Groups of anticonvulsants. Anticonvulsants and antiepileptic drugs. The role of the EEG in the diagnosis of epilepsy

Anticonvulsants are narrowly targeted drugs designed to relieve muscle spasms and other signs of an epileptic seizure. Some types of drugs can be taken in combination to achieve a better effect, and some are initially aimed at a comprehensive fight against the disease.

Because tablets and medicinal powders not only relieve sudden convulsions, but also alleviate the course of the disease as a whole, they are often classified as drugs (AELS). The first successful attempts at treatment with anticonvulsants were made in the late 19th and early 20th centuries. In 1857, potassium bromide was used to combat epilepsy, in 1912, phenobarbital began to be actively used, and in 1938, phenytoin was added to the list of antiepileptic drugs. Today, all over the world, including the Russian Federation, more than thirty types of drugs are used to eliminate the symptoms of epilepsy.

The main groups of medicines

Anticonvulsants are used depending on the focus of the epileptic seizure and the severity of the key symptoms. According to the modern classification, several types of antiepileptic drugs are distinguished:

• anticonvulsant barbiturates;
• drugs derived from hydantoin;
• oxazolidinone drugs;
• preparations based on succinimide;
• iminostilbenes;
• tablets containing benzodiazepines;
• medicines based on valproic acid;
• other anticonvulsants.

The main task of each group of drugs is to suppress spontaneously occurring muscle spasms without subsequent depression of the central nervous system and the formation of various psychophysical abnormalities. Any type of drug is prescribed by a doctor on a strictly individual basis after a comprehensive diagnosis of the patient and the determination of the affected area of ​​the brain. Since epilepsy occurs as a result of the formation of an excessive amount of intense electrical impulses in the neurons of the brain, the first step in the fight against the disease should be the appropriate drug intervention, which involves suppressing the activity of the affected areas of the brain and normalizing the work of its other parts.

Application features

Taking anticonvulsants lasts for several years until the patient recovers completely, or throughout life if the causes of epilepsy lie in
genetic predisposition or the disease has acquired a severe chronic form. In some cases, as an addition to drug treatment, it is proposed to perform an operation to eliminate the affected area of ​​the brain, followed by a course of rehabilitation for the patient. Surgical intervention is indicated only on the recommendation of a doctor after an appropriate diagnosis. Postoperative complications occur quite rarely and can be expressed in the form of numbness or short-term paralysis of that part of the body that was most susceptible to convulsive reactions, as well as the loss of some cognitive abilities due to the removal of one or another part of the brain.

Anticonvulsants, in turn, have a number of side effects and contraindications, which you must definitely familiarize yourself with before taking a medicine for epilepsy. It is also worth being extremely honest with your doctor, because, depending on the presence of a different type of disease in the body, a specialist can prescribe additional immunity-strengthening drugs, as well as select the most benign pills that relieve convulsions. Particular attention should be paid to pregnant women, allergy sufferers, people with disorders of the central nervous system, psycho-emotional disorders, patients with liver problems, impaired blood circulation or kidney failure. You can read more about the side effects of each drug in the table below.

Mechanisms of influence on the body

Tablets and medicinal powders from epileptic seizures also differ in the mechanism of action on the body's main receptors. There are three main criteria by which the effectiveness of the drug is determined in each individual case of epilepsy:

• Interaction with the main receptors of gamma-aminobutyric acid (GABA), which is responsible for the reactions of inhibition and excitation of neurons. Stimulation of receptors with the help of medications can reduce the intensity of the production of impulses by neurons and improve the process of inhibition. Tablets based on valproic acid, anticonvulsant barbiturates (phenobarbital), drugs containing benzodiazepines (diazepam, clonazepam, etc.), vigabatrin tablets have a similar effect;
• Decreased activity of glutamate receptors and their subsequent blocking. Glutamate is one of the main stimulating components of the nervous system; therefore, to effectively reduce the intensity of electrical impulses in neurons, it is necessary to reduce as many active glutamate receptors as possible;
• Blocking the functions of sodium and potassium channels in nerve cells for slow synaptic transmission of impulses and, as a result, the elimination of involuntary muscle spasms. A similar effect is provided by drugs carbamazepine, valproic group tablets, phenytoin and others.

To date, about 70% of people suffering from mild forms of epileptic seizures are successfully cured of the disease through the use of antiepileptic drugs. However, effective relief from the symptoms of epilepsy in more severe stages of the disease is still a topical issue for scientists and epileptologists from around the world. Any drug must meet special quality criteria, including the duration of the effect on the patient's body, high efficiency in a variety of partial and generalized seizures (especially in mixed types of the disease), anti-allergic properties, the absence of a sedative effect on the central nervous system, which consists in the occurrence of drowsiness, apathy, weakness, as well as drug dependence and addiction.

Descriptions of medicines

Anticonvulsants are divided according to the effectiveness of the impact on the body with a certain type of epileptic seizure. The table contains the main types of seizures, a list of drugs directed against the symptoms of a particular attack, as well as the main properties of each of the drugs.

Paroxysmal involuntary contractions of skeletal muscles. They can be symptoms of a number of diseases (meningitis, encephalitis, traumatic brain injury, epilepsy, cerebral edema, and others) or the result of secondary changes in the central nervous system that occur after general infections and poisonings, with metabolic disorders, in particular, with vitamin deficiency. B 6 , lack of calcium and so on. Often, convulsions are associated with systematic muscle fatigue, for example, in athletes, typists, violinists. Seizures sometimes occur in healthy people when swimming in cold water or during a night's sleep.

2. Blocking glutamate receptors or reducing its release from presynaptic endings ( lamotrigine). Since glutamate is an excitatory neurotransmitter, blockade of its receptors or a decrease in its amount leads to a decrease in the excitability of neurons.

3. Blocking of ion channels (sodium, potassium) in nerve cells, which complicates synaptic signal transmission and limits the spread of convulsive activity ( phenytoin , carbamazepine, valproic acid and sodium valproate).

It should be noted that the same drug may have several mechanisms of action.

The abundance of drugs for the treatment of epilepsy is explained by the variety of manifestations of this disease. After all, even epileptic convulsions can be of several types, and the mechanisms of their occurrence are also different. However, the creation of an ideal antiepileptic drug is still far away. Here is a short list of requirements that it must meet: high activity and long duration of action in order to prevent seizures for a long time, effectiveness in various types of epilepsy, since mixed forms of the disease are often found, the absence of sedatives, hypnotics, allergic and other properties (these substances are taken in for several months and even years), the inability to accumulate, cause addiction and drug dependence. And, for example, phenobarbital, even in small doses, can cause drowsiness, lethargy, it can accumulate in the body and be addictive. Phenytoin, as a more selective active substance, preventing the development of seizures, does not have a general inhibitory effect on the central nervous system, but, unfortunately, when taking it, dizziness, trembling of the body or its parts, involuntary eye movements, double vision, nausea, vomiting and other side effects. Carbamazepine, which is widely used in the treatment of various forms of epilepsy, like phenytoin, blocks sodium channels in the cell. Its advantage is a positive effect on the psyche: the mood improves, the activity and sociability of patients increase, and this facilitates their social and professional rehabilitation. But this drug also has disadvantages. At the beginning of treatment, carbamazepine can disrupt digestion, cause headache, dizziness, drowsiness, and inhibit psychomotor reactions. In this regard, it is not recommended to appoint drivers, machine operators and people of similar professions. When taking the drug, it is necessary to conduct regular blood tests, since a decrease in the number of leukocytes or platelets in the blood is possible. Even valproic acid, whose side effects are few and mild, enhances the undesirable properties of other antiepileptic drugs.

The negative effects of antiepileptic drugs are usually associated with a general inhibition of interneuronal transmission of impulses in the central and peripheral nervous system, which is due to insufficient selectivity of the drug action.

The role of the doctor in the treatment of epilepsy is especially increasing, because only a specialist can prescribe the necessary remedy, taking into account all factors: the spectrum of action, side effects, the form of the disease and the type of seizures.

The main antiepileptic drugs and their areas of application are shown in Table 3.1.1.

Table 3.1.1. The use of antiepileptic drugs

It is important for a patient taking antiepileptic drugs to know that the drug should not be stopped at the same time, as a withdrawal syndrome may develop, which will lead to more frequent and severe seizures. This is especially true for barbiturates and benzodiazepines, which take weeks and months to stop. Some anticonvulsants are listed below. You will find detailed information on them on the website.

[Tradename(composition or characteristic) pharmachologic effect dosage forms firm]

Benzonal tablets 0.05 g(benzobarbital) anticonvulsant children's table Aspharma(Russia)

Benzonal tablets 0.1 g(benzobarbital) anticonvulsant tab. Aspharma(Russia)

Gabitril(tiagabine) tab. Sanofi-Synthelabo(France)

Depakine(sodium valproate) antiepileptic por.lyof.d/in.; syrup for children Sanofi-Synthelabo(France)

Depakine chrono(sodium valproate + valproic acid) antiepileptic table p.o.del.; table.p.o.prolong.del. Sanofi-Synthelabo(France)

Depakine enteric 300(sodium valproate) antiepileptic tablet.p.o.solution/intestinal Sanofi-Synthelabo(France)

Carbamazepine-Acri(carbamazepine) antiepileptic, antidepressant tab. Akrikhin(Russia)

Clonazepam(clonazepam) anticonvulsant, antiepileptic, muscle relaxant, anxiolytic, sedative tab. Tarchominskie Zaklady Farmaceutyczne “Polfa”(Poland)

Convulex(valproic acid) antiepileptic drops for oral administration; caps solution/intestinal; syrup for children Gerot Pharmazeutika(Austria)

Convulsofin(calcium valproate) antiepileptic, anticonvulsant tab. Pliva(Croatia), manufacturer: AWD.pharma (Germany)

Lamictal(lamotrigine) anticonvulsant tab.; tab.zhev. GlaxoSmithKline(Great Britain)

Mazepin(carbamazepine) anticonvulsant, analgesic, sedative tab. ICN Pharmaceuticals(USA), manufacturer: ICN Marbiopharm (Russia)

Anticonvulsants are used to reduce or completely eliminate muscle cramps, as well as seizures of epilepsy. This group of drugs can be used for seizures, which have a different nature of origin.

If a person is often bothered by such manifestations, this is one of the first reasons why you need to see a doctor. Such manifestations can indicate the development of serious diseases both on the basis of the nervous system and in other organs.

• Seizures can occur in a person at different periods of life, starting from childhood. The most common causes of their manifestation are:
• Congenital malformations in the brain. In such cases, seizures begin to appear from early childhood.
• Insufficient saturation of tissues with oxygen.
• Lack of essential micronutrients.
• Traumatic brain injury.
• brain tumors.
• High temperature with SARS.
• Intoxication of the body as a result of poisoning.
• Epilepsy.

In order to get rid of the problem, it is necessary to make an accurate diagnosis. This is necessary in order to prescribe anticonvulsants precisely taking into account the individual characteristics of the human body.

When a seizure occurs, a person experiences not only a spasm, but also severe pain. The action of anticonvulsants should be aimed at eliminating symptoms, relieving signs, and relieving pain. These drugs should reduce pain, eliminate muscle spasm without inhibiting the central nervous system.

Any anticonvulsant is selected individually, taking into account the complexity and degree of development of the pathology. Depending on the severity of the disease, medications can be prescribed both for lifelong intake and for individual phases of the disease.

Fundamentals of therapy for seizures

Treatment of convulsive manifestations should be complex. For this, drugs of various effects are used:

• Means of a non-steroidal type that have an anti-inflammatory effect. They are aimed at reducing body temperature, eliminating pain.
• Medications of the analgesic group.
• Remedies for eliminating muscle spasms.
• Topical preparations, ointments and gels that are used to treat inflammation sites with muscle spasm.
• Sedative drugs to normalize the functioning of the nervous system.
• Anticonvulsants aimed at eliminating pain symptoms.

Some of the prescribed drugs have the effect of delaying the development of allergic reactions.

The main groups of anticonvulsants include:

• Iminostilbene - they are aimed at relieving tension in the muscles, after taking them, an improvement in the patient's mood is observed.
• Barbiturates are anticonvulsants that have a sedative effect. When taking drugs of this group, it must be borne in mind that they help lower blood pressure and have a hypnotic effect.
• An anticonvulsant drug based on a benzodiazepine. These types of drugs have a pronounced effect, most often they are used for epilepsy and long-term neuralgic disorders.
• Succininides are anticonvulsants for relieving spasm of individual muscles in case of neuralgia. It is necessary to drink drugs of this type with caution, since side effects in the form of nausea and sleep disturbances are possible.

The appointment of drugs is based on the nature of the origin of seizures.

Drugs for epilepsy

Any drugs should be prescribed only by a doctor, as they have many contraindications. Popular anticonvulsants include:

• Benzobamyl- the drug has a mild effect on the body, has low toxicity. A remedy for people with kidney pathologies, heart disease is contraindicated.
• primidon- an anticonvulsant drug that is used in severe forms of epilepsy. It has a powerful inhibitory effect on neurons.
• Feniton- a remedy used for slight inhibition of nerve endings. It is prescribed to patients with frequent convulsions.
• Voltaren- an anticonvulsant for neurological disorders in the spine.

Medicines for leg cramps

Spasm of the calf muscles most often occurs due to vascular pathologies, trauma, and also due to a lack of trace elements in the body. You can relieve spasm with the help of anticonvulsants for the legs. The complex can be used tablets and ointments.

The most popular anticonvulsants for leg cramps are:

• Detralex- the drug is able to reduce venous tension. It is prescribed to strengthen the walls of blood vessels, capillaries. Regular intake will reduce the manifestation of seizures. Detralex is prescribed for night cramps, heaviness in the legs, venous insufficiency. This remedy for seizures not only relieves an unpleasant symptom, but also eliminates the cause of the pathology. Thanks to the action of the anticonvulsant drug, the inflammatory process is removed and blood flow improves. As a side effect, allergic reactions may occur. In this regard, the drug is not prescribed for children under 18 years of age and pregnant women.

• Venoflebin- This is a medicine for leg cramps in the form of granules. It helps to get rid of the pain of varicose veins. Tablets are taken half an hour before meals, 8 granules 4 times a day. They need to dissolve under the tongue. In an acute condition, 40 granules are diluted in water and drunk at a time. Of the side effects, allergies may occur due to an overdose of the drug.

• Venarus- pills for cramps in the legs, increasing the elasticity of the walls of blood vessels, restoring blood flow. It is prescribed for heaviness in the legs, venous insufficiency. The drug can be used to treat varicose veins during pregnancy. The course of treatment is determined by a specialist.

• Troxevasin- an anticonvulsant, aimed at eliminating chronic problems with blood vessels. The main active ingredient reduces capillary fragility, strengthens blood vessels. The tool is used after trauma, varicose veins, high blood pressure.

• Rutascorbin- this name of pills for seizures is known to many. They have a positive effect on the entire body. The tool is used for lack of vitamins, capillary damage, swelling in the legs.

Often, cramps in the limbs occur due to a lack of certain components in the human body. In this case, leg cramp tablets should contain trace elements such as potassium, magnesium and calcium.

As such medicines are prescribed:

• Asparkam - the drug in the composition contains potassium and magnesium. It is used both for the treatment and for the prevention of cramps in the limbs.
• Propanorm is an anticonvulsant that has a number of side effects. It should not be taken without full medical advice. Propanorm is used for the full treatment of cramps in the limbs.
• Calcium D3 is an anticonvulsant drug prescribed to quickly replenish the body with calcium.
• Magnesium B6 - helps to improve the nervous excitation of muscles. As a side effect, allergic reactions may occur.

Anticonvulsants for children

Since any anticonvulsant acts depressingly on the nervous system, as well as on the respiratory center, it is necessary to select drugs for children with great care.

Anticonvulsants for children must meet several criteria. They should not have an overwhelming effect on the psyche of the child. You can give children only hypoallergenic drugs that are not addictive.

Most often, children are prescribed the following drugs:

• Carbamazepine- the drug reduces pain in patients suffering from neuralgia. After several days of taking the drug, the feeling of anxiety decreases, aggressiveness in adolescents decreases, and mood improves markedly. Epilepsy attacks become less frequent. The drug is prescribed for children from the age of three.

• Zeptol- a medicine for leg cramps with an analgesic effect. It is prescribed for trigeminal neuralgia and epilepsy. It is produced in the form of tablets and is intended for children from three years of age.
• Valparin- an anticonvulsant drug that does not depress breathing. The tool does not affect blood pressure, can be prescribed to children from birth. Most often used for convulsions at high temperatures. For children under three years of age, the drug is prescribed by injection.

• Convulex- anticonvulsants for children with a mild sedative effect. He is able to cope with convulsions of various origins. The product is available in tablets, drops and capsules.
• Sibazon is a tranquilizer with anticonvulsant effect. It should be taken with caution, as it can lower blood pressure. Produced in tablets and for intravenous injection. It can be prescribed for the relief of seizures in children from one year old.

If a child has seizures, no action can be taken on their own. Parents need to urgently call an ambulance and observe the child until it arrives. No anticonvulsant should be given without a doctor's prescription.

If night cramps recur regularly, you should consult a doctor. It is important to correctly establish the cause of this phenomenon in order to correctly select the right drugs.

ANTI-EPILEPTIC (ANTI-EPILEPTIC) MEDICINES

According to the modern classification, anticonvulsant drugs are divided into anticonvulsant barbiturates (benzobamil, benzonal, hexamidine, phenobarbital), hydantoin derivatives (diphenin), oxazolidinedione derivatives (trimethin), succinimides (pufemid, suxilep), iminostilbenes (carbamazepine), benzodiazepine derivatives (clonazepam), valproates (acediprol), various anticonvulsants (methindione, mydocalm, chloracone)

ACEDIPROLE (Acediprolum)

Synonyms: Sodium valproate, Apilepsin, Depakin, Konvuleks, Konvulsovin, Diplexil, Epikin, Orfilept, Valprin, Depaken, Deprakin, Epilim, Everiden, Leptilan, Orfiril, Propimal, Valpakin, Valporin, Valpron, etc.

Pharmachologic effect. It is a broad-spectrum antiepileptic agent.

Acediprol has not only an anticonvulsant (antiepileptic) effect. It improves the mental state and mood of patients. Acediprol has been shown to have a tranquilizing (anxiety-relieving) component, and unlike other tranquilizers, it does not have a somnolent (causing increased drowsiness), sedative (calming effect on the central nervous system) and muscle relaxant (muscle relaxing) action, while reducing the state of fear.

Indications for use. Applied in adults and children with different types of epilepsy: with various forms of generalized seizures - small (absences), large (convulsive) and polymorphic; with focal seizures (motor, psychomotor, etc.). The drug is most effective in absences (short-term loss of consciousness with complete memory loss) and pseudo-absences (short-term loss of consciousness without memory loss).

Method of application and dose. Take acediprol by mouth during or immediately after a meal. Start with taking small doses, gradually increasing them over 1-2 weeks. until a therapeutic effect is achieved; then select an individual maintenance dose.

The daily dose for adults is at the beginning of treatment 0.3-0.6 g (1-2 tablets), then it is gradually increased to 0.9-1.5 g. A single dose is 0.3-0.45 g. daily dose - 2.4 g.

The dose for children is selected individually depending on the age, severity of the disease, therapeutic effect. Usually the daily dose for children is 20-50 mg per 1 kg of body weight, the highest daily dose is 60 mg/kg. Begin treatment with 15 mg / kg, then increase the dose weekly by 5-10 mg / kg until the desired effect is achieved. The daily dose is divided into 2-3 doses. It is convenient for children to prescribe the drug in the form of a liquid dosage form - acediprol syrup.

Acediprol can be used alone or in combination with other antiepileptic drugs.

In small forms of epilepsy, it is usually limited to the use of only acediprol.

Side effect. Possible side effects: nausea, vomiting, diarrhea (diarrhea), stomach pain, anorexia (lack of appetite), drowsiness, allergic skin reactions. As a rule, these phenomena are temporary.

With prolonged use of large doses of acediprol, temporary hair loss is possible.

Rare, but the most serious reactions to acediprol are violations of the functions of the liver, pancreas and deterioration of blood clotting.

Contraindications. The drug is contraindicated in violations of the liver and pancreas, hemorrhagic diathesis (increased bleeding). Do not prescribe the drug in the first 3 months. pregnancy (at a later date, prescribed in reduced doses only with the ineffectiveness of other antiepileptic drugs). The literature provides data on cases of teratogenic (damaging the fetus) effect when using acediprol during pregnancy. It should also be borne in mind that in breastfeeding women, the drug is excreted in milk.

Release form. Tablets of 0.3 g in a package of 50 and 100 pieces; 5% syrup in glass bottles of 120 ml with a dosing spoon.

Storage conditions. List B. In a cool, dark place.

BENZOBAMIL (Benzobamylum)

Synonyms: Benzamyl, Benzoylbarbamyl.

Pharmachologic effect. It has anticonvulsant, sedative (sedative), hypnotic and hypotensive (lowering blood pressure) properties. Less toxic than benzonal and phenobarbital.

Indications for use. Epilepsy, mainly with subcortical localization of the focus of excitation, "diencephalic" form of epilepsy, status epilepticus in children.

Method of application and dose. Inside after eating. Doses for adults - 0.05-0.2 g (up to 0.3 g) 2-3 times a day, for children, depending on age - from 0.05 to 0.1 g 3 times a day. Benzobamil can be used in combination with dehydration (dehydrating), anti-inflammatory and desensitizing (preventing or inhibiting allergic reactions) therapy. In case of addiction (weakening or lack of effect with prolonged repeated use), benzobamil can be temporarily combined with equivalent doses of phenobarbital and benzonal, followed by their replacement with benzobamil again.

The equivalent ratio of benzobamyl and phenobarbital is 2-2.5:1.

Side effect. Large doses of the drug can cause drowsiness, lethargy, lowering blood pressure, ataxia (impaired coordination of movements), nystagmus (involuntary rhythmic movements of the eyeballs), difficulty speaking.

Contraindications. Damage to the kidneys and liver with a violation of their functions, decompensation of cardiac activity.

Release form. Tablets of 0.1 g in a package of 100 pieces.

Storage conditions. List B. In a tightly sealed container.

Benzonal (Benzonalum)

Synonyms: Benzobarbital.

Pharmachologic effect. It has a pronounced anticonvulsant effect; unlike phenobarbital, it does not give a hypnotic effect.

Indications for use. Convulsive forms of epilepsy, including Kozhevnikov epilepsy, focal and Jacksonian seizures.

Method of application and dose. inside. A single dose for adults is 0.1-0.2 g, a daily dose is 0.8 g, for children, depending on age, a single dose is 0.025-0.1 g, a daily dose is 0.1-0.4 g. The most effective and tolerable dose of the drug. Can be used in combination with other anticonvulsants.

Side effect. Drowsiness, ataxia (impaired coordination of movements), nystagmus (involuntary rhythmic movements of the eyeballs), dysarthria (speech disorder).

Release form. Tablets of 0.05 and 0.1 g in a package of 50 pieces.

Storage conditions.

GEXAMIDIN (Gexamidinum)

Synonyms: Primidone, Mizolin, Primaclone, Sertan, Deoxyphenobarbitone, Lepimidine, Lespiral, Liscantin, Mizodin, Milepsin, Prilepsin, Primolin, Prizolin, Sedilen, etc.

Pharmachologic effect. It has a pronounced anticonvulsant effect, in terms of pharmacological activity it is close to phenobarbital, but does not have a pronounced hypnotic effect.

Indications for use. Epilepsy of various genesis (origin), mainly large convulsive seizures. In the treatment of patients with polymorphic (diverse) epileptic symptoms, it is used in combination with other anticonvulsants.

Method of application and dose. Inside 0.125 g in 1-2 doses, then the daily dose is increased to 0.5-1.5 g. Higher doses for adults: single - 0.75 g, daily - 2 g.

Side effect. Itching, skin rashes, mild drowsiness, dizziness, headache, ataxia (impaired coordination of movements), nausea; with long-term treatment, anemia (a decrease in the number of red blood cells in the blood), leukopenia (a decrease in the level of white blood cells in the blood), lymphocytosis (an increase in the number of lymphocytes in the blood).

Contraindications. Diseases of the liver, kidneys and hematopoietic system.

Release form. Tablets of 0.125 and 0.25 g in a package of 50 pieces.

Storage conditions. List B. In a cool, dry place.

DIFENIN (Dipheninum)

Synonyms: Phenytoin, Difentoin, Epanutin, Hydantoinal, Sodanton, Alepsin, Digidantoin, Dilantin sodium, Diphedan, Eptoin, Hydantal, Fengidon, Solantoin, Solantil, Zentropil, etc.

Pharmachologic effect. It has a pronounced anticonvulsant effect; almost no hypnotic effect.

Indications for use. Epilepsy, mainly grand mal seizures. Difenin is effective in some forms of cardiac arrhythmias, especially in arrhythmias caused by an overdose of cardiac glycosides.

Method of application and dose. Inside after meals, "/2 tablets 2-3 times a day. If necessary, the daily dose is increased to 3-4 tablets. The highest daily dose for adults is 8 tablets.

Side effect. Tremor (trembling of the hands), ataxia (impaired coordination of movements), dysarthria (speech disorder), nystagmus (involuntary movements of the eyeballs), eye pain, irritability, skin rashes, sometimes fever, gastrointestinal disorders, leukocytosis (increased number of white blood cells), megaloblastic anemia

Contraindications. Diseases of the liver, kidneys, cardiac decompensation, pregnancy, cachexia (extreme exhaustion).

Release form. Tablets of 0.117 g in a package of 10 pieces.

Storage conditions. List B. In a dark place.

CARBAMAZEPIN (Carbamazepinum)

Synonyms: Stazepin, Tegretol, Finlepsin, Amizepin, Carbagretil, Karbazep, Mazetol, Simonil, Neurotol, Tegretal, Temporal, Zeptol, etc.

Pharmachologic effect. Carbamazepine has a pronounced anticonvulsant (antiepileptic) and moderately antidepressant and normothymic (improving mood) effect.

Indications for use. Carbamazepine is used for psychomotor epilepsy, major seizures, mixed forms (mainly with a combination of major seizures with psychomotor manifestations), local forms (post-traumatic and post-encephalitic origin). With small seizures, it is not effective enough.

Method of application and dose. Assign inside (during meals) to adults, starting with 0.1 g ("/2 tablets) 2-3 times a day, gradually increasing the dose to 0.8-1.2 g (4-6 tablets) per day.

The average daily dose for children is 20 mg per 1 kg of body weight, i.e. on average, at the age of up to 1 year - from 0.1 to 0.2 g per day; from 1 year to 5 years - 0.2-0.4 g; from 5 to 10 years -0.4-0.6 g; from 10 to 15 years -0.6-1 g per day.

Carbamazepine may be given in combination with other antiepileptic drugs.

As with other antiepileptic drugs, the transition to carbamazepine treatment should be gradual, with a decrease in the dose of the previous drug. It is also necessary to stop treatment with carbamazepine gradually.

There is evidence of the effectiveness of the drug in some cases in patients with various hyperkinesis (forced automatic movements due to involuntary muscle contraction). The initial dose of 0.1 g was gradually (after 4-5 days) increased to 0.4-1.2 g per day. After 3-4 weeks the dose was reduced to 0.1-0.2 g per day, then the same doses were prescribed daily or every other day for 1-2 weeks.

Carbamazepine has an analgesic (pain-relieving) effect in trigeminal neuralgia (inflammation of the facial nerve).

Carbamazepine is prescribed for trigeminal neuralgia, starting with 0.1 g 2 times a day, then the dose is increased by 0.1 g per day, if necessary, up to 0.6-0.8 g (in 3-4 doses). The effect usually occurs 1-3 days after the start of treatment. After the disappearance of pain, the dose is gradually reduced (up to 0.1-0.2 g per day). Prescribe the drug for a long time; If the drug is discontinued prematurely, pain may recur. Currently, carbamazepine is considered as one of the most effective drugs for this disease.

Side effect. The drug is usually well tolerated. In some cases, loss of appetite, nausea, rarely - vomiting, headache, drowsiness, ataxia (impaired coordination of movements), disturbance of accommodation (impaired visual perception) are possible. Reduction or disappearance of side effects occurs when the drug is temporarily discontinued or the dose is reduced. There is also evidence of allergic reactions, leukopenia (a decrease in the level of white blood cells in the blood), thrombocytopenia (a decrease in the number of platelets in the blood), agranulocytosis (a sharp decrease in granulocytes in the blood), hepatitis (inflammation of the liver tissue), skin reactions, exfoliative dermatitis (skin inflammation) . When these reactions occur, the drug is stopped.

Consideration should be given to the possibility of mental disorders in patients with epilepsy treated with carbamazepine.

During treatment with carbamazepine, it is necessary to systematically monitor the blood picture. It is not recommended to prescribe the drug in the first 3 months. pregnancy. Do not prescribe carbamazepine simultaneously with irreversible monoamine oxidase inhibitors (nialamide and others, furazolidone) due to the possibility of increasing side effects. Phenobarbital and hexamidine weaken the antiepileptic activity of carbamazepine.

Contraindications. The drug is contraindicated in violations of cardiac conduction, liver damage.

Release form. Tablets of 0.2 g in a package of 30 and 100 pieces.

Storage conditions. List B. In a dark place.

CLONAZEPAM (Clonazepamum)

Synonyms: Antelepsin, Klonopin, Ictoril, Ictorivil, Ravatril, Ravotril, Rivatril, Rivotril, etc.

Pharmachologic effect. Clonazepam has a sedative, muscle-relaxing, anxiolytic (anti-anxiety) and anticonvulsant effect. The anticonvulsant effect of clonazepam is more pronounced than that of other drugs in this group, and therefore it is used mainly for the treatment of convulsive conditions. In patients with epilepsy taking clonazepam, seizures occur less frequently and their intensity decreases.

Indications for use. Clonazepam is used in children and adults with small and large forms of epilepsy with myoclonic seizures (twitching of individual muscle bundles), with psychomotor crises, increased muscle tone. It is also used as a hypnotic, especially in patients with organic brain damage.

Method of application and dose. Treatment with clonazepam is begun with small doses, gradually increasing them until the optimal effect is obtained. The dosage is individual depending on the condition of the patient and his reaction to the drug. The drug is prescribed at a dose of 1.5 mg per day, divided into 3 doses. Gradually increase the dose by 0.5-1 mg every 3rd day until the optimal effect is obtained. Usually prescribed 4-8 mg per day. It is not recommended to exceed a dose of 20 mg per day.

Clonazepam is prescribed for children in the following doses: for newborns and children under 1 year old - 0.1-1 mg per day, from 1 year to 5 years old - 1.5-3 mg per day, from 6 to 16 years old - 3-6 mg per day day. The daily dose is divided into 3 doses.

Side effect. When taking the drug, coordination disorders, irritability, depressive states (a state of depression), increased fatigue, and nausea are possible. To reduce side effects, it is necessary to individually select the optimal dose, starting with smaller doses and gradually increasing them.

Contraindications. Acute diseases of the liver and kidneys, myasthenia gravis (muscle weakness), pregnancy. Do not take simultaneously with MAO inhibitors and phenothiazine derivatives. The drug should not be taken the day before and during work for drivers of transport and persons whose work requires a quick mental and physical reaction. During the period of treatment with the drug, it is necessary to refrain from drinking alcohol.

The drug crosses the placental barrier and into breast milk. It should not be given to pregnant women and during lactation.

Release form. Tablets of 0.001 g (1 mg) in a package of 30 or 50 pieces.

Storage conditions. List B. In a dark place.

METINDION (Methindionum)

Synonyms: Indomethacin, Inteban.

Pharmachologic effect. An anticonvulsant that does not depress the central nervous system, reduces affective (emotional) stress, improves mood.

Indications for use. Epilepsy, especially in the temporal form and epilepsy of traumatic origin (origin).

Method of application and dose. Inside (after eating) for adults, 0.25 g per reception. For epilepsy with frequent seizures, 6 times a day at intervals of 1 "/2-2 hours (Daily dose 1.5 g). For rare seizures in the same single dose, 4-5 times a day (1-1, 25 g per day).In case of seizures at night or in the morning, an additional 0.05-0.1 g of phenobarbital or 0.1-0.2 g of benzonal is prescribed. In case of psychopathological disorders in patients with epilepsy, 0.25 g 4 times a day If necessary, treatment with methindione is combined with phenobarbital, seduxen, eunoctine.

Side effect. Dizziness, nausea, tremor (trembling) of the fingers.

Contraindications. Severe anxiety, tension.

Release form. Tablets of 0.25 g in a package of 100 pieces.

Storage conditions.

MYDOCALM (Mydocalm)

Synonyms: Tolperison hydrochloride, Mideton, Menopatol, Myodom, Pipetopropanone.

Pharmachologic effect. Suppresses polysynaptic spinal reflexes and lowers the increased tone of skeletal muscles.

Indications for use. Diseases accompanied by increased muscle tone, including paralysis (complete absence of voluntary movements), paresis (reduction in strength and / or amplitude of movements), paraplegia (bilateral paralysis of the upper or lower extremities), extrapyramidal disorders (impaired coordination of movements with a decrease in their volume and jitter).

Method of application and dose. Inside, 0.05 g 3 times a day with a gradual increase in dose to 0.3-0.45 g per day; intramuscularly, 1 ml of a 10% solution 2 times a day; intravenously (slowly) 1 ml in 10 ml of saline 1 time per day.

Side effect. Sometimes a feeling of slight intoxication, headache, irritability, sleep disturbance.

Contraindications. Not identified.

Release form. Dragee 0.05 g in a package of 30 pieces; ampoules of 1 ml of a 10% solution in a package of 5 pieces.

Storage conditions. List B. In a dry, cool place.

PUFEMID (Puphemidum)

Pharmachologic effect. Anticonvulsant action.

Indications for use. With various forms of epilepsy such as petit mal (small seizures), as well as with temporal lobe epilepsy.

Method of application and dose. Inside before meals for adults, starting with 0.25 g 3 times a day, gradually increasing the dose, if necessary, up to 1.5 g per day; children under 7 years old - 0.125 g each, over 7 years old - 0.25 g 3 times a day.

Side effect. Nausea, insomnia. With nausea, it is recommended to prescribe the drug 1-1 "/2 hours after eating, with insomnia 3-4 hours before bedtime.

Contraindications. Acute diseases of the liver and kidneys, impaired hematopoietic function, pronounced atherosclerosis, hyperkinesis (forced automatic movements due to involuntary muscle contraction).

Release form. Tablets of 0.25 g in a package of 50 pieces.

Storage conditions. List B. In dark glass jars.

SUXILEP (Suxilep)

Synonyms: Ethosuximide, Azamide, Pycnolepsin, Ronton, Zarontin, Etomal, Etimal, Pemalin, Petinimide, Succimal, etc.

Pharmachologic effect. Anticonvulsant action.

Indications for use. Small forms of epilepsy, myoclonic seizures (convulsive twitching of individual muscle groups).

Method of application and dose. Inside (taken with meals) 0.25-0.5 g per day with a gradual increase in dose to 0.75-1.0 g per day (in 3-4 doses).

Side effect. Dyspeptic disorders (digestive disorders); in some cases, headache, dizziness, skin rashes, leukopenia (decrease in the level of leukocytes in the blood) and agranulocytosis (a sharp decrease in the number of granulocytes in the blood).

Contraindications. Pregnancy, breastfeeding.

Release form. Capsules of 0.25 g in a package of 100 pieces.

Storage conditions. List B. In a dry, cool place.

TRIMETIN (Trimethinum)

Synonyms: Trimethadion, Ptimal, Tridion, Trimedal, Absentol, Edion, Epidion, Pethidion, Trepal, Troksidone.

Pharmachologic effect. It has an anticonvulsant effect.

Indications for use. Epilepsy, mainly petit mal (small seizures).

Method of application and dose. Inside during or after meals, 0.25 g 2-3 times a day, for children, depending on age, from 0.05 to 0.2 g 2-3 times a day.

Side effect. Photophobia, skin rashes, neutropenia (a decrease in the number of neutrophils in the blood), agranulocytosis (a sharp decrease in granulocytes in the blood), anemia (a decrease in hemoglobin in the blood), eosinophilia (an increase in the number of eosinophils in the blood), monocytosis (an increase in the number of monocytes in the blood).

Contraindications. Violations of the liver and kidneys, diseases of the optic nerve and blood-forming organs.

Release form. Powder.

Storage conditions. List B. In a dry, cool place.

PHENOBARBITAL (Phenobarbitalum)

Synonyms: Adonal, Efenal, Barbenil, Barbifen, Dormiral, Epanal, Episedal, Fenemal, Gardenal, Hypnotal, Mefabarbital, Neurobarb, Nirvonal, Omnibarb, Phenobarbitone, Sedonal, Sevenal, Somonal, Zadonal, etc.

Pharmachologic effect. Usually considered as a sleeping pill. However, at present, it is of the greatest importance as an antiepileptic agent.

In small doses, it has a calming effect.

Indications for use. Treatment of epilepsy; used for generalized tonic-clonic seizures (grand mal), as well as for focal seizures in adults and children. In connection with the anticonvulsant effect, it is prescribed for chorea (a disease of the nervous system, accompanied by motor excitation and uncoordinated movements), spastic paralysis, and various convulsive reactions. As a sedative in small doses in combination with other drugs (antispasmodics, vasodilators) is used for neurovegetative disorders. As a sedative.

Method of application and dose. For the treatment of epilepsy, adults are prescribed starting with a dose of 0.05 g 2 times a day and gradually increasing the dose until the seizures stop, but not more than 0.5 g per day. For children, the drug is prescribed in smaller doses in accordance with age (not exceeding the highest single and daily doses). Treatment is carried out for a long time. It is necessary to stop taking phenobarbital with epilepsy gradually, since the sudden withdrawal of the drug can cause the development of a seizure and even status epilepticus.

For the treatment of epilepsy, phenobarbital is often prescribed in combination with other drugs. Usually these combinations are selected individually depending on the form and course of epilepsy and the general condition of the patient.

As a sedative and antispasmodic, phenobarbital is prescribed at a dose of 0.01-0.03-0.05 g 2-3 times a day.

Higher doses for adults inside: single - 0.2 g; daily - 0.5 g.

The simultaneous use of phenobarbital with other sedative-acting drugs (sedatives) leads to an increase in the sedative-hypnotic effect and may be accompanied by respiratory depression.

Side effect. Inhibition of the activity of the central nervous system, lowering blood pressure, allergic reactions (skin rash, etc.), changes in the blood count.

Contraindications. The drug is contraindicated in severe lesions of the liver and kidneys with a violation of their functions, alcoholism, drug addiction, myasthenia gravis (muscle weakness). It should not be prescribed in the first 3 months. pregnancy (to avoid teratogenic effects /damaging effect on the fetus/) and women who are breastfeeding.

Statement form. Powder; tablets of 0.005 g for children and 0.05 and 0.1 g for adults.

Storage conditions. List B. In a dark place.

Gluferal (Gluferalum)

Combined preparation containing phenobarbital, bromisoval, sodium caffeine benzoate, calcium gluconate.

Indications for use.

Method of application and dose. Adults after meals, depending on the condition, from 2-4 tablets per dose. The maximum daily dose is 10 tablets. Children, depending on age, are prescribed from 1/2 to 1 tablet per reception. The maximum daily dose for children under 10 years old is 5 tablets.

side effects and Contraindications.

Release form. Tablets containing: phenobarbital - 0.025 g, bromisoval - 0.07 g, sodium caffeine benzoate - 0.005 g, calcium gluconate - 0.2 g, 100 pieces in an orange glass jar.

Storage conditions. List B. In a dark place.

PAGLUFERAL-1,2,3 (Pagluferalum-1,2,3)

Combined preparation containing phenobarbital, bromisoval, sodium caffeine benzoate, papaverine hydrochloride, calcium gluconate.

Pharmacological action is due to the properties of its constituent components.

Indications for use. Mainly in epilepsy with grand tonic-clonic seizures.

Method of application and dose. Different ratios of ingredients in different variants of paglufersht tablets make it possible to individually select doses. Start taking 1-2 tablets 1-2 times a day.

side effects and Contraindications. The same as for phenobarbital.

Release form. Pagluferal tablets 1, 2 and 3 containing, respectively: phenobarbital - 0.025; 0.035 or 0.05 g, bromized - 0.1; 0.1 or 0.15 g, sodium caffeine benzoate -0.0075; 0.0075 or 0.01 g, papaverine hydrochloride -0.015; 0.015 or 0.02 g, calcium gluconate - 0.25 g, in orange glass jars of 40 pieces.

Storage conditions. List B. In a dark place.

SEREY MIXTURE (Mixtio Sereyski)

Complex powder containing phenobarbital, bromisoval, sodium caffeine benzoate, papaverine hydrochloride, calcium gluconate.

Pharmacological action is due to the properties of its constituent components.

Indications for use. Mainly in epilepsy with grand tonic-clonic seizures.

Method of application and dose. 1 powder 2-3 times a day (for mild forms of the disease, a powder with a lower weight content of components is taken, for more severe forms, a powder with a higher weight content of components / see Release form. /).

Side effects and contraindications. The same as for phenobarbital.

Release form. Powder containing: phenobarbital - 0.05-0.07-0.1-0.15 g, bromisoval - 0.2-0.3 g, sodium caffeine benzoate - 0.015-0.02 g, papaverine hydrochloride - 0.03 -0.04 g, calcium gluconate -0.5-1.0 g.

Storage conditions. List B. In a dry, dark place.

FALILEPSIN (Fali-Lepsin)

Combined preparation containing phenobarbital and pseudonorephedrine.

Pharmacological action is due to the properties of its constituent components. The inclusion of pseudonorephedrine in its composition, which has a moderate stimulating effect on the central nervous system, somewhat reduces the inhibitory effect (drowsiness, decreased performance) of phenobarbital.

Indications for use. Various forms of epilepsy.

Method of application and dose. Adults and children over 12 years of age, starting with 1/2 tablet (50 mg) per day, gradually increasing the dose to 0.3-0.45 g (in 3 divided doses).

Release form. Tablets of 0.1 g, in a package of 100 pieces.

Storage conditions. List B. In a dark place.

CHLORACON (Chloraconum)

Synonyms: Beclamid, Gibicon, Nidran, Posedran, Benzchlorpropamide.

Pharmachologic effect. It has a pronounced anticonvulsant effect.

Indications for use. Epilepsy, mainly with grand mal seizures; psychomotor agitation of an epileptic nature; with frequent convulsive seizures (in combination with other anticonvulsants); prescribed for patients with epilepsy during pregnancy and those who have had liver disease.

Method of application and dose. Inside, 0.5 g 3-4 times a day, if necessary, up to 4 g per day; children - 0.25-0.5 g 2-4 times a day (depending on age).

Side effect. Irritant effect on the gastric mucosa in patients with gastrointestinal diseases. With long-term treatment, it is necessary to monitor the function of the liver, kidneys, blood picture.

Release form. Tablets of 0.25 g in packs of 50 pieces.

Storage conditions. List B. In a dry, cool place.

Anticonvulsants are medicines used to treat seizures as the main manifestation of epilepsy. The term “antiepileptic” drugs is considered more correct, since they are used to combat epileptic seizures, which are far from 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. After all, there are many varieties of seizures with different mechanisms of development. The search for innovative means is also determined by the resistance (resistance) 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 learn for yourself information about the main antiepileptic drugs and the features of their use.

Some basics of epilepsy pharmacotherapy

A feature of the use of drugs is their good tolerability. The most common side effects include:

• dizziness and drowsiness;
• dry mouth, impaired appetite and stool;
• blurred vision;
• erectile dysfunction.

Gabapentin is not used in children under 12 years of age, Pregabalin is prohibited under 17 years of age. Drugs are not recommended for pregnant women.

Phenytoin and Phenobarbital

These are "veterans" among therapeutic drugs for epilepsy. To date, they are not first-line drugs, they are resorted to only in case of resistance to treatment with other drugs.

Phenytoin (Difenin, Digidan) can be used for all types of seizures, with the exception of absences. The advantage of the drug is its low price. The effective dose is 5 mg/kg/day. The drug can not be used for problems with the liver and kidneys, heart rhythm disturbances in the form of various blockades, porphyria, heart failure. When using Phenytoin, side effects may occur in the form of dizziness, fever, agitation, nausea and vomiting, trembling, excessive hair growth, swollen lymph nodes, increased blood glucose, difficulty breathing, allergic rashes.

Phenobarbital (Luminal) has been used as an anticonvulsant since 1911. It is used for the same types of seizures as Phenytoin, at a dose of 0.2-0.6 g / day. The drug "faded" into the background due to the large number of side effects. Among them, the most common are: the development of insomnia, the appearance of involuntary movements, cognitive impairment, rashes, lowering blood pressure, impotence, toxic effects on the liver, aggressiveness and depression. The drug is prohibited for alcoholism, drug addiction, severe liver and kidney diseases, diabetes mellitus, severe anemia, obstructive bronchial diseases, and pregnancy.

Levetiracetam

One of the new drugs for the treatment of epilepsy. The original drug is called Keppra, generics - Levetinol, Komviron, Levetiracetam, Epiterra. Used to treat both partial and generalized seizures. The daily dose is, on average, 1000 mg.

Main side effects:

• drowsiness;
• asthenia;
• dizziness;
• abdominal pain, loss of appetite and stool;
• rashes;
• double vision;
• increased cough (if there are problems with the respiratory system).

There are only two contraindications: individual intolerance, pregnancy and lactation (because the effect of the drug has not been studied in such conditions).

The list of existing drugs for epilepsy can be continued further, since the ideal drug does not yet exist (there are too many nuances in the treatment of epileptic seizures). Attempts to create a "gold standard" for the treatment of this disease are ongoing.

Summing up the above, I would like to clarify that any drug from anticonvulsants is not harmless. It must be remembered that treatment should be carried out only by a doctor, there can be no question of any independent choice or change of the drug!