8 drugs for seizures (antiepileptic drugs, probes)

Review of the best according to the editors. About the selection criteria. The the material is subjective, is not advertising and is not serves as a guide to the purchase. Before purchase is needed consultation with a specialist.

You do not need to have a medical education to understand that such cramps. Each of us had them all. Cramp is painful, unpredictable, and involuntary skeletal contraction the muscles. But it happens that the muscle only trembles slightly. So, for example, the eye can twitch spontaneously, or rather – eyelid. This is not a cramp, but a fasciculation, that is, not synchronous involuntary contraction of the entire muscle, and trembling of individual fibers that are innervated by a small motor branch. It may to bother and annoy, but more often than not the topic of the article applies.

What are cramps?

Here is an example of true but local seizures. Older people as well patients with heart failure and edema quite often take diuretics. Very famous and effective Furosemide, or Lasix, which has a pronounced diuretic effect. But at the same time he has an important drawback: he is from the body along with the liquid also removes potassium. Therefore, if we accept a large dose, and at the same time not compensate for the future loss potassium by (Pananginum tablets or Asparkam), then it is possible to reach hypokalemia, in which the concentration of potassium in the plasma blood drops. A characteristic symptom of hypokalemia after administration diuretics will cramp, most often at night, and most often in calf muscles. This is the most common cause of unauthorized seizures. overdose of diuretics.

Physiological seizure may occur when swimming in cold water, based on the tonic contraction reflex – order for intensive work in conditions of vasospasm and lack nutrients.

A number of other reasons can be added to these examples. familiar to doctors. It:

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

But in the present, the material will be about completely different convulsions, and about other medicines – not about Panangin, and not About drugs for anesthesia, which stop opistotonus (spilled cramps) with tetanus. They help with cramps that not born in the muscle itself or in a muscle group, but in the cerebral cortex brain. Simultaneous synchronous discharge of motor or sensory neurons, focal or general “flash” leads to or convulsive syndrome in all its diversity, or non-convulsive equivalents (sensitive aura, vegetative). This disease is called epilepsy, or epileptic disease. But there is also an episindrome. And what is this, and what is its difference?

Epilepsy or episindrome?

In addition to epilepsy, which is considered the primary disease from to end unclear reasons, convulsive syndrome (episindrome) may provoke another pathology, for example, a head tumor brain, or tumor of the meninges, which periodically compresses and irritates the cerebral cortex. This condition, when which has a clear cause of irritation of the cortex, is called not epilepsy, and episindrome. Episyndrome is considered secondary phenomenon, and it is important to find this reason in time. Quite often it the syndrome occurs as a result of a severe traumatic brain injury, as a consequence of purulent encephalitis and meningitis, and with others conditions. If, despite all the persistent searches for a cause, they were unsuccessful, and the patient has a periodically explicit clinic seizures, or their equivalents, are then diagnosed epilepsy.

The role of EEG in the diagnosis of epilepsy

For the diagnosis of epilepsy and episindroma, there is, in addition to the obvious clinics, just one but very accurate way of instrumental diagnostics, which is used in different versions. This is a record. EEG, or electroencephalogram, which captures the biocurrents of neurons brain. If there are special ones on the EEG, pathological rhythms, for example peak-wave complexes, then the patient there is increased convulsive readiness, and epileptic activity. Such a person will not be given permission to drive a car, it cannot serve in the armed forces, it will not pilot, because at any moment this convulsive readiness, recorded on an encephalogram may appear real a fit. There are also non-convulsive equivalents that are also needed. be sure to treat.

Here for the treatment of epilepsy, and seizures caused by focal discharges of various parts of the cerebral cortex, and there are anticonvulsants. Their other name is antiepileptic drugs, PEP.

Do not think that a long and sometimes lifelong treatment with the established diagnosis of epilepsy with these agents, it is aimed only prevent the occurrence of convulsive syndrome, although this also very important. Taking antiepileptic drugs allows prevent the development of characteristic personality changes that called epileptoid psychopathy. Peculiar to her vindictiveness, excessive pathological circumstance, scrupulousness, suspiciousness, ridiculous contrast of use in the use of diminutive and gentle nouns (“little knife”, “bed”) in combination with cruelty.

Epilepsy is a fairly often diagnosed disease, and is a social problem for developed countries. So, in the USA, about 1% and the population has various diagnoses related to this disease, and more often epilepsy, only a stroke is diagnosed. In total, there are about 50 million patients in the world, and the frequency of occurrence in Russia on average – 7 cases per 2000 population, or 1 case per 285 people. This is quite a lot, and PEPs are in demand. Before consider anticonvulsants and their effects on the body, – A bit of the history of treatment for epilepsy.

From the history of treatment of epilepsy

Perhaps the real, scientific epilepsy began in the middle of XIX century. Before that, patients were isolated, lived in monasteries, were considered holy fools or soothsayers of truth. True, sometimes they tried treat and craniotomy, which often ended in death.

The first successful drug that really had efficiency, there was potassium bromide, and bromine compounds became use as sedatives and cures. Reason prescribing bromine was one of the false theories that believed that epilepsy occurs due to excessive sexual drives, and the patient must be reassured. With bromine, they just “guessed”, so same as with other means. For about 50 years, epilepsy has been treated. bromine drugs, but true anticonvulsant activity, they are not possess and only inhibit central nervous function system.

But with the beginning of the 20th century, the first drug with the true anticonvulsant activity from the group of barbiturates, which called phenobarbital. For decades, it has been used for treatment of various forms of epilepsy, and is still used, however, with severe restrictions. Surprisingly, phenobarbital is the only over-the-counter drug from the barbiturate group in Russia, which can be acquired quite freely, though not in pure form. It is part of the usual Valocordin or Corvalol, with peppermint oil, hop oil, ethyl bromisovalerianate and ethyl alcohol, providing sedative and sleeping pills act.

Then the discoveries fell, as if from a cornucopia. In the thirties years phenytoin was found, in the late sixties – carbamazepine, which are still considered the “gold standard” in treatment epilepsy. Then, from the eighties to nineties in treatment regimens antiepileptic drugs of 2 and 3 generations began to be used. This article discusses the most famous tools, belonging to the first and second generations – affordable and popular language.

All drugs for the treatment of epilepsy should prevent spontaneous development of a common impulse that affects the entire neuron. For it is necessary to reduce the activity of neurons, that is, to reduce action potential, and ability of a nerve cell to take from other neurons and transmit excitement. It is achieved various mechanisms. Will be considered first antiepileptic drugs of the first generation, and then – and more modern. For each drug will be given synonyms and trade names registered in the territory Russian Federation. A range of retailers will be given for drugs prices relevant for pharmacies of all forms of ownership in the territory Russian Federation for September 2019.

Overview of modern drugs for seizures (antiepileptic drugs, probes)

Nomination review position Name of product price
First generation probe 1 Carbamazepine (Finlepsin, Tegretol) 67 rub
2 Valproic acid (Depakin-chrono, Convulex) 234 rub
3 Ethosuximide (Suksilep) 2 190 rub.
4 Phenobarbital 269 ​​rub
Remedies for second-generation seizures 1 Lamotrigine (Convulsan, Lamictal, Lamitor, Lamolep, Seisar) 790 rub
2 Topiramat (Topamax, Maxitopyr, Topalepsin) 736 rub
3 Levetiracetam (Keppra, Comviron, Levetinol, Epiterra, Epitropyl) 776 rub
4 Neurontin (gabapentin) 892 rub

First generation probe

Surprisingly, the entire antiepileptic activity of drugs the first generation was discovered as a result of random research. There were no targeted searches or modifications already known drugs in search of higher activity. By chance phenobarbital, phenytoin, valproate, ethosuximide and other medicines. Consider those that are still then help patients, even with severe forms of epilepsy, and in in some cases, they are still preferred by epileptologists even the latest drugs.

Carbamazepine (Finlepsin, Tegretol)

Carbamazepine

Carbamazepine is perhaps the most widely used antiepileptic agent. Probably the share of everyone else drugs account for less sales than just carbamazepine.

And this is because its pharmacological action is not only anticonvulsant, but also analgesic. He is very good relieves a special kind of pain, neuropathic pain. This pain develops by a mechanism similar to a burst of neuron activity in 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 a stroke electric current, has an unpleasant, burning tint.

In addition, carbamazepine is used in psychiatry as a normotimic. and anti-manic drug. Carbamazepine acts by blocking sodium channels, and thereby inhibits action potential neurons. This leads to an increase in the reduced convulsive threshold, and reduces the risk of developing an attack. Carbamazepine is indicated for simple, partial seizures, as well as in generalized conditions, which are called the great tonic-clonic convulsive a fit.

If it is used in children, it well reduces depression and anxiety, reduces the potential for irritability and aggression. Also Carbamazepine is indicated in the treatment of chronic alcoholism, for relief of alcohol withdrawal symptoms, symptoms such as irritability and tremor.

There is carbamazepine in prolonged form, which acts longer, for example Finlepsin Retard. The merit of this forms in that the concentration of the substance in the blood plasma is more constant and stable, and less prone to jumps. It improves anticonvulsant effect. Commissioning of the prolonged form made it possible to use carbamazepine only once per day.

Carbamazepine is annually included in the list of vital Essential Medicines (Essential Drugs), and is inexpensive. So, Finlepsin in a dosage of 200 mg No. 50 costs from 200 to 270 rubles., And domestic INN-generic Carbamazepine manufactured by Obolenskoye, can be purchased even for 60 rubles. Of course, there is a suspicion that It will not work as well as well-known brands.

Advantages and disadvantages

The dignity of carbamazepine can be considered the breadth of action, he It is used for various forms of epilepsy, and not only for it. is he cheap, assigned without any problems for a long period, but has some limitations. It can not be used with severe anemia and a decrease in leukocytes in the blood, with cardiac arrhythmias (atrioventricular block), in case of hypersensitivity to tricyclic antidepressants, the representative of which he is an.

Care must be taken in case of heart failure, and especially in combination with chronic alcoholism, in the case of increased secretion of antidiuretic hormone and insufficiency adrenal cortex, as well as with glaucoma. Especially need to be carefully watch pregnant women who should apply Carbamazepine in minimum dosages. Also a drawback is the need to take the drug quite often (except retarded form), up to three times a day. Against the background of carbamazepine various side effects develop, most often drowsiness, dizziness, loss of appetite and other disorders. therefore the patient after the start of treatment must be observed in a doctor. There are also symptoms of overdose, and special cases interactions with other medicines, but they are all known, and well studied.

Valproic acid (Depakin-chrono, Convulex)

Valproic

This first-generation drug is widely known here under the name Depakin-chrono, which is released by Sanofi, or Konvuleks, the Austrian company Valeant. This medicine is more expensive than Carbamazepine, two, or even three times. Depakine 500 mg No. 30 costs from 220 to 650 rubles., and Konvuleks has about the same cost.

The active substance of Convulex is valproic acid, therefore, experts call these medicines valproate – soluble salts of this acid. They are used in hospitals and ambulatory, available in tablets, in syrup, and even in ampoules for intravenous use.

The drug, in addition to the anticonvulsant effect, relaxes muscles, acting as a central muscle relaxant (Midokalm, Sirdalud), and produces a sedative effect. It enhances brake concentration mediator, gamma-aminobutyric acid, because it blocks the work an enzyme that destroys this mediator.

Valproic acid is indicated for severe enough disorders such as epilepticus when it administered intravenously. Also, medicines are used for large, or generalized seizures in adults and children who may to flow differently. Convulex also treats specific syndromes, which cause severe epilepsy in children, for example Lennox-Gastaut or West syndrome. The drug is used to treat febrile seizures, as well as for the purpose of treatment manic-depressive psychosis in psychiatry, which is now called bipolar affective disorder. Apply the drug should be in those dosages and according to the scheme that was prescribed 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, and in psychiatric practice, and in relief of emergency conditions. Plus valproate also in that the remedy is effective in all forms of seizures and in all types of epilepsy, so you can start treatment with it any form of epilepsy, and valproic acid will be drug of choice, or first row.

The drug is available, still has a not very high price, but it has a number of contraindications. First of all, these are severe dysfunctions liver and pancreas, hepatitis and pancreatitis, decrease platelet count in the blood plasma, as well as pregnancy and the period of thoracic feeding. With great care, valproate is prescribed to children, and especially before the age of three, and also if the child takes several antiepileptic drugs at once. Combination funds are always less predictable than monotherapy.

Plus Convulex and Depakin can be considered quite good. tolerance, and low number of side effects that dose dependent. If there are adverse reactions, then this is most often nausea, tiredness, flashing flies before the eyes, anemia or changes in body weight, both in the direction of increase and in decrease side. In tests, the patient may increase bilirubin, the concentration of hepatic transaminases and nitrogen.

Do not combine concurrent administration in one patient valproate and carbamazepine because convulex together with carbamazepine contributes to an easier overdose of the latter. Do not combine Convulex with phenobarbital, antipsychotics, antidepressants and some antibiotics from the group carbapenems.

It is strictly forbidden to take with valproate treatment alcohol, as, however, in the case of other drugs, because the reception ethyl alcohol facilitates the appearance of epileptic seizures. The combination of ethanol and valproate intake leads to its enhanced toxic effects on the liver.

Ethosuximide (Suksilep)

ETOSUKSIMID

This drug is from the group of antiepileptic drugs of the first generations can be considered by far the most expensive. Bottle 100 capsules, however, will cost about 3,000 rub., in pharmacies it is found infrequently, and may even be in deficit. If we talk about the average, optimal daily dose, then this is 15 mg per kg of weight in adults. Therefore the person who will weigh 80 kg, you will need 5 such tablets per day, which means that the package for 3000 rubles will end after 20 days of admission. The cost of the monthly course will be approximately 4,500 rubles.

Why is suksilep used? First of all, for the treatment of small epileptic seizures. Its niche is special small seizures with myoclonic component, impulsive juvenile seizures, as well as special forms of absences. Such a “narrow specialization” and allowed Suksilep to be a leader in the “narrow niche” in demand, despite its relatively high cost. As in any another case, the antiepileptic drug Suksilep begins applied with dose titration, gradually increasing it by one tablet every 5 days until seizures contract or disappear at all. You can raise the drug, but only to the limit – to dosages of not more than 6 tablets per day.

Advantages and disadvantages

Suksilep is usually well tolerated, and from contraindications it is severe dysfunction of the internal organs: liver and kidney. The medicine is contraindicated in pregnant and lactating women, and side effects of this drug are about the same as that of carbamazepine. Naturally, the biggest minus of the drug is its high price and not always in pharmacies. But still, given its unique action on particular forms of epilepsy has put up with these shortcomings – because there are no competitors yet. A drug only imported: French company Delfarm Lille, or German companies – Jena Farm, and Mibe Artsnaymittel.

Phenobarbital

Phenobarbital

Phenobarbital is a really cheap drug, and with it I had to start a review of cure drugs. One pack of 10 100 mg tablets each, sold for only 23 rubles. Almost a monopoly on the production of phenobarbital has Federal enterprise – Moscow endocrine plant. In addition to this dosage, it is available in tablets of 50 mg, and 5 mg.

The official instruction for phenobarbital states that it is not only antiepileptic, but also sleeping pills. Like all barbiturates, it interacts with a particular structure gamma-aminobutyric acid, and lowers the excitability of cell membranes of neurons. Phenobarbital causes a large dosage drowsiness, hypnotic effect and sedation. That’s why he enters Corvalol composition.

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

It is for this, for “plugging holes”, and is issued Corvalol. If you count the amount of Corvalol, which is annually sold in Russia, then phenobarbital, even purely by weight, will be the most a commonly used anticonvulsant other indications. Take phenobarbital carefully, and only on the recommendation of a specialist! Few people know about this, but only 2 g of phenobarbital taken orally can cause fatal the outcome, and ingestion of 1 g causes serious poisoning. it means that half a glass of Corvalol, or 100 ml, drunk, for example, for the purpose of intoxication, contain 1.82 g of phenobarbital, and after such a “dose” you can not wake up.

Advantages and disadvantages

About phenobarbital or you can say the proverb: “old horse not spoil the furrow. “This tool for many years, and even decades was an effective anticonvulsant, but its long-term application turned out to cause significant mental impairment functions that lead to a decrease in intelligence, memory depression. Patients who have been on monotherapy for a long time phenobarbital, developed quite serious psychoses, especially in children’s age.

Moreover, the range of action of phenobarbital on various forms epilepsy is not as wide as that of carbamazepine or valproic acids, for example, if we are talking about abscess epilepsy, then on the contrary, it aggravates the course of this form of the disease, and even sometimes provokes attacks. Therefore, at present, phenobarbital, despite its prevalence and cheapness, it is considered the best drug of the first choice only if talking about seizures in newborns.

Remedies for second-generation seizures

Since the beginning of the 1990s, funds from convulsions of the second generation. These are the ones that are now famous. drugs like Neurontin and Lamictal, Keppra and Trileptal, Lyrics and Topamax other means.

If we compare them with first-generation drugs, then they the main difference is targeted search, not accidental discovery, and much fewer side effects. First medicine generations quite often influenced various enzyme systems, and slowed down, or increased their activity. It caused unwanted bursts of hormonal background, provoked cognitive impairment. Therefore, in the treatment of epilepsy means second generation more simplicity in schemes, and commitment patients to treatment – significantly higher. Of course, and the cost of these drugs above.

Given that in patients, for example, with generalized epilepsy, personality changes, such compliance, or commitment is absolutely essential for success. IN in general, their main difference is greater security and better portability. In order not to list and not repeat, immediately give here the most common common side effects for gabapentin, topamax and lamotrigine. Often, of course, dizziness occurred, and then – transient diplopia, or double vision. On Topamax, there were disorders speech, but the most frequent was always drowsiness. Consider the most typical and popular representatives of the second generation cure for seizures.

Lamotrigine (Convulsan, Lamictal, Lamitor, Lamolep, Seisar)

Lamotrigine (Convulsan, Lamictal, Lamitor, Lamolep, Seisar)

Perhaps Lamotrigine is the most famous among epileptologists second generation drug and it is a folic antagonist acid, and a pretty good sodium channel blocker. His role – suppress the output of neurotransmitters that excite neurons in synaptic cleft. It is rapidly absorbed by ingestion, and lives in the body for a long time, its half-life is more than 30 hours. Therefore, Lamotrigine can be taken in the morning, once in a day.

Lamotrigine is indicated for use in patients over 12 years of age for treatment various forms of epilepsy, listing which give nothing a person without a medical education. For example, this is – combination therapy of refractory partial epilepsy, as well as Lennox-Gastaut syndrome in children. But it can be used for treating large convulsive seizures, i.e. generalized epilepsy. Important that the international antiepileptic league called it the drug of choice for older high evidence for the treatment of partial forms.

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

The original drug Lamiktal, which is produced by the company Glaxosmithkline from the UK will cost an average of 2000 rub. per package (capsules 100 mg No. 30), and this package may enough for a week. Accordingly, a monthly course of treatment the original drug will cost 8,000 rubles. per month. It is for Russian is very, very expensive. Gideon company Lamolep Richter will cost 1400 rubles. in the same dosage, and monthly the course will cost 5500, but it is also a high cost. Most a cheap analogue is Lamotrigine, Canonfarm company’s INN generic, and its cost is about 600 rubles. for packing.

Advantages and disadvantages

Of the side effects of Lamotrigine, the most common, and, alas, unpleasant and dangerous, are considered skin rashes, or exanthema. Quite rarely, it manifests itself as a severe syndrome – Stevens-Johnson or Lyell when the skin exfoliates and it the condition is life-threatening, and is characterized by high mortality. If only the patient on the background of taking Lamotrigine appeared the slightest hint of skin change, the drug is an urgent canceled, because in most cases the rash is stubborn and irreversible character. This is of course a very serious side effect, but, fortunately, very rare. The development of this can be avoided if increase the dose when choosing the right concentration very slowly.

Another side effect is vitiligo, drowsiness and nausea, decrease in platelets in blood plasma, leukopenia and increase hepatic transaminases. But if we talk about side effects in population, the lamotrigine is tolerated quite well. In patients in addition to the antiepileptic effect, mood improves, he exhibits an antidepressant effect and improves attention. In Lamotrigine well treats epilepsy in the elderly, and especially with the presence of depression.

Topiramat (Topamax, Maxitopyr, Topalepsin)

Topiramat (Topamax, Maxitopyr, Topalepsin)

Original Topamax manufactured by Janssen Сilag from Switzerland, costs from 1100 to 1300 rubles per package (60 50 mg capsules). Domestic analogue can be bought at a price about 190 rubles, but you need to consider that the concentration is half that 25 mg, and the number of capsules is also half as much (30 pcs.). therefore you must immediately multiply by four so that the comparison is fair. And then the equivalent amount of topiramate produced in Russia, will cost about 800 rubles. Therefore, it’s better to hold out a little, and purchase the original Swiss drug.

Topamax reduces the frequency of action potential, and works with gamma-aminobutyric acid, blocking sodium channels. He is shown to treatment strictly over two years of age, as for the first time diagnosed epilepsy, and as part of a comprehensive treatment, along with other drugs. It is important that Topamax can be used. for the prevention of migraine attacks, and is used only in interictal period.

Topamax should be used by opening the capsules, and mixing them with any soft food, swallow immediately and without chewing. Can swallow whole but pre-disperse causes faster and more uniform absorption. Daily average the dose that must be carefully selected together with the doctor is approximately 300 mg. This means that the original product is enough for 10 days, and the cost of a monthly course of treatment will be about 3300 rubles.

Advantages and disadvantages

Topiramate is well tolerated, there are no withdrawal symptoms, if you need to abruptly cancel this tool. Most often Patients noted a decrease in body weight, which depends on the dose. In the presence of obesity, this is very positive, but, alas, not mandatory side effect. However, there was another. Decreased concentration, dizziness, drowsiness, and weakness. This means that against the backdrop of Topamax treatment, it’s better not to get behind the wheel. Of course, this applies to persons with migraine, because patients with epilepsy are prohibited from driving. In addition, topiramate contraindicated in pregnant and lactating women, and in patients with urolithiasis, since the remedy can lead to the formation of calcium or phosphate stones – it alkalizes urine. Especially should be observed women taking hormonal contraceptives with Topamax. Efficiency contraceptives can be significantly reduced.

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

LEVETIRACETAM (KEPPRA, KOMVIRON, LEVETINOL, EPITERRA, EPITROPIL)

For the first time, the Croatian company Pliva began producing Keppru. Now it is produced by the Belgian company UCB – Pharma, and in Russia produced in the form of levetiracetam companies “Ozone” and “R-farm”. One a pack of Keppra tablets in an amount of 30 pieces will cost approximately 800 rub., 250 mg each. Domestic medicine will cost more than half the price of Ozone levetiracetam in September 2019 can be bought for 315 rubles.

This drug remains a mystery in many ways, since it is still the antiepileptic mechanism of levetiracetam is unclear. However he it is used both for partial seizures and for primary generalized, large seizures in adults and in children over 12 years old. Partial seizures may or may not have a secondary seizure generalization, but levetiracetam will be quite effective. It is applied twice a day, and the dose begins one at a time tablet twice a day. This is the stage of getting used to the drug and evaluating its portability. After 2 weeks, the dose is doubled, up to 1 g in day. Usually, the therapeutic effect begins at this dosage, and in if necessary, it can be increased, but not more than twice, to 3 g per day. In addition to such monotherapy, there may be complex therapy, when in addition to levetiracetam, any other drug, then the calculation is based on the dosage on kilogram of body weight.

Advantages and disadvantages

Keppra and quality levetiracetam are well tolerated, and significantly improves the quality of life of patients. Of side effects most often drowsiness, and the higher, the more pronounced it is. On the second place – weight loss, diarrhea, double vision. Of course, people with drowsiness do not want to sit down steering wheel, but a patient with a diagnosis of epilepsy cannot get right, therefore, this condition is not very relevant. Also for patients with such the diagnosis is forbidden to work in hazardous working conditions, with moving machines and mechanisms, this also needs to be taken into account. After all, it’s not always a patient with a newly diagnosed convulsive syndrome can be immediately removed by the labor protection department, or transferred to non-hazardous work. Do not use levetiracetam in tablets for children up to four years, and in solution – up to 1 month. Caution him the elderly, and people with severe liver damage. In extreme cases, the medicine can be used in pregnant women and during breastfeeding feeding, but this should be decided by the council.

Neurontin (gabapentin)

Neurontin (gabapentin)

Unlike antiepileptic drugs of 2 generations, gabapentin gained triumphant fame in addition to the treatment of epilepsy, and in another area is the treatment of neuropathic pain, and more more effective than carbamazepine. He is known as a drug that significantly improves the quality of life in chronic, burning, and non-curable carbamazepine pain. Gabapentin works with conditions such as trigeminal neuralgia, a condition after shingles called postherpetic neuralgia.

The most expensive drug is the original drug. Neurontin, Pfizer company. One pack of 300 mg capsules per 50 pieces will cost an average of 1000 rubles. A drug The tebantin of the company Gideon Richter will cost about the same. The maximum cost of Konvalis (domestic company Pharmstandard – 700 rubles.), And Katen Belupo company costs from 350 to 680 rub

It would seem that this is a low cost, but, unlike others drugs, selection of gabapentin therapy and increase doses can have quite large limits.

Gabapentin acts a little differently than a simple blocker sodium channels. It does not affect capture at all, not on GABA metabolism – this inhibitory mediator. It is believed that he affects in general, not on the sodium channel, but on the calcium channel. It’s important that it does not affect the metabolism of dopamine, serotonin and norepinephrine, and no side effects of SSRIs that are used as widespread antidepressants.

The drug is indicated, primarily for the treatment of neuropathic pain, and as an anticonvulsant – for the treatment of partial seizures in the presence of secondary generalization and without it in children over 12 years old 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 one capsule 3 times in day. The maximum dosage is 4 times greater, i.e. 3600 mg per day. But doctors say that a dosage of over 1800 mg per day is unlikely will give a positive effect, usually a reduction in pain or anticonvulsant activity works up to this dose, that is, up to dosage 2 capsules 3 times daily.

Afraid that the drug will be poorly tolerated is not worth it, he It is well tolerated in doses up to almost 5 g per day. It is estimated that one pack of Neurontin is enough for about 3 days with an average dose calculation. Then the monthly rate will cost 10,000 rubles. AND given its continued use for the treatment of neuropathic pain, this pharmacoeconomic aspect it makes up a well-known a problem.

Advantages and disadvantages

The great advantage of gabapentin is its really proven effectiveness, reducing burning and unpleasant pains, who torment people at night, and even cause suicide. The inconvenience can be considered frequent admission – three times a day, the need to count the number of capsules before reaching desired effect. Gabapentin, on the other hand, is tolerated almost all is very good, and of the side effects most often constipation, shortness of breath, blurred vision. Effects depend on doses, and drowsiness may also occur at high dosages and motor coordination disorder.

It should be remembered that it can not be used for children under 12 years old age as the main drug for treatment partial seizures. During pregnancy and lactation, apply it is possible, but again – by agreement of specialists, if the benefit for the mother outweighs the potential risk to the fetus. Since it is the medicine is secreted into breast milk, and the effect or its absence on the baby is unclear, then breastfeeding amid treatment gabapentin is necessary given this risk.

What’s next?

Today, the 21st century has already exchanged a second decade. Ready 3rd generation pharmaceuticals, such as Briviak. However their the appointment is still inferior to the first and second generation drugs, because even their potential is not yet clear, and even the means the second generation can easily be used for several decades to treat epilepsy.

On the other hand, sharing schemes are constantly improving, new possibilities are opening up, me and drug combinations. Some experts believe that existing drugs quite enough. Compliance as much as possible will give a much greater effect. better than the following treatment principles:

  1. start treating epilepsy as early as possible, which means that it is necessary to timely diagnose it as much as possible exactly;
  2. you need to choose a medicine as a single drug. It `s that there is a cure with one medicine, much more desirable than combine two or even three antiepileptic drugs;
  3. rationally control the dose, and reduce it before acceptable level when effects will exceed insignificant side effects.

In addition, non-drug methods are constantly being improved. treatment of this ancient, but so well-known disease. Therefore, if you, or your relatives there are strange bouts of seizures, it is urgently necessary contact a neurologist. It is very important to remember that epilepsy is not always cramping. They can be regarded as a fall, incomprehensible fainting, seizures similar to hysterical, and also just incomprehensible state of stunning, and freezing in one pose. Sometimes ambulatory arises automatically. Ok if that pressing is not a computer key. But sometimes you can instead of onions continue to cut your own fingers. Only after electroencephalography with provocation, and possibly several times, after a thorough examination by a neurologist – an epileptologist, you can set diagnosis and prescribe treatment.


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An online magazine about style, fashion, etiquette, lifestyle, and about choosing the best products and services.
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