Tag Archives: Vigabatrin

Pharmacological Treatment of Pain

While medications are often prescribed for all types of chronic pain, research has consistently shown that several classes have proven efficacy for the treatment of neuropathic pain. Ideally, pharmacotherapy of pain would be specifically selected on the basis of considerations of etiology (e.g., ischemic, neuropathic), pathophysiology (e.g., demyelination, central pain), and anatomy (e.g., C fibers,… Read More »

Treatment Of Childhood Absence Epilepsy

Childhood absence epilepsy (CAE) typically requires treatment because the seizures are frequent and interfere with normal cognitive functioning. International League Against Epilepsy Guidelines (Newly Diagnosed Epilepsy) According to the ILAE guidelines, the absence of class I and class II randomized controlled trials (RCTs) for children with absence seizures implies a marked deficiency in adequately powered,… Read More »

Treatment Of Childhood Absence Epilepsy: American Academy Of Neurology Guidelines

New Anti-Epileptic Drugs Only American Academy of Neurology (AAN) guidelines evaluating efficacy of new anti-epileptic drugs state only that lamotrigine is effective in children with newly diagnosed absence seizures (level B recommendation). Ethosuximide After ethosuximide was described as effective in absence epilepsy in 1958, a number of open-label, non-comparative studies where ethosuximide was added to… Read More »

Treatment Of The Child Or Adolescent With Newly Diagnosed Epilepsy

Paediatric epilepsy is amazingly diverse. In some children, basic diagnosis, seizure classification and treatment are straightforward. Other patients have difficult-to-diagnose seizures, complicated seizure classification and a variable response to treatment. Some seizures are subclinical, others are barely noticeable, and occasionally they are life threatening. Many children with epilepsy have no associated disabilities, but all children… Read More »

Treatment of the epilepsy patient with hepatic disease

The liver is the principal organ of drug metabolism. Some drugs are absorbed from the gut, delivered to the liver and undergo first-pass metabolism prior to reaching the systemic circulation. Metabolism of these drugs is significantly affected by hepatic vascular supply; if hepatic blood flow is reduced, first-pass metabolism is decreased and more drug reaches… Read More »

Treatment of the epilepsy patient with renal disease

Seizures may occur in uraemic encephalopathy, dialysis disequilibrium syndrome and dialysis encephalopathy. In addition, renal insufficiency and dialysis may both have effects on anti-epileptic drug pharmacokinetics. Renal impairment can alter the fraction of anti-epileptic drug absorbed, volume of distribution, protein binding and renal drug clearance. Renal impairment may alter the gastric pH, cause small intestinal… Read More »

Second-Generation Anti-Epileptic Drugs

Drugs are listed in order of approval in the USA, from oldest to newest. Felbamate Felbamate is a broad-spectrum anti-epileptic drug. It is not considered to be a first-line drug because of its potential for serious idiosyncratic side-effects, including potentially fatal aplastic anaemia (incidence of 1 in 3000) and hepatic failure (incidence of 1 in… Read More »

Anti-Epileptic Drug Selection

Selection of anti-epileptic drugs can be very confusing. Each anti-epileptic drug has unique characteristics, including spectrum of activity, cost, pharmacokinetic and pharmacodynamic properties, likelihood for dose-related side-effects and risk of serious health risks. Therefore, to the frustration of many prescribers, there is not a ‘first choice’ selection in specific treatment situations such as initiation in… Read More »

Multiple Sclerosis and Pain

Multiple sclerosis () is a progressive disease. It is characterized by initial destruction of myelin and eventually axons and cell bodies. It can affect any part of the central nervous system (CNS). It is well established that multiple sclerosis is a painful condition. There are varying reports of the incidence of pain such as: •… Read More »

Which drug is associated with ciliochoroidal detachment?

Which medication is associated with ciliochoroidal detachment? A. Gabapentin (Neurontin) B. Topiramate (Topamax) C. Divalproex sodium (Depakote) D. Carbamazepine (Tegretol) E. Vigabatrin (Sabril) The answer is B. Topiramate (Topamax) may cause idiosyncratic ciliochoroidal detachment and ciliary body edema, leading to anterior displacement of the lensiris diaphragm, lens thickening, and acute angle-closure glaucoma and acute myopia.… Read More »