Drugs
In the following list, the dates in parentheses are the earliest approved use
of the drug.
Aldehydes
-
Paraldehyde (1882). One of the earliest anticonvulsants. Still used to
treat
status epilepticus, particularly where there are no resuscitation
facilities.
Aromatic allylic alcohols
-
Stiripentol (2001 - limited availability). Indicated for the treatment
of severe
myoclonic epilepsy in infancy (SMEI).
Barbiturates
Barbiturates are
rugs
that act as central nervous system (CNS)
epressants,
and by virtue of this they produce a wide spectrum of effects, from mild
edation to
nesthesia.
The following are
classified as anticonvulsants:
-
Phenobarbital (1912). See also the related drug
rimidone.
-
Methylphenobarbital (1935). Known as mephobarbital in the US. No longer
marketed in the UK
-
Metharbital (1952). No longer marketed in the UK or US.
-
Barbexaclone (1982). Only available in some European countries.
Phenobarbital was the main anticonvulsant from 1912 till the development of
phenytoin in 1938. Today, phenobarbital is rarely used to treat epilepsy in new
patients since there are other effective drugs that are less sedating.
Phenobarbital sodium injection can be used to stop acute convulsions or
status epilepticus, but a benzodiazepine such as lorazepam, diazepam or
midazolam is usually tried first. Other barbiturates only have an anticonvulsant
effect at anaesthetic doses.
BenzodiazepinesThe benzodiazepines are a class of
rugs
with ypnotic,
nxiolytic,
anticonvulsive,
amnestic and
muscle relaxant properties. Benzodiazepines act as a central nervous system
depressant. The relative strength of each of these properties in any given
benzodiazepine varies greatly and influences the indications for which it is
prescribed. Long-term use can be problematic due to the development of
tolerance and
ependency.
Of the many drugs in this class, only a few are used to treat epilepsy:
-
Clobazam (1979). Notably used on a short-term basis around menstruation
in women with catamenial epilepsy.
-
Clonazepam (1974).
-
Clorazepate (1972).
The following benzodiazepines are used to treat
status epilepticus:
-
Diazepam (1963). Can be given rectally by trained care-givers.
-
Midazolam (N/A). Increasingly being used as an alternative to diazepam.
This water-soluble drug is squirted into the side of the mouth but not
swallowed. It is rapidly absorbed by the
buccal mucosa.
-
Lorazepam (1972). Given by injection in hospital.
Nitrazepam,
emazepam,
and especially
nimetazepam are powerful anticonvulsant agents, however their use is rare
due to an increased incidence of side effects and strong sedative and
motor-impairing properties.
Bromides
-
Potassium bromide (1857). The earliest effective treatment for epilepsy.
There would not be a better drug for epilepsy until phenobarbital in 1912.
It is still used as an anticonvulsant for dogs and cats.
Carbamates
-
Felbamate (1993). This effective anticonvulsant has had its usage
severely restricted due to rare but life-threatening side effects.
CarboxamidesThe following are carboxamides:
-
Carbamazepine (1963). A popular anticonvulsant that is available in
generic formulations.
-
Oxcarbazepine (1990). A derivative of carbamazepine that has similar
efficacy but is better tolerated.
Fatty acidsThe following are fatty-acids:
- The
valproates �
valproic acid,
sodium valproate, and
divalproex sodium (1967).
-
Vigabatrin (1989).
-
Progabide
-
Tiagabine (1996).
Vigabatrin and progabide are also analogs of GABA.
Fructose derivatives
-
Gaba analogs
-
Gabapentin (1993).
-
Pregabalin (2004).
HydantoinsThe following are hydantoins:
-
Ethotoin (1957).
-
Phenytoin (1938).
-
Mephenytoin
-
Fosphenytoin (1996).
OxazolidinedionesThe following are oxazolidinediones:
-
Paramethadione
-
Trimethadione (1946).
-
Ethadione
Propionates
Pyrimidinediones Main article:
Pyrimidinediones
Pyrrolidines
-
Brivaracetam
-
Levetiracetam (1999).
-
Seletracetam
Succinimides
The following are succinimides:
-
Ethosuximide (1955).
-
Phensuximide
-
Mesuximide
Sulfonamides
-
Acetazolamide (1953).
-
Sulthiame
-
Methazolamide
-
Zonisamide (2000).
Triazines
Ureas
Valproylamides (amide derivatives of valproate)
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