Physostigmine
Droperidol, Pentazocine	The medications work effectively at the trigger point of the convulsive syndrome, but contain morphine, which can cause respiratory arrest in newborns; the antidote is Nalorphine
Lidocaine	The drug almost instantly stops seizures of any etiology when administered intravenously; it is usually used as a premedication, and then as a drip.
Hexenal	A powerful anticonvulsant, but the medicine depresses the respiratory center and is used in children very limitedly, only for health reasons

Indications and contraindications

Anticonvulsants are prescribed by a doctor in accordance with the cause of the pathology, this may be:

• epilepsy of various origins and severity;
• spasms of the lower and upper extremities;
• osteochondrosis;
• flat feet;
• dehydration;
• muscle strain during sports or heavy physical activity;
• alcoholism;
• Parkinson's or Addison's disease;
• liver cirrhosis;
• diseases of peripheral nerves and blood vessels;
• tumor growth;
• diabetes.

In addition, the lack of regular physical activity over time leads to a set of extra pounds, muscle atrophy, and cramps.

General contraindications to taking anticonvulsants are:

• individual intolerance to components;
• pregnancy, lactation;
• age restrictions in accordance with the instructions for use of the product (old people and children);
• dysfunction of the liver, kidneys;
• hypertension or hypotension;
• mental disorders.

Since there are a lot of antiepileptic and anticonvulsant drugs today, they all belong to different pharmacological groups, you should focus on contraindications by carefully studying the instructions for each specific drug.

Side effects

Anticonvulsants when taken are dangerous due to negative manifestations:

• development of anemia;
• feeling of constant drowsiness;
• hypotension;
• allergization (sensitization) of the body;
• hormonal imbalance.

Diphenine should be especially noted; the drug causes gum hyperplasia.

Last update: October 26, 2019

Updated: 10.10.2019 14:57:59

Expert: Boris Kaganovich

*Review of the best sites according to the editors. About the selection criteria. This material is subjective in nature, does not constitute advertising and does not serve as a purchase guide. Before purchasing, consultation with a specialist is required.

You don't need a medical degree to understand what seizures are. Each of us had them all. A cramp is a painful, unpredictable, and involuntary contraction of skeletal muscles. But it happens that the muscle only trembles slightly. For example, the eye, or rather the eyelid, may twitch spontaneously. This is not a spasm, but a fasciculation, that is, not a synchronous involuntary contraction of the entire muscle, but a trembling of individual fibers that are innervated by the small motor branch. This can be disturbing and annoying, but more often than not, it is not related to the topic of the article.

What are cramps?

Here is an example of true but localized seizures. Elderly people, as well as patients with heart failure and edema, often take diuretics. Furosemide, or Lasix, which has a pronounced diuretic effect, is very well known and effective. But at the same time, it has an important drawback: it removes potassium from the body along with the liquid. Therefore, if you take it in a large dose, and at the same time do not compensate for the future loss of potassium through (Panangin or Asparkam tablets), you can achieve a state of hypokalemia, in which the concentration of potassium in the blood plasma decreases. A characteristic symptom of hypokalemia after taking diuretics will be cramps, most often at night, and most often in the calf muscles. This is the most common reason convulsions from unauthorized overdose of diuretics.

A physiological spasm can also occur when swimming in cold water, based on the tonic contraction reflex - an order for intense work in conditions of vascular spasm and lack of nutrients.

To these examples we can add a number of other reasons that are familiar to doctors. This:

1. meningitis, or inflammatory disease of the meninges;
2. encephalitis, inflammation of the brain substance;
3. febrile convulsions in children, which are safe, but which parents are very afraid of;
4. tonic convulsions during tetanus, which are so strong that bones even break.

But in this material we will talk about completely different convulsions, and about other medications - not about Panangin, and not about anesthesia, which stop opisthotonus (spread convulsions) in tetanus. They help with those cramps that are born not in the muscle itself or in a group of muscles, but in the cerebral cortex. Simultaneous synchronous discharge of motor or sensory neurons, a focal or general “flash” leads to the emergence of either a convulsive syndrome in all its diversity, or non-convulsive equivalents (sensitive aura, vegetative). This disease is called epilepsy, or falling sickness. But there is also an episyndrome. What is this, and what is its difference?

Epilepsy or episyndrome?

In addition to epilepsy, which is considered a primary disease with completely unclear causes, convulsive syndrome (episyndrome) can also be provoked by other pathologies, for example, a brain tumor, or a tumor of the meninges, which periodically compresses and irritates the cerebral cortex. This condition, in which there is a clear cause of irritation of the cortex, is not called epilepsy, but episyndrome. Episyndrome is considered a secondary phenomenon, and it is important to find this cause in time. Quite often, this syndrome occurs as a consequence of severe traumatic brain injury, as a consequence of purulent encephalitis and meningitis, and in other conditions. If, despite all the persistent searches for the cause, they have not been successful, and the patient has periodically obvious symptoms of seizures, or their equivalents, then a diagnosis of epilepsy is made.

The role of EEG in the diagnosis of epilepsy

To diagnose epilepsy and episyndrome, besides the obvious clinic, there is only one, but very accurate way instrumental diagnostics, which is used in different versions. This is a recording of an EEG, or electroencephalogram, which captures the biocurrents of brain neurons. If the encephalogram contains special, pathological rhythms, for example peak-wave complexes, then the patient has increased convulsive readiness and epileptic activity. Such a person will not be given permission to drive a car, he cannot serve in the armed forces, he will not be a pilot, since at any moment this convulsive readiness recorded on the encephalogram can manifest itself as a real seizure. There are also non-convulsive equivalents, which also need to be treated.

Anticonvulsants exist for the treatment of epilepsy and seizures caused by focal discharges in various areas of the cerebral cortex. Another name for them is antiepileptic drugs, AEDs.

You should not think that long-term and sometimes life-long treatment with an established diagnosis of epilepsy with these drugs is intended only to prevent the appearance of convulsive syndrome, although this is also very important. Taking antiepileptic drugs helps prevent the development of characteristic personality changes called epileptoid psychopathy. She is characterized by rancor, excessive pathological thoroughness, scrupulousness, suspiciousness, the absurd contrast of the use of diminutive nouns in everyday life (“knife”, “bed”) in combination with cruelty.

Epilepsy is a fairly commonly diagnosed disease and is a social problem in developed countries. Thus, in the USA, about 1% of the population has various diagnoses related to this disease, and more often than not epilepsy is diagnosed only by stroke. There are about 50 million patients in the world, and the incidence rate in Russia is on average 7 cases per 2000 population, or 1 case per 285 people. This is quite a lot, and PEPs are in demand. Before considering anticonvulsants and their effect on the body, a little history of the treatment of epilepsy.

From the history of treatment of epilepsy

Perhaps the present, scientific epilepsy began in the middle of the 19th century. Before this, patients were isolated, lived in monasteries, and were considered holy fools or prophets of truth. True, sometimes they tried to treat them with craniotomy, which more often ended in death.

The first successful drug that was actually effective was potassium bromide, and bromine compounds began to be used as sedatives and anti-convulsants. The reason for the prescription of bromine drugs was one of the false theories, which believed that epilepsy occurs due to excessive sexual desire, and the patient must be reassured. With bromine they simply “guessed”, just like with other agents. For about 50 years, epilepsy was treated with bromine drugs, but they do not have true anticonvulsant activity and only inhibit the functions of the central nervous system.

But with the beginning of the 20th century, the first drug with true anticonvulsant activity from the group of barbiturates, called phenobarbital, was discovered. For many decades it has been used to treat various forms of epilepsy, and is still used today, although with serious limitations. Surprisingly, phenobarbital is the only over-the-counter drug from the group of barbiturates in Russia, which can be purchased completely freely, although not in its pure form. It is part of the usual Valocordin or Corvalol, along with mint oil, hop oil, ethyl bromizovalerate and ethyl alcohol, providing a sedative and hypnotic effect.

Then discoveries rained down as if from a cornucopia. In the thirties, phenytoin was discovered, in the late sixties - carbamazepine, which is still considered the “gold standard” in the treatment of epilepsy. Then, from the eighties and nineties, 2nd and 3rd generation antiepileptic drugs began to be used in treatment regimens. This article discusses the most famous tools belonging to the first and second generations - in an accessible and popular language.

All drugs for the treatment of epilepsy must prevent the spontaneous development of a general impulse that affects the entire neuron. To do this, it is necessary to reduce the activity of neurons, that is, to reduce the action potential, and the ability nerve cell receive from other neurons and transmit excitation. This is achieved through various mechanisms. First, first generation antiepileptic drugs will be considered, and then more modern ones. For each drug, synonyms and commercial names registered in the Russian Federation will be given. A range will be given for the drugs retail prices, relevant for pharmacies of all forms of ownership on the territory of the Russian Federation for September 2019.

Review of modern drugs for seizures (anti-epileptic drugs, AEDs)

First generation AED

Surprisingly, all the antiepileptic activity of first-generation drugs was discovered as a result of random studies. There were no targeted searches or modifications of already known drugs in search of higher activity. Phenobarbital, phenytoin, valproate, ethosuximide and other drugs were found by chance. Let's consider those of them that still help patients, even with severe forms of epilepsy, and in some cases they are still preferred by epileptologists even to the newest drugs.

Carbamazepine (Finlepsin, Tegretol)

Carbamazepine is perhaps the most widely used antiepileptic drug. Probably, all other drugs account for less sales than carbamazepine alone.

And that's because it pharmachologic effect- not only an anticonvulsant, but also an analgesic. He takes pictures very well special kind pain, neuropathic pain. This pain develops by a mechanism similar to the burst of neuronal activity during an epileptic seizure. This pain occurs after herpetic neuralgia, with trigeminal neuralgia, and is characterized by a very rapid, paroxysmal course, the attack is similar to an electric shock, and has an unpleasant, burning tinge.

In addition, Carbamazepine is used in psychiatry as a mood stabilizer and antimanic drug. Carbamazepine acts by blocking sodium channels and thereby inhibiting the action potential of neurons. This leads to an increase in the reduced seizure threshold, and reduces the risk of developing a seizure. Carbamazepine is indicated for simple, partial seizures, as well as for generalized conditions, which are called major tonic-clonic seizures.

When used in children, it is effective in reducing depression and anxiety and reducing the potential for irritability and aggression. Carbamazepine is also prescribed in the treatment of chronic alcoholism, to relieve alcohol withdrawal syndrome, symptoms such as increased excitability and tremor.

There is also Carbamazepine in a prolonged form, which lasts longer, for example Finlepsin Retard. The merit of this form is that the concentration of the substance in the blood plasma is more constant and stable, and less susceptible to fluctuations. This improves the anticonvulsant effect. The introduction of a prolonged form led to the possibility of using Carbamazepine only once a day.

Carbamazepine is annually included in the list of vitally important drugs (VEDs), and is inexpensive. Thus, Finlepsin in a dosage of 200 mg No. 50 costs from 200 to 270 rubles, and the domestic INN-generic Carbamazepine produced by Obolenskoye can be purchased even for 60 rubles. Of course, there is a suspicion that it will not perform as well as well-known brands.

Advantages and disadvantages

The advantage of Carbamazepine can be considered its breadth of action; it is used for various forms of epilepsy, and not only for it. It is cheap, prescribed without any problems for a long period, but has some limitations. It should not be used in case of severe anemia and a decrease in leukocytes in the blood, with cardiac arrhythmias (atrioventricular block), in case of increased sensitivity to tricyclic antidepressants, of which it is a representative.

Caution must be exercised in case of heart failure, and especially in combination with chronic alcoholism, in case of increased secretion of antidiuretic hormone and adrenal insufficiency, as well as in glaucoma. Particular attention should be paid to pregnant women who should use carbamazepine in minimal dosages. Another disadvantage is the need to take the drug quite often (except for the retardated form), up to three times a day. Carbamazepine also causes various side effects, most often drowsiness, dizziness, loss of appetite and other disorders. Therefore, the patient must be observed by a doctor after starting treatment. There are also symptoms of overdose, and special cases of interaction with other drugs, but they are all known and well studied.

Valproic acid (Depakine-chrono, Konvulex)

This first-generation drug is widely known in our country under the name Depakine-chrono, which is produced by the company Sanofi, or Konvulex, by the Austrian company Valeant. This medicine is two or even three times more expensive than Carbamazepine. Depakine 500 mg No. 30 costs from 220 to 650 rubles, and Convulex has approximately the same cost.

The active ingredient of Convulex is valproic acid, so experts call these drugs valproates - soluble salts of this acid. They are used in hospitals and on an outpatient basis, available in tablets, syrup, and even in ampoules for intravenous use.

The drug, in addition to its anticonvulsant effect, relaxes muscles, acting as a central muscle relaxant (Mydocalm, Sirdalud), and produces a sedative effect. It increases the concentration of the inhibitory neurotransmitter, gamma-aminobutyric acid, because it blocks the work of the enzyme that destroys this neurotransmitter.

Valproic acid is indicated for fairly severe disorders, such as status epilepticus, when it is administered intravenously. Medicines are also used for grand or generalized seizures in adults and children, which can occur differently. Convulex is also used to treat specific syndromes that cause severe epilepsy in children, for example Lennox-Gastaut syndrome or West syndrome. The drug is used to treat febrile childhood seizures, as well as to treat manic-depressive psychosis in psychiatry, which is now called bipolar affective disorder. The drug should be used in the dosages and according to the regimen prescribed by the doctor; any self-medication is excluded.

Advantages and disadvantages

The drug is available in a variety of dosage forms, and can be used in pediatrics, psychiatric practice, and in the management of emergency conditions. Another advantage of valproate is that the drug is effective for all forms of seizures and all types of epilepsy, so you can start treating any form of epilepsy with it, and valproic acid will be the drug of choice, or the first line.

The drug is available, is still not very expensive, but has a number of contraindications. First of all, these are severe dysfunction of the liver and pancreas, hepatitis and pancreatitis, a decrease in platelets in the blood plasma, as well as pregnancy and breastfeeding. Valproate is prescribed with great caution to children, especially under the age of three, and also if the child is taking several antiepileptic drugs at once. A combination of drugs is always less predictable than monotherapy.

The advantage of Konvulex and Depakine can be considered to be fairly good tolerability, and a low number of side effects, which depend on the dose. If there are any adverse reactions, they are most often nausea, a feeling of fatigue, spots flashing before the eyes, anemia, or changes in body weight, both upward and downward. In the patient's tests, the level of bilirubin, the concentration of liver transaminases and nitrogen may increase.

The simultaneous administration of valproate and carbamazepine should not be combined in one patient, since Convulex together with carbamazepine contributes to an easier overdose of the latter. You should not combine Konvulex with phenobarbital, antipsychotics, antidepressants and some antibiotics from the carbapenem group.

It is strictly forbidden to take alcohol during treatment with valproate, as is the case with other medications, because taking ethyl alcohol facilitates the occurrence of epileptic seizures. The combination of ethanol and valproate intake leads to an increased toxic effect on the liver.

Ethosuximide (Suxilep)

This drug from the group of first-generation antiepileptic drugs can be considered, of course, the most expensive. A bottle of capsules, however, in the amount of 100 pieces, will cost about 3,000 rubles; it is rarely found in pharmacies, and may even be in short supply. If we talk about the average, optimal daily dose, then this is 15 mg per kg of weight in adults. Therefore, a person who weighs 80 kg will need 5 such tablets per day, which means that a package for 3,000 rubles will end after 20 days of taking it. The cost of a monthly course will be approximately 4,500 rubles.

Why is Suxilep used? First of all, for the treatment of small epileptic seizures. Its niche is special petit mal seizures with a myoclonic component, impulsive juvenile petit mal seizures, as well as special forms of absence seizures. This “narrow specialization” allowed Suksilep to be a leader in a “narrow niche”, in demand, despite its relatively high cost. As in any other case, the antiepileptic drug Suxilep begins to be used with dose titration, gradually increasing it by one tablet every 5 days until seizures are reduced or disappear completely. You can increase the drug, but only to the limit - up to a dosage of no more than 6 tablets per day.

Advantages and disadvantages

Suxilep is usually well tolerated, and contraindications include severe functional impairment internal organs: liver and kidneys. The medicine is contraindicated in pregnant and lactating women, and the side effects of this drug are approximately the same as those of carbamazepine. Naturally, the biggest disadvantage of the drug is its high price and it is not always available in pharmacies. But still, given its unique effect on special forms of epilepsy, we have to put up with these shortcomings - after all, there are no competitors yet. The drug is produced only imported: by the French company Delpharm Lille, or by the German companies Jena Pharm and Mibe Arzneimittel.

Phenobarbital is a really cheap drug and should have been the starting point for a review of seizure medications. One package of 10 tablets, 100 mg each, sells for only 23 rubles. The federal enterprise, the Moscow Endocrine Plant, has a virtual monopoly on the production of phenobarbital. In addition to this dosage, it is available in tablets of 50 mg and 5 mg.

The official instructions for phenobarbital state that it is not only an antiepileptic, but also a hypnotic drug. Like all barbiturates, it interacts with the special structure of gamma-aminobutyric acid, and reduces excitability cell membranes neurons. Phenobarbital causes drowsiness, hypnotic effect and sedation in large dosages. That is why it is included in Corvalol.

Phenobarbital has another important property that is not related to epilepsy. It treats jaundice, but only that jaundice that is associated with hemolytic disease of the newborn, and is not a consequence of viral and alcoholic hepatitis, or cirrhosis of the liver. In addition to epilepsy and convulsive syndrome in newborns, the medicine is indicated for spastic paralysis, agitation, sleep disorders, if special, expensive modern drugs are not available.

It is for this reason, to “plug holes,” that Corvalol is produced. If we calculate the amount of Corvalol, which is sold annually in Russia, then phenobarbital, even purely by weight, will be the most frequently used anticonvulsant drug used for other indications. Phenobarbital should be taken with caution, and only on the recommendation of a specialist! Few people know about this, but just 2g of phenobarbital taken orally can cause death, and ingestion of 1g causes serious poisoning. This means that half a glass of Corvalol, or 100 ml, drunk, for example, for the purpose of alcoholic intoxication, contains 1.82 g of phenobarbital, and after such a “dose” you may not wake up.

Advantages and disadvantages

About phenobarbital, or you can put it in a proverb: “an old horse will not ruin a furrow.” This drug has been an effective anticonvulsant drug for many years, and even decades, but its long-term use turned out to cause significant disturbances in mental functions, leading to a decrease in intelligence and memory depression. Patients who were on phenobarbital monotherapy for a long time developed quite serious psychoses, especially in childhood.

At the same time, the range of action of phenobarbital on various forms of epilepsy is not as wide as that of carbamazepine or valproic acid. For example, if we are talking about absence epilepsy, then, on the contrary, it aggravates the course of this form of the disease, and even sometimes provokes seizures. Therefore, at present, phenobarbital, despite its prevalence and low cost, is considered the best drug of first choice only when it comes to seizures in newborns.

Second generation anti-seizure drugs

Since the beginning of the 1990s in clinical practice includes second-generation anti-seizure medications. These are now well-known drugs such as Neurontin and Lamictal, Keppra and Trileptal, Lyrica and Topamax. other means.

If we compare them with first-generation drugs, then their main difference is a targeted search, rather than an accidental discovery, and a much smaller number of side effects. First generation drugs quite often affected various enzyme systems and inhibited or increased their activity. This caused unwanted surges in hormonal levels and provoked cognitive disorders. Therefore, in the treatment of epilepsy with second-generation drugs, there is greater simplicity in the regimens, and patient adherence to treatment is much higher. Of course, the cost of these drugs is higher.

Given that personality changes may occur in patients with, for example, generalized epilepsy, such compliance or adherence is absolutely necessary for success. In general, their main difference is greater safety and better tolerability. In order not to list or repeat ourselves, we will immediately list here the most common common side effects for gabapentin, Topamax and lamotrigine. Most often, of course, dizziness occurred, and then transient diplopia, or double vision. Speech disorders occurred while taking Topamax, but the most common was always drowsiness. Let's look at the most typical and popular representatives of the second generation of drugs for the treatment of seizures.

Perhaps Lamotrigine is the most famous second-generation drug among epileptologists, and it is a folic acid antagonist and a fairly good sodium channel blocker. Its role is to suppress the release of neurotransmitters that excite neurons into the synaptic cleft. It is quickly absorbed when taken orally, and lives in the body for quite a long time, its half-life is more than 30 hours. Therefore, Lamotrigine can be taken in the morning, once a day.

Lamotrigine is indicated for use in persons over 12 years of age for the treatment of various forms of epilepsy, the listing of which does not give anything to a person without a medical education. For example, this is a combination therapy for refractory partial epilepsies, as well as Lennox-Gastaut syndrome in children. But it can also be used to treat grand mal seizures, that is, generalized epilepsy. It is important that the International League Against Epilepsy named it the drug of choice for the elderly with a high level of evidence for the treatment of partial forms.

The average daily dose of Lamotrigine, for example, in combination with carbamazepine, is 400 mg. It is also used to treat parkinsonism and reduce the risk of depression in bipolar disorder.

The original drug Lamictal, which is produced by Glaxosmithkline from the UK, will cost, on average, 2000 rubles. per package (100 mg capsules No. 30), and this package can last for a week. Accordingly, a monthly course of treatment with the original drug will cost 8,000 rubles. per month. This is very, very expensive for a Russian. The drug Lamolep from Gedeon Richter will cost 1,400 rubles. in the same dosage, and a monthly course will cost 5500, but this is also a high cost. The cheapest analogue is Lamotrigine, an INN generic from Canonpharma, and its cost is about 600 rubles. per package.

Advantages and disadvantages

Of the side effects of Lamotrigine, the most common, and, alas, unpleasant and dangerous, is skin rashes, or exanthema. Quite rarely, it manifests itself as a severe syndrome - Stevens-Johnson or Lyell, when the skin peels off, and this condition is life-threatening and is characterized by high mortality. If the patient has the slightest hint of skin changes while taking Lamotrigine, the drug is immediately discontinued, since in most cases the rash is persistent and irreversible. This is of course a very serious side effect, but fortunately it is very rare. The development of this can be avoided if you increase the dose very slowly when selecting the desired concentration.

Another “side” can be called vitiligo, drowsiness and nausea, a decrease in platelets in the blood plasma, leukopenia and an increase in liver transaminases. But if we talk about side effects in the population, Lamotrigine is tolerated quite well. In patients, in addition to the antiepileptic effect, mood improves, it exhibits an antidepressant effect and improves attention. In particular, Lamotrigine is a good treatment for epilepsy in the elderly, and especially in the presence of depression.

The original Topamax, which is produced by Janssen Сilag from Switzerland, costs from 1100 to 1300 rubles per package (60 capsules of 50 mg). The domestic analogue can be bought at a price of about 190 rubles, but you need to take into account that the concentration is half as much, 25 mg, and the number of capsules is also half as much (30 pieces). Therefore, it is necessary to immediately multiply by four in order for the comparison to be fair. And then the equivalent amount of topiramate produced in Russia will cost about 800 rubles. Therefore, it is better to hold out a little and buy the original Swiss drug.

Topamax reduces the frequency of action potentials, and works with gamma-aminobutyric acid to block sodium channels. It is indicated for treatment strictly over two years of age, both for newly diagnosed epilepsy and as part of complex treatment, together with other drugs. It is important that Topamax can be used to prevent migraine attacks, and is used only during the inter-attack period.

Topamax should be used by opening the capsules and mixing them with any soft food, swallowing immediately and without chewing. You can swallow it whole, but pre-dispersing the product causes faster and more uniform absorption. The average daily dose, which should be carefully selected with your doctor, is approximately 300 mg. This means that the original remedy will last for 10 days, and the cost of a monthly course of treatment will be approximately 3,300 rubles.

Advantages and disadvantages

Topiramate is well tolerated and there are no withdrawal symptoms if you need to abruptly discontinue this drug. Most often, patients experienced a dose-dependent decrease in body weight. In the presence of obesity, this is a very positive, but, alas, not a necessary side effect. However, there was something else. Concentration decreased, dizziness, drowsiness, and weakness appeared. This means that while being treated with Topamax, it is better not to drive. Of course, this applies to people with migraines, since patients with epilepsy are prohibited from driving. In addition, topiramate is contraindicated in pregnant and lactating women, and in patients with urolithiasis, since the drug can lead to the formation of calcium or phosphate stones - it alkalinizes the urine. Women taking hormonal contraceptives while taking Topamax should be especially monitored. The effectiveness of contraceptives may be significantly reduced.

Levetiracetam (Keppra, Comviron, Levetinol, Epiterra, Epitropil)

Keppra was first produced by the Croatian company Pliva. Now it is produced by the Belgian company UCB - Pharma, and in Russia the product is produced in the form of levetiracetam by the companies Ozon and R-Pharm. One package of Keppra tablets in the amount of 30 pieces will cost approximately 800 rubles, 250 mg each. Domestic medicine will cost more than half as much; levetiracetam from the Ozon company can be purchased for 315 rubles in September 2019.

This drug remains largely a mystery, since the antiepileptic mechanism of levetiracetam is still unclear. However, it is used both for partial seizures and for primary generalized, grand mal seizures in adults and in children over 12 years of age. Partial seizures may or may not have secondary generalization, but levetiracetam will be quite effective. It is applied twice a day and starts with a dose of one tablet twice a day. This is the stage of getting used to the drug and assessing its tolerability. After 2 weeks, the dose is doubled to 1 g per day. Typically, the therapeutic effect begins at this dosage, and if necessary, it can be increased, but not more than doubled, to 3 g per day. In addition to such monotherapy, there may also be complex therapy, when, in addition to levetiracetam, some other drug is prescribed, then the calculation is made based on the dosage per kilogram of body weight.

Advantages and disadvantages

Keppra and high-quality levetiracetam are well tolerated and significantly improve the quality of life of patients. The most common side effect is drowsiness, and the higher the level, the more pronounced it is. In second place are weight loss, diarrhea, and double vision. Of course, it is not advisable for people with development of drowsiness to drive, but a patient diagnosed with epilepsy cannot obtain a license, so this condition is not very relevant. Also, patients with this diagnosis are prohibited from working in hazardous working conditions, with moving machines and mechanisms; this must also be taken into account. After all, a patient with newly diagnosed convulsive syndrome cannot always be immediately removed by the occupational safety department or transferred to a non-hazardous job. Levetiracetam tablets should not be used in children under four years, and in solution - up to 1 month. It is prescribed with caution to the elderly and to persons with severe liver damage. In extreme cases, the medicine can be used in pregnant women and during breastfeeding, but this should be decided by a council.

Unlike 2nd generation antiepileptic drugs, gabapentin has gained triumphant fame in addition to the treatment of epilepsy, and in another area - the treatment of neuropathic pain, and is more effective than the prescription of carbamazepine. It is known as a drug that significantly improves the quality of life in chronic, burning pain that is intractable to carbamazepine. Gabapentin works for conditions such as trigeminal neuralgia, a condition following shingles called postherpetic neuralgia.

The most expensive drug is the original Neurontin from Pfizer. One package of 300 mg capsules in an amount of 50 pieces will cost an average of 1000 rubles. The drug Tebantin from Gedeon Richter will cost about the same. The maximum cost of Convalis (from the domestic company Pharmstandard is 700 rubles), and Catena from Belupo costs from 350 to 680 rubles.

It would seem that this is a low cost, but, unlike others medicines, selection of gabapentin therapy and dose escalation may have quite large limits.

Gabapentin works a little differently than a simple sodium channel blocker. It does not at all affect the capture or metabolism of GABA, this inhibitory neurotransmitter. It is believed that it affects in general, not the sodium channel, but the calcium channel. Importantly, it does not affect the metabolism of dopamine, serotonin and norepinephrine, and does not have the side effects of SSRIs, which are used as widely used antidepressants.

The drug is indicated primarily for the treatment of neuropathic pain, and as an anticonvulsant - for the treatment of partial seizures with and without secondary generalization in children over 12 years of age and in adults. It is also used as an additional drug in complex therapy for the treatment of partial seizures.

It was said above that Neurontin and its analogues are sold in 300 mg capsules, and you need to start with one capsule 3 times a day. The maximum dosage is 4 times higher, that is, 3600 mg per day. But doctors note that a dosage above 1800 mg per day is unlikely to have a positive effect; usually, pain reduction or anticonvulsant activity works up to this dose, that is, up to a dosage of 2 capsules 3 times a day.

There is no need to be afraid that the drug will be poorly tolerated; it is well tolerated in doses of almost 5 g per day. It is estimated that one package of Neurontin will last about 3 days with an average dose calculation. Then the monthly course will cost 10,000 rubles. And given its long-term use for the treatment of neuropathic pain, this pharmacoeconomic aspect poses a known problem.

Advantages and disadvantages

The great advantage of gabapentin is its truly proven effectiveness, reducing the burning and unpleasant pain that torments people at night, and even causing suicide. The inconvenience can be considered frequent use - three times a day, the need to count the number of capsules until the desired effect is achieved. On the other hand, gabapentin is very well tolerated by almost everyone, and the most common side effects include constipation, shortness of breath, and blurred vision. The effects are dose dependent, and at high dosages drowsiness and incoordination may also occur.

It should be remembered that it should not be used in children under 12 years of age as the main drug for the treatment of partial seizures. It can be used during pregnancy and breastfeeding, but again, by agreement of specialists, if the benefit to the mother outweighs the potential risk to the fetus. Because this medicine is secreted in breast milk, and the effect or lack thereof on the infant is unclear, then breastfeeding during treatment with gabapentin is necessary, taking into account this risk.

What's next?

Today the 21st century has already entered its second decade. 3rd generation pharmaceuticals are already ready, for example Briviac. However, their purpose is still inferior to the drugs of the first and second generation, since even their potential is not yet fully clear, and even the drugs of the second generation can easily be used for several decades to treat epilepsy.

On the other hand, co-administration regimens are constantly improving, new possibilities are opening up, and drug combinations. Some experts believe that existing medications are sufficient. A much greater effect will be obtained by following the following principles of treatment as best as possible:

1. start treating epilepsy as early as possible, which means that it is necessary to diagnose it in a timely manner as accurately as possible;
2. you need to choose a medicine as a monotherapy. This, that is, treatment with one drug, is much more desirable than combining two or even three antiepileptic drugs;
3. rationally control the dose and reduce it to an acceptable level when the effects exceed minor side effects.

In addition, non-drug methods of treating this ancient but well-known disease are constantly being improved. Therefore, if you or your relatives experience incomprehensible seizures, you should urgently contact a neurologist. It is very important to remember that epilepsy is not always seizures. They can be regarded as a fall, incomprehensible fainting, seizures similar to hysterical ones, as well as simply an incomprehensible state of stupor and freezing in one position. Sometimes outpatients arise automatically. It’s good if this press is not a computer key. But sometimes you can continue cutting your own fingers instead of onions. Only after electroencephalography with provocation, and possibly several times, after a thorough examination by a neurologist - epileptologist, can a diagnosis be made and treatment prescribed.

Attention! This rating is subjective in nature, is not an advertisement and does not serve as a purchase guide. Before purchasing, consultation with a specialist is required.

Anticonvulsants are medications used to combat seizures, the main manifestation of epilepsy. The term “anti-epileptic” drugs is considered more correct, since they are used to combat epileptic seizures, which are not always accompanied by the development of seizures.

Anticonvulsants, today, are represented by a fairly large group of drugs, but the search and development of new drugs continues. This is due to the variety of clinical manifestations of epilepsy. After all, there are many types of seizures with different development mechanisms. The search for innovative drugs is also determined by the resistance (stability) of epileptic seizures to some existing drugs, the presence of side effects that complicate the patient’s life, and some other aspects. From this article you will gain information about the main antiepileptic drugs and the features of their use.

Effect of anticonvulsants

During an attack, a person experiences not only muscle spasms, but also pain due to them. The action of anticonvulsants is aimed at eliminating these manifestations, stopping the attack so that it does not progress from pain to epileptic, convulsive phenomena. A nerve impulse is activated along with a specific group of neurons, just as it does when transmitted from motor neurons in the cerebral cortex.

Anticonvulsant pills should relieve pain and muscle spasms without suppressing the central nervous system. Such medications are selected individually, taking into account the degree of complexity of the pathology. Depending on this, medications can be used for a certain period or throughout life if a genetic or chronic form of the disease is diagnosed.

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What it is

People have been familiar with epilepsy for a long time: even the ancient Greek healers associated epileptic seizures with the world of the gods and believed that this illness was sent to them because of the unworthy way of their existence. In 400 BC, the outstanding ancient Greek physician and philosopher Hippocrates described this phenomenon. He believed that the cause of epileptic seizures was natural conditions that could provoke liquefaction of the brain.

In the Middle Ages, this disease was feared, believing that it was transmitted from a patient during an epileptic seizure. Meanwhile, they were in awe of her, since many saints and prophets suffered from such an illness.

Modern medicine has proven that epilepsy is a chronic brain disease, characterized by regularly recurring seizures. This is a very common disease, affecting about 50 million people worldwide, which is approximately 1% of the total population of the planet.

Groups of anticonvulsants

To prevent epileptic seizures and convulsions, doctors have developed different means, which differ in their operating principle. The doctor should prescribe specific anticonvulsants based on the nature of the seizures. Highlight the following groups anticonvulsants:

Group	Name	Action
Barbiturates and derivatives	Phenobarbital, Benzamil, Benzoylbarbamyl, Benzonal, Benzobamyl.	Aimed at inhibiting neurons of the epileptic focus. As a rule, it has an indiscriminate depressant effect on the central nervous system.
Benzodiazepine-based drugs	Rivotril, Clonazepam, Ictorivil, Antelepsin, Ravatril, Klonopin, Ictoril.	These medications affect the activity of inhibitory neurons by acting on GABA receptors.
Iminostilbenes	Carbamazepine, Zeptol, Finlepsin, Amizepine, Tegretol.	They have a restrictive effect on the propagation of electrical potential along neurons.
Sodium valproate and derivatives	Acediprol, Epilim, Sodium Valproate, Apilepsin, Valparin, Diplexil, Konvulex.	They have a sedative, tranquilizing effect, improve emotional background sick.
Succinimides	Ethosuximide, Pufemid, Ronton, Sucimal, Etimal, Suxilep, Pycnolepsin, Valparin, Diphenin, Xanax, Keppra, Actinerval;	Prescribed for the treatment of absence seizures, the tablets are a calcium channel blocker. Eliminate muscle spasms due to neuralgia.

Some basics of pharmacotherapy for epilepsy

The main goal of epilepsy treatment is to maintain and improve the patient's quality of life. They are trying to achieve this by completely eliminating epileptic seizures. But at the same time, the developed side effects from constant use of medications should not exceed the negative impact of seizures. That is, one cannot strive to eliminate seizures “at any cost.” It is necessary to find a “golden mean” between the manifestations of the disease and the adverse effects of antiepileptic drugs: so that both the number of seizures decreases and the side effects are minimal.

The choice of antiepileptic drug is determined by several parameters:

• clinical form of the attack;
• type of epilepsy (symptomatic, idiopathic, cryptogenic);
• age, gender, weight of the patient;
• the presence of concomitant diseases;
• way of life.

The attending physician faces a difficult task: from all the abundance of antiepileptic drugs, select (and, it would be good, on the first try) an effective remedy. Moreover, monotherapy for epilepsy is desirable, that is, the use of one drug. Only in cases where several drugs in turn are unable to cope with attacks, they resort to the simultaneous use of two or even three drugs. Recommendations have been developed for the use of individual drugs based on their effectiveness in this or that form of epilepsy and types of seizures. In this regard, there are first- and second-line drugs of choice, that is, those with which it is necessary to start treatment (and the likelihood of their effectiveness is higher), and those that should be resorted to in case of ineffectiveness of first-line drugs.

The difficulty of selecting a drug largely depends on the availability of its individual (!) effective dose and tolerability. That is, two patients with the same types of seizures, the same gender, weight and approximately the same age, and even the same comorbidities, may require different doses of the same drug to control the disease.

It should also be taken into account that the drug must be used for a long time without interruption: after control of the attacks is established, for another 2-5 years! Unfortunately, sometimes it is necessary to take into account the financial capabilities of the patient.

Anticonvulsants for epilepsy

Some products are available without a prescription, some only with one. Any pills for epilepsy should only be prescribed by a doctor to avoid side effects and not provoke complications. It is important to go to the hospital in a timely manner quick diagnostics will increase the chances of remission and the duration of taking the medication. Popular anticonvulsant drugs for epilepsy are listed below:

1. Feniton. The tablets belong to the hydantoin group and are used to slightly slow down the reaction of nerve endings. This helps stabilize neural membranes. It is usually prescribed to patients who suffer from frequent seizures.
2. Phenobarbital. Included in the list of barbiturates, it is actively used for therapy in the first stages, to maintain remission. The medicine has a calming, mild effect, which is not always enough during epilepsy, so it is often prescribed along with other drugs.
3. Lamotrigine. It is considered one of the most powerful antiepileptic drugs. A properly prescribed course of treatment can completely stabilize the functioning of the nervous system without disrupting the release of amino acids.
4. Benzobamyl. This drug has low toxicity and a mild effect, so it can be prescribed to a child who suffers from seizures. The drug is contraindicated for people with pathologies of the heart, kidneys, and liver.
5. Sodium valproate. This is an antiepileptic drug, also prescribed for behavioral disorders. It has a number of serious side effects: the appearance of a rash, deterioration in clarity of consciousness, decreased blood clotting, obesity, and deterioration of blood circulation.
6. Primidon. This antiepileptic drug is used for severe attacks of epilepsy. The medicine has a powerful inhibitory effect on damaged neurons, which helps stop attacks. You can take this anticonvulsant only after consulting your doctor.

Why is drug therapy often ineffective?

Most patients with epilepsy are forced to take antiepileptic drugs (AEDs) for life, or at least for a very long period.

This leads to the fact that in 70% of all cases success is achieved. This is a fairly high figure. But, unfortunately, as statistics say, 20% of patients remain with their problem. Why does this situation arise?

For those for whom drugs for the treatment of epilepsy do not have the desired effect, specialists suggest neurosurgical intervention.

In addition, methods of vagal nerve stimulation and special diets can be used. The effectiveness of therapy largely depends on the following factors:

• qualifications of the attending physician;
• correct determination of the type of epilepsy;
• a well-chosen drug of the first or second category;
• quality of life of the patient;
• the patient follows all the doctor’s instructions;
• the difficulty of treating polymorphic seizures, which are often difficult to identify;
• high cost of medicines;
• patient refusal to take medications.

The last point is related to the fear of side effects. Many patients stop taking medications simply because they worry that one of their internal organs will begin to fail.

Of course, no one has canceled the side effects, but the doctor will never prescribe a drug whose effectiveness will be less expensive than the potential threat. In addition, thanks to the development of modern pharmacology, it is always possible to adjust the treatment program.

Anticonvulsants for neuralgia

It is recommended to start treatment as early as possible; to do this, you need to consult a specialist after the first symptoms of the disease. Therapy is based on a whole range of medications to eliminate the causes and signs of nerve damage. Anticonvulsants play a leading role in treatment. They are needed to prevent epilepsy attacks and seizures. The following anticonvulsants are used for neuralgia:

1. Clonazepam. It is a benzodiazepine derivative and differs in that it has anxiolytic, anticonvulsant, and sedative effects. The mechanism of action of the active substance helps to improve sleep and relax muscles. It is not recommended to use it without a doctor’s prescription, even according to the instructions.
2. Carbamazepine. According to the classification, the medicine belongs to iminostilbenes. It has a pronounced anticonvulsant, moderate antidepressant effect, and normalizes the emotional background. Helps significantly reduce pain due to neuralgia. The antiepileptic drug acts quickly, but the course will always be long, because if you stop taking the medication prematurely, the pain may return.
3. Phenobarbital. Belongs to the group of barbiturates, which act as a sedative and hypnotic drug in the treatment of neuralgia. This anticonvulsant is not prescribed in large doses; it should be taken strictly as prescribed by the doctor, because the side effects of anticonvulsants are contraindicated in a number of other diseases.

Treatment of epilepsy in Moscow

In Moscow, successful treatment of epilepsy is performed at the Yusupov Hospital. Neurologists and epileptologists at the Yusupov Hospital are the best specialists in their field. Doctors use evidence-based medicine methods that have shown the greatest effectiveness in treating epilepsy. Neurologists constantly study modern innovations in medicine, so they are aware of the latest effective developments in the treatment of pathology. Use in patient care modern methods, as well as the extensive experience of doctors, allow us to achieve maximum results in the treatment of pathology.

At the Yusupov Hospital, drug therapy is tailored strictly individually based on examination data and taking into account all the patient’s characteristics. Adequate therapy helps to significantly improve the patient’s condition, reduce the number of attacks and achieve long-term remission of the disease.

Make an appointment with neurologists and epileptologists, get information about the work diagnostic center, you can clarify another question of interest by calling the Yusupov Hospital.

Andrey Igorevich Volkov

Neurologist, Candidate of Medical Sciences

Anticonvulsants for children

Choice in in this case falls on medications that should significantly reduce the excitability of the central nervous system. Many medications of this type can be dangerous for the baby because they depress breathing. Anticonvulsants for children are divided into two groups according to the degree of danger to the child:

• Drugs that have little effect on breathing: lidocaine, benzodiazepines, hydroxybutyrates, fentanyl, droperidol.
• More dangerous substances that have an inhibitory effect: barbiturates, chloral hydrate, magnesium sulfate.

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When choosing a medicine for children, the pharmacology of the drug is very important; adults are less susceptible to side effects than a child. The list of main drugs used in the treatment of children includes the following medications:

1. Droperidol, Fentanyl– have an effective effect on the hippocampus, from which the signal for seizures comes, but does not contain morphine, which can cause breathing problems in infants under 1 year of age. This problem can be eliminated with nalorphine.
2. Benzodiazepines– Sibazon is usually used, which may be called diazepam or seduxen. Intravenous administration of the drug stops seizures within 5 minutes; respiratory depression can be observed with large doses of the drug. The situation can be corrected by administering physostigmine intramuscularly.
3. Lidocaine. The drug can almost immediately suppress any type of seizure in children if given intravenously. In therapy, as a rule, a saturating dose is first administered, then droppers are used.
4. Phenobarbital. Used for prevention and treatment. It is prescribed, as a rule, for mild attacks, because the result from use develops within 4-6 hours. The main advantage of the medication is that the effect in children can last up to 2 days. Good results are observed when taken simultaneously with Sibazon.
5. Hexenal. A strong drug, but it has a depressant effect on breathing, which greatly limits its use in children.

Bibliography

• ICD-10 (International Classification of Diseases)
• Yusupov Hospital
• Bryukhanova N.O., Zhilina S.S., Ayvazyan S.O., Ananyeva T.V., Belenikin M.S., Kozhanova T.V., Meshcheryakova T.I., Zinchenko R.A., Mutovin G. R., Zavadenko N.N.. Aicardi-Goutieres syndrome in children with idiopathic epilepsy // Russian Bulletin of Perinatology and Pediatrics. - 2019. - No. 2. - P. 68–75.
• Victor M., Ropper A.H. Guide to neurology according to Adams and Victor: textbook. manual for the postgraduate system. prof. physician education / Maurice Victor, Allan H. Ropper; scientific ed. V. A. Parfenov; lane from English edited by N. N. Yakhno. - 7th ed. - M.: Med. information agency, 2006. - 677 p.
• Rosenbakh P. Ya.,. Epilepsy // Encyclopedic Dictionary of Brockhaus and Efron: in 86 volumes (82 volumes and 4 additional). - St. Petersburg, 1890-1907.

New generation anticonvulsants

When choosing a medication, the doctor must take into account the origin of the pathology. New generation anticonvulsants are aimed at solving a wider range of causes and causing a minimum number of side effects. Developments are ongoing, so over time, more and more modern products appear that cannot be bought in an online store or ordered home. Among the modern options, the following effective new generation antiepileptic drugs are distinguished:

1. Difenin– indicated for severe seizures, trigeminal neuralgia.
2. Zarontin (aka Suxilep). A remedy that has proven to be highly effective must be treated continuously.
3. Keppra contains the substance Levetiracetam, the mechanism of its effect on the body is not fully understood. Experts suggest that the drug acts on glycine and gamma-aminobutyric acid receptors. A positive effect has been confirmed in the treatment of generalized seizures of epilepsy and partial seizures with Keppra.
4. Ospolot– a new generation anticonvulsant, the effect of the active substance has not been fully studied. The use of the drug for partial epileptic seizures is justified. The doctor prescribes daily dose, which should be divided into 2-3 doses.
5. Petnidan– the active ingredient is called ethosuximide, highly effective in the treatment of absence seizures. It is imperative to coordinate your appointment with your doctor.

How does the disease appear?

Many patients wonder what caused the onset of the disease, because this is a dangerous condition and requires mandatory medical supervision. Medicine identifies three main groups of factors that can lead to the development of the disease:

• Idiopathic ( genetic predisposition). Even after tens of generations, the disease can be transmitted. In this case, there are no organic defects or damage in the brain, but there is a certain reaction of neurons. With this form of pathology, an epileptic attack can begin without a reason.
• Symptomatic. The disease can appear after injury, intoxication or tumor processes in the brain. This form of epilepsy occurs spontaneously, and a seizure can occur unpredictably.
• Cryptogenic. A little-studied factor, the exact cause of which has not yet been established. A seizure can occur due to any psycho-emotional stimulus.

The disease can manifest itself at any age, however, according to statistics, epilepsy is more likely to affect young children, adolescents and adults over 60 years of age. To date, medicine has identified about 40 different types of epilepsy. Therefore, the treating doctor must carry out an accurate diagnosis to establish the form of the disease and determine the nature of the seizures. The effectiveness of the results in certain cases depends entirely on the adequacy of the choice of antiepileptic drug and the prescription of the treatment regimen. If treatment is untimely or inadequate, the patient may die. Therefore, a full examination of the patient and an accurate diagnosis of the disease is necessary.

A spontaneous attack can occur due to hormonal changes in the body, alcohol intoxication, or the appearance of flickering and flashing images while driving a car.

Side effects of anticonvulsants

Most anticonvulsants are available by prescription and are not available over the counter. This is due to the large number and high risk of side effects from drug overdose. A doctor can choose the right drug based on test results; it is not recommended to buy medications on your own. The most common side effects of anticonvulsants when taken in violation of the rules are:

• lack of confidence when walking;
• dizziness;
• vomiting, drowsiness, nausea;
• double vision;
• respiratory depression;
• allergic reactions (rash, deterioration of hematopoiesis, liver failure).

Polytherapy: combined treatment regimen

When treating this pathology, the doctor strives to achieve monotherapy. This allows you to select the appropriate drug, optimal dosage and appropriate treatment regimen, as well as achieve high clinical effectiveness. In addition, monotherapy minimizes the side effects of treatment.

However, in some situations it is more advisable to choose a combined drug regimen. This is what they do:

• In shape pathological process, which combines several types of attacks at once and there is no possibility of full-fledged monotherapy;
• For conditions accompanied by the same type of epileptic seizures, but not treatable with any medication.

In these cases, medications with different mechanisms of action are used in treatment regimens. However, the chosen treatment tactics must be rational and combine drugs that do not interfere with each other. For example, a prohibited combination is the simultaneous use of phenobarbital with primidone and benzobarbital or phenytoin with lamotrigine.

When using a combined treatment technique, a slight decrease in the therapeutic effect is possible. Often, patients experience signs of intoxication when using one of the drugs that was previously well tolerated. Therefore, at the initial stages of polytherapy, monitoring the level of drugs used in the blood plasma is necessary.

Price of anticonvulsants

Most medications can be found in a catalog on pharmacy websites, but for some groups of medications you will need a doctor's prescription. The cost of medicines may vary depending on the manufacturer and place of sale. The estimated price for anticonvulsants in the Moscow region is as follows:

Duration of treatment

The cessation or reduction of epileptic seizures, reducing their duration, alleviating and improving the psycho-emotional state of the patient is already considered a positive trend in treatment. The use of the latest pharmacotherapy techniques makes it possible to achieve complete relief or significant minimization of seizures.

The duration of drug therapy is determined by the type of attacks and form of the disease, age and individual characteristics patient. Practical recovery can occur with idiopathic forms of epilepsy. A small percentage of relapses occur in idiopathic forms with absence seizures that occur in childhood or adolescence. Cancellation of treatment for low-recurrence epilepsy is possible after two years of remission. In other cases, the question of stopping therapy can be raised only after five years of remission. In this case, the EEG should show a complete absence of pathological activity.

Termination therapeutic treatment is carried out gradually, with a reduction in dosage to 1/8 daily over 6-12 months. Antiepileptic therapy should not be discontinued in patients with severe symptoms.

What other drugs are used to treat the disease?

For epilepsy, nootropics are also widely used: Piracetam, Phenotropil, Pantogam, Neuromultivit. They have a positive effect on neuronal activity. After their use, the nature (frequency and duration) of attacks decreases, and the individual’s cognitive abilities improve.

Epilepsy cannot be treated with antibiotics because they do not have a positive effect on the disease. However, drugs in this group are prescribed when a person is attacked by any other infections. In this case, the following can be used: paracetamol, aspirin, antiviral drugs (kagocel and others), as well as other antipyretics.

Tranquilizers also help normalize neuron activity. They have a hypnotic, relaxing, anticonvulsant effect. However, doctors warn that you should not take tranquilizers for a long period of time, as they can cause persistent addiction.

If epilepsy is diagnosed, magnesia and magnesium-containing drugs (they have an anticonvulsant, vasodilator, and sedative effect) may also be prescribed. In the treatment of the disease, neuroleptics are also used (used in the treatment of psychoses that occur against the background of epilepsy - delirium, hallucinations, etc.)

Painkillers

Sometimes attacks are accompanied by pain. In these cases, doctors solve several problems at once:

• relief of severe pain;
• preventing its manifestation in the future;
• return of the patient to physical activity.

In this case, remedies are chosen without pronounced side effects; there are already enough of them for such an illness.

Cinnarizine for epilepsy:

• Bulgarian prescription drug in tablet form;
• has not only an analgesic, but also a vasodilator effect without affecting blood pressure;
• taken after meals in doses up to 25 mg;
• Use with caution during pregnancy and Parkinson's disease.

Mexidol:

• It is believed that with similar effects, the drug also improves memory;
• causes a minimum of allergic reactions;
• Recently the drug has been declared a prescription drug.

Is it possible to be cured of epilepsy forever?

As the data shows medical statistics, the highest chances for complete cure for epilepsy in children and adolescents. In this category, the cure rate reaches 80-82%.

Among adult patients, the recovery rate is already 45-50%. In 32% of cases, patients note that the frequency, number and duration of epileptic seizures have decreased significantly.

Unfortunately, in medical practice There is such a thing as resistant epilepsy - it accounts for approximately 20-23% of all cases of the disease and is considered incurable with medication. In this case, only surgery helps.

Surgical treatment is considered the most effective for intractable epilepsy and leads to a cure in 91% of cases.

Sleeping pills and sedatives

Since epilepsy is a disease of increased excitability, the components of this group are prescribed without fail.

Moreover, they do not always have a high cost, but they are always effective.

Valerian for epilepsy:

• Available over-the-counter in the form of tablets and tinctures;
• has a depressing effect on nervous system;
• relaxes muscle tension;
• slows down the heart rate;
• take 3-4 tablets or 30-40 ml 3 times a day;
• Contraindicated in case of fructose intolerance.

Phenazepam for epilepsy:

• prescription;
• Available in tablet form;
• single dosage – from 0.5 mg to 7-9 mg in difficult cases;
• quickly becomes addictive;
• side effects: urinary incontinence, dizziness;
• Contraindicated for glaucoma and alcohol poisoning.

Afobazole for epilepsy:

• available without a prescription in tablet form;
• has a mild effect;
• the daily dose should not exceed 30 mg, taken 3 times a day;
• Side effects include dry mouth and dizziness;
• compatible with alcohol, but for epilepsy this combination, like alcohol in general, is not recommended;

What injection is given for epilepsy? Relanium for epilepsy:

• prescription; Available in the form of ampoules for intramuscular or intravenous administration;
• the main side effects are drowsiness, dizziness;
• perfectly relieves feelings of anxiety, as the beginning of increased arousal;
• Contraindications – acute respiratory failure, pregnancy, allergic reactions.

Tenoten for epilepsy:

• available in tablet form without a prescription;
• daily dose: 1 tablet 2 times a day, regardless of meals;
• Contraindications include intolerance and increased sensitivity to lactose.

Antiepileptic drugs during pregnancy

During this period, doctors are especially attentive to the condition of the expectant mother. Convulsive syndrome poses a great danger to the life of the child; it can cause abdominal injuries and, as a result, damage to the fetus.

Pregnancy is not a reason to discontinue treatment with antiepileptic drugs. But to the expectant mother It is worth understanding that they increase the risk of intrauterine defects in the baby. The drugs usually prescribed are Hexamidine, Carbamazepine, Benzonal, Depakine and others. Folic acid is also often prescribed to pregnant women.

Some older people experience cramping in their legs. There are various explanations for this, and it is extremely important to find out what exactly a particular patient is experiencing. For example, active aging processes, as well as poor condition of leg blood vessels and muscle atrophy, could lead to cramps. If a person is given intramuscular injections, then because of this, convulsive conditions may also occur later.

It should be understood that older people are susceptible to various diseases. We are talking about liver and kidney diseases, varicose veins, and arthritis. In addition, seizures can occur due to diabetes mellitus, as well as neurological pathologies. That is why it is important to find out exactly what a particular person has to deal with.

Is it possible to take

Sometimes there are conditions that cannot be eliminated without the use of antibiotics.

For example, bronchitis that is not treated in time can result in pneumonia, and associated bacterial infection will lead to serious consequences.

Epilepsy does not negate antibiotic therapy, but there are some drugs whose use is unacceptable.

If the doctor, knowing about the diagnosis, prescribed an antibacterial drug that raises doubts, then you cannot cancel it yourself.

You can see another doctor and get additional tests. After which, the doctor can review his prescriptions and change the list of medications.

You cannot select medications for the treatment of bacterial diseases yourself.

Antidepressants

Depression is a psychopathological disorder that occurs quite often in epilepsy. And in some cases, epilepsy and depression have the same cause. Depressed states of patients affect the progression of the disease and even mortality. It turns out that depression is more common in men with epilepsy.

Treatment of depressive conditions is carried out depending on the patient’s condition. It should be noted that depression often manifests itself as a side effect. But it is rarely diagnosed anyway. The reason for this is its atypical manifestation.

Antidepressants should be prescribed by a doctor or psychotherapist. An important problem is that not all patients are willing to tell their doctor about the symptoms of depression. But people with epileptic psychoses and disorders should pay special attention to depressive symptoms. Such patients must be observed by a psychiatrist.

Prescribed drugs are divided into 2 groups:

• drugs with a high risk of provoking epileptic seizures: amoxapine, maprotiline and others;
• low-risk drugs; These antidepressants include SSRIs, SSRIs

Afobazole can be prescribed in complex therapy.

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) do not directly affect muscle tone, but they stop pain syndrome which accompanies a cramp. In addition, they normalize the rheological properties of the blood, reducing the risk of spasms in the future.

NSAIDs are used in combination with drugs from other groups (anticonvulsants, muscle relaxants) for prolonged and painful spasms of skeletal muscles.

Lornoxicam

The active ingredient of this drug is lornoxicam. This substance inhibits cyclooxygenase and inhibits the production of prostaglandins, which leads to pain relief.

The cost of the medicine is from 150 rubles. for 10 tablets (4 mg). On the pharmaceutical market, a more common analogue of Lornoxicam is the drug Xefocam.

Celecoxib

Celecoxib inhibits cyclooxygenase-2 and blocks the formation of prostaglandins, reducing muscle pain due to frequent and prolonged spasms. Unlike other NSAIDs, this drug does not affect platelet adhesion and blood clotting.

The cost of Celecoxib is from 172 rubles. for 10 tablets (200 mg). More popular on the drug market are analogues of celecoxib - Celebrex and Dilax.

Nise

The drug Nise has high anti-inflammatory and analgesic activity. Its active ingredient is nimesulide, which competitively blocks COX-2 and COX-1, inhibiting the production of prostaglandins and the occurrence of pain.

Nise is not prescribed to pregnant women and nursing mothers.

The cost of the drug is from 160 rubles. for 20 tablets (100 mg).

Vitamin and mineral complexes

As medications for leg cramps, your doctor may prescribe vitamin and mineral complexes that contain vitamin D, calcium, magnesium and potassium. Most often they are used in combination with other medications (for example, venotonics).

The following complexes are effective for muscle cramps:

1. Magnerot (active ingredient - magnesium orotate). The drug compensates for the lack of magnesium, which normalizes the function of the nervous system and enhances the effects of potassium. The cost of Magnerot starts from 293 rubles. for 20 tablets (500 mg).
2. Panangin (potassium and magnesium aspartate). Panangin saturates the body with magnesium and potassium, providing their synergistic effect and reducing the intensity of vascular spasms that lead to seizures. The cost of the mineral complex is from 149 rubles. for 50 tablets (158 mg of potassium and 140 mg of magnesium).
3. Asparkam. Asparkam is an analogue of Panangin. Its cost is from 33 rubles. for 20 tablets (175 mg of potassium and magnesium).
4. Complivit. This complex contains vitamins A, E, B1, B2, B3, B5, B6, B9, B12, C and P, as well as compounds of magnesium, iron, copper, calcium, zinc, manganese and cobalt. Complivit is prescribed for increased physical and emotional stress, treatment of systemic diseases and during the recovery period. The cost of the complex is from 123 rubles. for 30 tablets.
5. Calcium D3 Nycomed (calcium carbonate and cholecalciferol). This drug combines two components that affect the conduction of nerve impulses, electrolyte balance in the blood and the frequency of muscle spasms. The cost of the product is from 294 rubles. for 50 tablets (500 mg calcium and 200 IU vitamin D3).
6. Magne B6 (magnesium lactate and pidolate, pyridoxine). The combination of magnesium and vitamin B6 helps reduce anxiety, normalizes central nervous system function and reduces the incidence of muscle spasms. The cost of the complex is from 420 rubles. for 5 tablets (100 magnesium and 10 mg B6).

Indications and contraindications

Anticonvulsants are prescribed by a doctor in accordance with the cause of the pathology, this may be:

• epilepsy of various origins and severity;
• spasms of the lower and upper extremities;
• osteochondrosis;
• flat feet;
• dehydration;
• muscle strain during sports or heavy physical activity;
• alcoholism;
• Parkinson's or Addison's disease;
• liver cirrhosis;
• diseases of peripheral nerves and blood vessels;
• tumor growth;
• diabetes.

In addition, the lack of regular physical activity over time leads to a set of extra pounds, muscle atrophy, and cramps.

General contraindications to taking anticonvulsants are:

• individual intolerance to components;
• pregnancy, lactation;
• age restrictions in accordance with the instructions for use of the product (old people and children);
• dysfunction of the liver, kidneys;
• hypertension or hypotension;
• mental disorders.

Since there are a lot of antiepileptic and anticonvulsant drugs today, they all belong to different pharmacological groups, you should focus on contraindications by carefully studying the instructions for each specific drug.

What should parents do during a seizure?

Many mothers do not know what to do during a child’s seizures at a high temperature, and may panic. Vanity and shouting will not lead to anything good. You need to calm down and act.

1. First of all, you need to call a doctor.
2. Then undress the child as much as possible, lay him on a hard surface, such as a tabletop, and ensure a flow of fresh air into the room. In summer you can open the window, in winter you can turn on the fan.
3. You need to stay close to the child, monitoring his condition. If the baby is holding his breath, there is no need to fiddle with it. It's better to wait until he exhales and start doing artificial respiration. During the attack, it is impossible to carry out artificial respiration, since the upper respiratory tract is blocked by the spasm.
4. There is no need to take the initiative and try to pour any medicine or water into the child’s mouth. Also, do not unclench his jaws to insert a finger or spoon into his mouth. Such actions can only worsen the baby’s condition.
5. To reduce the temperature during a seizure, you should not give medications orally, but it is quite acceptable to use rectal suppositories with paracetamol.

Short-term attacks (up to 15 minutes), occurring sporadically or very rarely, do not require drug treatment.

To stop more frequent and prolonged seizures, the doctor may prescribe anticonvulsants like Phenobarbital, Phenytoin, Valproic acid, etc.

Convulsions during fever in children What to do?

If a child experiences convulsions of any origin for the first time, including febrile ones, the child needs immediate medical attention and subsequent hospitalization in a hospital to determine their cause and clarify the diagnosis. Therefore, if a child has convulsions with a fever, it is necessary to call an ambulance.

Before the ambulance arrives

1. • Open a window or vent to provide access to fresh air.
   • Eliminate the possibility of injury, especially to the head.
   • Turn the child on his side, unclench his teeth, fix his tongue, to prevent tongue retraction and asphyxia with vomit.
   • Measure the baby's body temperature if this has not been done before. If the temperature is elevated, undress the child, wipe with cool water, you can use an antipyretic (rectal suppositories or intramuscular injection).

Causes of pathology

Most common physiological reasons muscle cramps are caused by hypothermia and prolonged stay in an uncomfortable position. They provoke rapid narrowing of blood vessels or compression of nerve fibers, which lead to spasms. If a convulsive attack occurred at night, it could be caused by a sudden change in the position of the legs or the whole body.

The regular occurrence of painful muscle spasms is a pathological sign and a reason to consult a doctor (phlebologist, endocrinologist, orthopedist or neurologist).

Pathological causes of leg cramps include:

1. Varicose veins lower limbs. The expansion and loss of vascular tone in the legs provokes circulatory disorders in the superficial and deep veins. This leads to stagnation of blood, swelling and spasms (convulsions).
2. Lack of vitamins and microelements. A lack of potassium and calcium, which regulate the rheological properties of the blood and prevent vascular spasm, provokes frequent and painful cramps of the calf muscles. A risk factor for cramps is also a deficiency of magnesium and vitamin D3. A lack of essential nutrients can result from poor nutrition, disruption of the body’s acid-base balance, vomiting, diarrhea, etc.
3. Poor nutrition. Excessive consumption of animal protein, low-carbohydrate diets and fasting shift the body's acid-base balance to the acidic side, causing calcium leaching. A large number of salt against the background of a lack of potassium causes fluid retention in the body and vascular spasms.
4. Pathologies of the musculoskeletal system. The causes of cramps can be defects in the shape of the foot (transverse and longitudinal flatfoot), lumbar stenosis, as well as the consequences of injuries to the legs and spine, which led to pinched nerves.
5. Diseases of the central nervous system. Leg cramps may occur when malignant tumors brain and spinal cord, traumatic brain injuries, severe central nervous system infections, epilepsy and other diseases.
6. Hormonal disbalance. Deficiency of iodine-containing hormones thyroid gland(hypothyroidism), decreased adrenal function, diabetes mellitus and other pathologies of the endocrine system provoke accelerated excretion of trace elements and other disorders that can lead to seizures.
7. Excessive physical and emotional stress. Intense sports activities, lack of cool-down after training and regular stress lead to an increase in the level of the stress hormone (cortisol), which negatively affects the general condition of the body and reduces the absorption of calcium in the body. small intestine. Additional risk factors are increased sweating, non-compliance with the drinking regime, high content protein in the diet (when gaining muscle mass) and insufficient carbohydrate intake (when losing weight).
8. Reception medications and bad habits. Taking diuretics (diuretics), some psychostimulants, statins, analeptics and other drugs leads to the loss of mineral salts that regulate vascular tone. An overdose of caffeine and nicotine causes vasospasm, which provokes prolonged and intense cramps.
9. Pregnancy. Pressure of the uterus on the vessels and increased need for calcium for construction skeletal system fetus leads to an increased risk of varicose veins, the development of inferior vena cava syndrome and a decrease in calcium concentration in the body of the expectant mother. Most often, cramps in pregnant women occur at night: this is due to compression of the inferior vena cava by the uterus and the occurrence of venous stagnation during a long stay in a horizontal position.

In childhood, leg cramps often appear during the period of active growth. The reason for contacting a pediatrician or neurologist should be prolonged and frequent spasms: they may indicate neurological diseases (spasmophilia, epilepsy, etc.).

In elderly patients, leg cramps can occur due to leg diseases (varicose veins, atherosclerosis of the lower extremities), osteochondrosis, increased sensitivity of the nervous system and pathologies of internal organs.

• 1 Anticonvulsants
• 2 Classification of epilepsy
• 3 Pathogenesis of seizures and mechanisms of action of anticonvulsants 3.1 Partial seizures
• 3.2 Primary generalized seizures: absences
• 3.3 Genetic factors

• 4 General information about anticonvulsants

• 4.1 Historical background
• 4.2 Basics of anticonvulsant therapy

• 5 Hydantoins

5.1 Phenytoin

• 6 Barbiturates

6.1 Phenobarbital

• 7 Deoxybarbiturates

7.1 Primidone

• 8 Iminostilbenes

• 8.1 Carbamazepine
• 8.2 Oxcarbazepine

• 9 Succinimides

9.1 Ethosuximide

• 10 Valproic acid
• 11 Benzodiazepines
• 12 Other anticonvulsants

• 12.1 Gabapentin
• 12.2 Lamotrigine
• 12.3 Acetazolamide
• 12.4 Felbamate
• 12.5 Levetiracetam
• 12.6 Tiagabine
• 12.7 Topiramate
• 12.8 Zonisamide

• 13 General principles of anticonvulsant therapy

13.1 Duration of treatment

• 14 Perspectives

List of prohibited

Here the list is a little longer, and prescriptions may depend not only on the severity and frequency of convulsive attacks, but also on the age of the patient and the presence of concomitant pathologies.

Prohibited:

• all penicillin drugs;
• aminoglycosides (Streptomycin, Gentamicin);
• quinolones and fluoroquinolones (Oxolin, Ofloxacin, Norfloxacin);
• anti-tuberculosis (isoniazid, pyrazinamide, etc.);
• cephalosporins;
• polymyxins (Colistin).

Sulfonamides are used under constant medical supervision in a hospital.

Original or generic?

A generic is a drug that is inexpensive compared to the original. The latter has a patent from a pharmacological organization. It is undergoing laboratory and clinical testing. The generic contains the same active substance, but is produced by a different company. The production technologies of the generic are different from the original, as are the excipients for production.

Doctors recommend using branded drugs in the treatment of a disease such as epilepsy. If it is preferable for the patient to replace the original medicine with a generic, then in this case it is necessary to adjust the dose of the drug. Most often a higher dose is prescribed. Choosing a generic also increases the likelihood of more frequent side effects.

Anticonvulsants are medications that can prevent seizures of varying severity and origin without affecting other body functions. This broad pharmacological group is also called anticonvulsants. It is divided into several subgroups of the second and third levels, as well as new and old generation drugs. The attending physician must decide which medicine is suitable in each individual case.

Show all

Classification

Anticonvulsants are divided into several generally accepted classifications, each of which is actively used in medicine. The first classification divides anticonvulsants according to their mechanism of action, the second - according to the chemical structure of the active substance.

No anticonvulsant drug is available in pharmacies without a prescription.

By mechanism of action

Anticonvulsants work by two main mechanisms: stimulation of dopaminergic transmission and inhibition of cholinergic transmission. The funds representing these groups are presented in the table:

Anticholinergics, which do not have a central effect but are effective locally, are, as a rule, not used in the treatment of convulsions.



By chemical structure

The classification of drugs with anticonvulsant action according to their chemical structure is more extensive. It includes five main groups that combine drugs based on the structure of the active substance:

The table shows the main groups of anticonvulsants by chemical structure. Medicines based on valproic acid, iminostilbenes, and oxazolidinones can also be used. When treating convulsions and neuralgia, it is important not only to achieve a therapeutic effect, but also to reduce the likelihood of side effects. For this purpose, a classification of anticonvulsants has been developed for each type of epileptic seizure. The classification presents new generation drugs.



Drugs of choice

Drugs of choice are drugs that are widely used for certain diseases and in most cases studied are most effective. The main convulsive pathologies and the list of drugs of choice for them:

• psychomotor and grand mal seizures, status epilepticus - Difenin;
• psychomotor and grand mal seizures during stroke - Carbamazepine;
• psychomotor seizures, myoclonic epilepsy - Clonazepam;
• severe psychomotor partial seizures, clonic-tonic convulsions - Lamotrigine;
• myoclonic epilepsy – sodium valproate;
• focal seizures, status epilepticus in children - Benzobamil.

If the drugs of choice do not have an effect or are poorly tolerated, the option of replacing the drug with an analogue in action from the second line of drugs for a specific pathology is considered.

Difenin

A drug based on phenytoin represents the first line of treatment for status epilepticus and grand mal seizures. Sold in the form of tablets, 10 pieces in a blister, 99.5 mg of active ingredient per tablet.




Pharmacological properties

Inhibits convulsive activity, stabilizes the threshold of excitability. Actively distributed in tissues, secreted by saliva and gastric juice, penetrates the placenta. Metabolized in the liver.

Indications

Difenin is indicated for the following pathologies:

• grand mal seizures;
• status epilepticus;
• heart rhythm disturbances due to organic lesions of the central nervous system;
• overdose of cardiac glycosides;
• trigeminal neuralgia.

Applicable as prophylactic for the prevention of epilepsy in neurosurgery.

Contraindications

The use of Diphenin for heart failure, atrioventricular block, and sinus bradycardia is prohibited. Not prescribed for liver or kidney failure, porphyria.

Use with caution for children with rickets, the elderly and diabetics, and chronic alcoholism. Combination with Delavirdine is contraindicated.

Adverse reactions

When treated with phenytoin-based drugs, side effects such as nausea, vomiting, nervousness, and dizziness are observed. A laboratory blood test may reveal leukopenia, granulocytopenia, thrombocytopenia, and pancytopenia.

Undesirable reactions such as thickening of the lips and facial contours, osteoporosis, skin rashes, dermatitis, and systemic lupus erythematosus cannot be excluded. The allergic reaction is accompanied by anaphylaxis.

Carbamazepine

Drugs based on it are indicated for psychomotor and grand mal seizures. Carbamazepine is dispensed in tablets with a concentration of the active substance of 0.2 g.



Pharmacological properties

Drugs used for leg cramps and generalized seizures work by blocking sodium channels and reducing synaptic transmission of nerve impulses.

Carbamazepine stabilizes nerve fiber membranes and prevents the occurrence of neuronal discharges. You should choose a drug for the legs after additional consultations with a cardiologist and phlebologist.

Indications for use

Carbamazepine is indicated for the following pathologies:

• epilepsy;
• seizures;
• tonic-clonic seizures;
• mixed forms of seizures;
• alcohol withdrawal;
• acute manic states.

Can be used for neuralgia of the glossopharyngeal and trigeminal nerves as part of complex therapy.

Contraindications

Carbamazepine is not prescribed to patients with atrioventricular block, bone marrow suppression and hepatic porphyria, including cutaneous porphyria tarda. Combination with MAO inhibitors is prohibited.

Adverse reactions

The most common adverse reactions from the central nervous system are: dizziness, headache, drowsiness, migraine, weakness. Taking Carbamazepine may be accompanied by undesirable effects from the gastrointestinal tract: nausea, vomiting.

Allergic manifestations are characterized by urticaria, skin rashes, vasculitis, lymphadenopathy. If there are disturbances in other organs as a result of allergies, the drug should be discontinued.

Clonazepam

Representative of the group of benzodiazepine derivatives. Available in the form of tablets with a concentration of the active substance - clonazepam - 2 mg. Contains lactose.




Pharmacological properties

It affects many structures of the central nervous system, the limbic system and the hypothalamus, structures associated with the regulation of emotional functions. Strengthens the inhibitory effect of GABAergic neurons in the cerebral cortex.

Reduces the activity of noradrenergic, cholinergic, serotonergic neurons. Acts as an anticonvulsant, sedative, anti-anxiety and hypnotic.

Indications

The use of Clonazepam is indicated in the following cases:

• all forms of epilepsy in adults and children;
• epileptic seizures - complex and simple;
• secondary caused simple seizures;
• primary and secondary tonic-clonic seizures;
• myoclonic and clonic convulsions;
• Lennox-Gastaut syndrome;
• paroxysmal fear syndrome.

Can be used to eliminate fears and phobias, in particular the fear of open spaces. Not used to treat phobias in minor patients.

Contraindications

The use of Clonazepam is contraindicated in cases of respiratory dysfunction or respiratory failure, disorders of consciousness and sleep apnea.

Prescription is prohibited for patients with acute-angle glaucoma, myasthenia gravis, and during breastfeeding. Severe liver and/or kidney dysfunction is a contraindication.

Adverse reactions

The most common adverse reactions are observed from the central nervous system: fatigue, muscle weakness, impaired coordination of movements, dizziness. Symptoms are temporary and disappear on their own or when the dosage is reduced.

At long-term treatment the phenomenon of slow speech and weakened coordination, visual disturbances in the form of double vision develops. Allergic reactions are possible.

Lamotrigine

One of the most popular drugs against seizures and epilepsy. Available in tablet form. One tablet contains 25, 50, 100 or 200 mg of lamotrigine.

The drug also contains lactose monohydrate.



Pharmacological properties

An anticonvulsant drug whose mechanism of action is associated with blocking voltage-gated sodium channels of the presynaptic membrane. The drug acts so that glutamate, an amino acid that plays a decisive role in the formation of an epileptic seizure, does not enter the synaptic cleft.

Indications and contraindications

For adults and children over 12 years of age, Lamotrigine is prescribed as primary and additional treatment for epilepsy, including partial and generalized seizures. Effective against tonic-clonic seizures and seizures associated with Lennox-Gastaut syndrome.

Lamotrigine is used in children over 2 years of age for the same indications.

Contraindications include hypersensitivity to active substance or other components of the drug.

Seizures of various origins occur six times more often in children than in adults. They can be the result of dehydration, imbalance of fluids and minerals, critical deficiency of potassium and magnesium, hypothermia, poisoning, intoxication, epilepsy, pinched nerve in the canal, and so on. Seizures require immediate intervention, especially if they occur in children in the first two years of life, because if the spasms are not eliminated in time, this is fraught with serious damage to the baby’s central nervous system and cerebral edema. Anticonvulsants come to the rescue.

Anticonvulsants for children are prescribed in combination with other medications (anti-inflammatory, analgesics, antivirals, sedatives) after identifying the cause of seizures.

To do this, the doctor will carefully study the full picture of the disease, take into account what time of day the child most often experiences seizures, how often they occur, and what provokes them. Treatment usually takes place in a hospital setting under the constant supervision of doctors.

Therapy with anticonvulsants will also require a lot of additional studies - ECG, MRI, etc.

How do they work?

Anticonvulsants act on the central nervous system, suppressing it, thereby stopping convulsive spasms. However, some representatives of anticonvulsants have an additional effect - they depress the respiratory center, and this can be very dangerous for children, especially small ones. Such respiratory depressants against seizures include barbiturates and magnesium sulfate.

Medicines that have a slight effect on the child’s breathing are benzodiazepines, droperidol with fentanyl, and lidocaine.

With the help of relatively gentle benzodiazepines (Sibazon, Seduxen), you can cope with seizures of any origin. They prevent the propagation of nerve impulses in the brain and spinal cord.

Droperidol with fentanyl is quite often used to treat children.

Lidocaine for fast intravenous administration stops any seizures by acting at the cellular level - ions begin to penetrate the cell membrane more easily.

Among the barbiturates, the most famous are Phenobarbital and Hexenal.“Phenobarbital” acts for a long time, but the effect of taking it is not achieved immediately, and when stopping seizures, time sometimes plays a decisive role. Moreover, with age, the effect of the drug is achieved faster. In children under one year old, it occurs only 5 hours after administration, and in children over two years old, Phenobarbital is absorbed from the gastrointestinal tract twice as fast.

They try not to prescribe Hexenal to children, as it has a very strong effect on respiratory system, suppressing it like anesthetics.

Magnesium sulfate is also used infrequently in pediatrics, mainly to eliminate seizures associated with cerebral edema and magnesium imbalance.

The most important factor in treating seizures in children is determining the optimal dose of the drug. It is calculated strictly individually; specialists try to start treatment with small doses, gradually increasing them as needed.

The most difficult question to answer is how long the course of treatment with anticonvulsants lasts. There is no single standard, since the child needs to take them either until complete recovery, or for the rest of his life if the seizures are associated with severe hereditary pathologies.

Classification

According to the method of action and active substance, all anticonvulsants are divided into several groups:

• Iminostilbenes. Anticonvulsant medications with excellent analgesic and antidepressant effects. Improves mood, eliminates muscle spasms.
• Valproate. Anticonvulsants, which have the ability to relax muscles while providing a sedative effect. They also improve mood and normalize the patient’s psychological state.
• Barbiturates. They perfectly stop seizures, lower blood pressure and have a fairly pronounced hypnotic effect.
• Succiminids. These are anticonvulsant medications, which are indispensable in cases where it is necessary to eliminate spasms in individual organs, with neuralgia.
• Benzodiazepines. With the help of these medications, prolonged convulsive seizures are suppressed; the drugs are prescribed for epilepsy.

Pediatric anti-seizure medications must meet several important criteria. They should not have a suppressive effect on the psyche, should not cause addiction or dependence, and the medications must be hypoallergenic.

Parents have neither the moral nor the legal right to choose such serious drugs for their children on their own. All anticonvulsants in Russian pharmacies are sold only upon presentation of a prescription, which is prescribed by a doctor after establishing the causes of convulsive conditions.

List of anticonvulsant medications for children

"Carbamazepine". This antiepileptic drug from the category of iminosbenes has many advantages. It reduces pain in those who suffer from neuralgia. Reduces the frequency of attacks in epilepsy; after several days of taking the drug, there is a decrease in anxiety, a decrease in aggressiveness in adolescents and children. The medicine is absorbed quite slowly, but it acts completely and for a long time. The product is available in tablets. Carbamazepine is prescribed to children from 3 years of age.

"Zeptol". An antiepileptic drug such as iminostilbenes improves mood by suppressing the production of norepinephrine and dopamine and relieves pain. The drug is prescribed for epilepsy and trigeminal neuralgia. The drug is available in tablet form. Children can be given the medicine from the age of three.

"Valparine". Anticonvulsant medicine of the vaoproate group. The drug does not depress breathing, does not affect blood pressure, and has a moderate sedative effect. "Valparin" is prescribed for the treatment of epilepsy, for seizures associated with organic brain lesions, for febrile seizures (convulsions at high temperatures in children from birth to 6 years).

"Apilepsin". This anticonvulsant drug is prescribed not only for the treatment of epilepsy, but also for childhood tics, as well as for febrile seizures in children. The medicine is available in the form of drops for oral administration, tablets, dry substance for intravenous injections and droppers, and also in the form of syrup. Children under 3 years of age can take the medication in syrup. Starting from 3 years, other forms of the drug are allowed.

"Convulex". The anticonvulsant drug of the vaoproate group has a mild sedative effect and the ability to relax muscles. The drug allows you to cope with a wide range of seizures of various origins, from epileptic to febrile. In addition, Konvulex is prescribed to children who have bipolar disorders. Release forms are different - from dry substances for subsequent preparation of injections to capsules and tablets. The so-called “children's” forms of the medicine are oral drops and syrup. Capsules and tablets are contraindicated in children under 3 years of age. They can only be given liquid forms of Convulex.

"Phenobarbital". This anticonvulsant belongs to the category of barbiturates. It depresses some areas of the cerebral cortex, including the respiratory center. Has a hypnotic effect. The drug will be prescribed to a child for the treatment of epilepsy, severe sleep disorders, spastic paralysis, and a number of seizures not associated with manifestations of epilepsy. Available in tablets. Can be prescribed to children from birth.

"Clonazepam". The brightest representative group of benzodiazepines. Approved for use in children of any age with epilepsy, nodule spasms, and atonic seizures. Available in tablets and solution for intravenous administration.

"Sibazon"- a tranquilizer with an anticonvulsant effect. May lower blood pressure. Used for muscle cramps of various origins. Available in tablets and solution for intravenous injection. It is used to relieve epileptic seizures and febrile convulsions in children from one year of age.

In addition, Antilepsin, Iktoril, Rivotril, Pufemid, Ronton, Etimal and Sereysky’s Mixture are effective against childhood seizures.

What not to do?

If your child has seizures, do not try to figure out the cause on your own. Call " Ambulance“And while you are waiting for the doctors, carefully observe the baby - what type of convulsions he is experiencing, how severe the pain syndrome is, pay attention to the duration of the convulsive spasms. All this information will be useful later for specialists to establish the correct diagnosis.

You should not give your child any anticonvulsants on your own. Also, do not give your baby water or food, because their particles can get into the respiratory tract and cause suffocation.

Do not try to get the child's tongue. This is a common misconception. The baby won’t swallow his tongue, but he can suffocate if fragments of teeth injured when trying to open his jaw get into his respiratory tract.

Do not hold a child in a state of convulsions in one fixed position. This can cause serious joint injuries, sprains, and muscle tears.

The famous pediatrician Komarovsky talks in detail about seizures:

Advice for parents from a doctor at the Russian Union of Pediatricians: