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Anticonvulsant Agents: Pharmacology and Biochemistry

NeuroPsychopharmacotherapy

  • 26 Accesses

Abstract

Anticonvulsant drugs, often referred to as antiepileptic drugs or, more recently, antiseizure drugs (ASDs), are the main form of symptomatic treatment for patients with epilepsy. Currently, about 30 ASDs are available for epilepsy therapy. Most ASDs are small, lipophilic, and uncharged, which enables them to penetrate into the brain and reach their targets. Most ASDs have elimination half-lives in the range of 5–15 h, so twice-daily administration is sufficient to maintain effective drug levels. Most ASDs act by modulation of voltage-gated ion channels; by enhancement of GABA-mediated inhibition; through interactions with elements of the synaptic release machinery; by blockade of ionotropic glutamate receptors; or by combinations of these mechanisms. As a consequence of differences in their mechanisms of action, most ASDs do not suppress all types of seizures, so appropriate treatment choices are important. The goal of epilepsy therapy is the complete elimination of seizures, which, however, is not achievable in about a third of patients. Both in vivo and in vitro models of seizures and epilepsy are used to discover ASDs that are more effective in patients with yet drug-resistant seizures. In addition to epilepsy, ASDs are used in the treatment of acute symptomatic seizures, cluster seizures, and status epilepticus. Furthermore, several ASDs are important therapies in nonepileptic conditions, including neuropathic pain, migraine, and bipolar disorders. Most ASDs are relatively well tolerated, but rare and unpredictable idiosyncratic adverse drug reactions, particularly skin reactions, may occur. Furthermore, some older ASDs induce liver drug metabolism and act as teratogens. Detailed knowledge of the adverse effect profiles of ASDs is an essential component of treating epilepsy successfully and maintaining a high quality of life for every patient, particularly those receiving polypharmacy for drug-resistant seizures.

I dedicate this work to my late friend and colleague, Professor Dieter Schmidt, who inspired me throughout my scientific career.

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Authors and Affiliations

  1. Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany

    Wolfgang Löscher

  2. Center for Systems Neuroscience, Hannover, Germany

    Wolfgang Löscher

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  1. Wolfgang Löscher
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Correspondence to Wolfgang Löscher .

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  1. Dept Psychiatry , Psychosomatics & Psychotherapy, University of Würzburg, Medical School Clinical Neurochemistry, Würzburg, Germany

    Peter Riederer

  2. Inst für Psychologische Medizin, Haag, Bayern, Germany

    Gerd Laux

  3. Fujita Health University School Medicine, Toyoake, Aichi, Japan

    Toshiharu Nagatsu

  4. Center Translational Res Neurol Diseases, Dalian Med Uni Shanghai Inst Health Sc Center Translational Res Neurol Diseases, Dalian, China

    Weidong Le

  5. Würzburg, Bayern, Germany

    Christian Riederer

Section Editor information

  1. Beta Neurology – Competence Center for Epilepsy, Beta Klinik GmbH, Bonn, Germany

    Christian E. Elger

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Löscher, W. (2021). Anticonvulsant Agents: Pharmacology and Biochemistry. In: Riederer, P., Laux, G., Nagatsu, T., Le, W., Riederer, C. (eds) NeuroPsychopharmacotherapy. Springer, Cham. https://doi.org/10.1007/978-3-319-56015-1_466-1

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    Anticonvulsant Agents: Pharmacology and Biochemistry
    Published:
    30 July 2021

    DOI: https://doi.org/10.1007/978-3-319-56015-1_466-2

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    Anticonvulsant Agents: Pharmacology and Biochemistry
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    DOI: https://doi.org/10.1007/978-3-319-56015-1_466-1

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