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Antiepileptic drugs and mechanisms of epileptogenesis. A review

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Abstract

This paper analyzes the effect of conventional (phenobarbital, phenytoin, carbamazepine, ethosuximide, valproate) and some novel (vigabatrin, lamotrigine, felbamate) AEDs on some basic mechanisms involved in focal and/or generalized epileptogenesis (Na+ voltage-dependent channels and sustained repetitive firing, L-, N-, and T-type Ca2+ currents, GABA-mediated inhibition, Glu/Asp-mediated excitation, after-hyperpolarization). According to this analysis, AEDs can be divided into two main categories, those with only one specific action and those with multiple actions. A speculative correlation is proposed between AED effects on the mechanism of epileptogenesis and their known clinical effect on seizures.

Sommario

Vengono analizzate le azioni dei farmaci antiepilettici convenzionali (fenobarbital, fenitoina, carbamazepina, etosuccimide, valproato) e di quelli appartenenti alla nuova generazione (vigabatrin, lamotrigina, felbamato) sui meccanismi di base implicati nella genesi dell' epilessia focale e/o generalizzata. I meccanismi considerati sono: (1) canali Na+ voltaggio-dipendenti e scarica ripetitiva prolungata; (2) correnti Ca2+ dipendenti di tipo L, N e T; (3) inibizione GABA-mediata; (4) eccitazione Glu/Asp-mediata; (5) iperpolarizzazione postuma. Sulla base di queste variabili, i farmaci antiepilettici possono essere divisi in due principali categorie, quelli che presentano una sola azione specifica e quelli che agirebbero in più modi. Inoltre, si è cercato di correlare gli effetti che i farmaci antiepilettici hanno sui meccanismi di base dell' epilettogenesi con la loro azione clinica sulle crisi.

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  1. Cattedra di Neurologia, Università di Torino. Facoltà di Medicina e Chirurgia di Novara, C.so Mazzini 18, 28100, Novara, (Italy)

    Mutani R., Cantello R., Gianelli M. & Civardi C.

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  1. Mutani R.
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  3. Gianelli M.
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Mutani, R., Cantello, R., Gianelli, M. et al. Antiepileptic drugs and mechanisms of epileptogenesis. A review. Ital J Neuro Sci 16, 217–222 (1995). https://doi.org/10.1007/BF02282992

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