RESUMO
As drogas utilizadas para prevenção de convulsões podem impactar na movimentação dentária durante o tratamento ortodôntico. O objetivo deste estudo foi avaliar a influência de drogas anticonvulsivantes no tratamento ortodôntico. O desenho deste estudo é uma revisão narrativa da literatura onde uma busca eletrônica foi realizada sem restrição de idioma e data em três bases de dados (PubMed via MEDLINE, SCOPUS e BVS). Foram utilizados os seguintes termos para o PubMed e BVS: anticonvulsants drugs AND orthodontic movement e para o SCOPUS: anticonvulsants AND drugs AND orthodontic AND movement. Uma pesquisa complementar foi realizada nas referências bibliográficas dos estudos incluídos. Os artigos indicaram que o uso de medicação anticonvulsivante favorece o desenvolvimento de hiperplasias gengivais, xerostomia e alterações no metabolismo ósseo que modulam a taxa de movimentação ortodôntica. Dentro das limitações desta revisão, concluiu-se que não há contraindicações para tratamento ortodôntico em pacientes utilizando anticonvulsivantes, no entanto os ortodontistas devem estar cientes dos potenciais efeitos adversos advindos do uso desses medicamentos para que possam adotar medidas para mitigar esses riscos.
Drugs used to prevent seizures can have an impact on tooth movement during orthodontic treatment. This study aimed to evaluate the influence of anticonvulsant medications on orthodontic treatment. The design of this study is a narrative literature review in which an electronic search was carried out without language or date restriction in three databases (PubMed/MEDLINE, SCOPUS, and BVS). The following terms were used for PubMed and BVS: anticonvulsants drugs AND orthodontic movement and SCOPUS: anticonvulsants AND drugs AND orthodontic AND movement. A complementary search was carried out on the bibliographical references of the included studies. The articles indicated that using anticonvulsant medication favors the development of gingival hyperplasia, xerostomia, and alterations in bone metabolism that modulate the rate of orthodontic movement. Within the limitations of this review, it was concluded that there is no contraindication for orthodontic treatment in patients using anticonvulsants. However, orthodontists should be aware of the potential adverse effects arising from the use of these drugs so that they can adopt measures to minimize these risks.
Assuntos
Aparelhos Ortodônticos , Ortodontia , Terapêutica , AnticonvulsivantesRESUMO
OBJECTIVE: The aim of the study was to evaluate the effects of commonly used medications for epilepsy on thyroid function tests in children. METHODS: Epileptic children treated with valproic acid, levetiracetam, carbamazepine, and oxcarbazepine were retrospectively examined along with a healthy control group. Levels of free thyroxine 4 and thyroid-stimulating hormone were compared. RESULTS: In patients receiving valproic acid monotherapy, thyroid-stimulating hormone levels increased compared to both the control group and pre-treatment levels, while free thyroxine 4 levels remained unchanged. In those receiving carbamazepine or oxcarbazepine monotherapy, average free thyroxine 4 levels were found to be lower compared to the control group and pre-treatment levels, with no difference in thyroid-stimulating hormone levels. For patients receiving levetiracetam monotherapy, there was no difference in free thyroxine 4 and thyroid-stimulating hormone levels compared to the control group and pre-treatment levels. CONCLUSION: Despite significant changes in thyroid hormone levels with valproic acid, carbamazepine, and oxcarbazepine treatment, no significant clinical findings were observed. Additionally, no effect of levetiracetam on thyroid function tests was detected.
Assuntos
Anticonvulsivantes , Carbamazepina , Epilepsia , Levetiracetam , Oxcarbazepina , Testes de Função Tireóidea , Tireotropina , Tiroxina , Ácido Valproico , Humanos , Carbamazepina/uso terapêutico , Carbamazepina/análogos & derivados , Carbamazepina/farmacologia , Levetiracetam/uso terapêutico , Levetiracetam/farmacologia , Anticonvulsivantes/uso terapêutico , Anticonvulsivantes/farmacologia , Ácido Valproico/uso terapêutico , Criança , Feminino , Masculino , Estudos Retrospectivos , Oxcarbazepina/uso terapêutico , Oxcarbazepina/farmacologia , Epilepsia/tratamento farmacológico , Tireotropina/sangue , Tiroxina/sangue , Pré-Escolar , Estudos de Casos e Controles , Adolescente , Piracetam/análogos & derivados , Piracetam/uso terapêutico , Glândula Tireoide/efeitos dos fármacosRESUMO
A 9-year-old male with autism and a history of well-controlled epilepsy presented with acute headache, fever, and generalized tonic-clonic seizures. Initial diagnostics, including imaging and cerebrospinal fluid analysis, were inconclusive. However, further serological testing suggested the presence of the chikungunya virus, establishing a diagnosis of chikungunya-associated neurological manifestation. The patient was treated with anticonvulsants, antibiotics for secondary bacterial pneumonia, and supportive care, leading to a gradual recovery. This case highlights the importance of considering systemic viral infections in pediatric patients with neurological symptoms and underscores the potential for arboviruses like chikungunya to cause neurological manifestation.
Assuntos
Febre de Chikungunya , Vírus Chikungunya , Humanos , Masculino , Febre de Chikungunya/complicações , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/tratamento farmacológico , Criança , Brasil , Vírus Chikungunya/isolamento & purificação , Convulsões/etiologia , Convulsões/virologia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/virologia , Doenças do Sistema Nervoso/diagnóstico , Anticonvulsivantes/uso terapêuticoRESUMO
OBJECTIVE: The purpose of this study is to analyze composition of HMS (homemade CBD), NLS (non-licensed commercial products), and bioequivalent CBD (BES) collected from Chilean patients that voluntary accepted to analyze the "CBD-substance." METHODS: Samples were collected through an open invitation for different patients to anonymously and free of charge participate in the analysis of CBD oil. The analysis of the active principle was performed using High-Resolution Liquid Chromatography (HPLC). RESULTS: A total of 35 samples were collected between March 2020 and September 2021, including two BES, six NLS, and 27 HMS products. The BES had an average CBD concentration of 89.15 mg/mL and an average THC concentration of 0.015 mg/mL, which complied with the maximum THC levels required by regulatory authorities (<0.2% THC.). The NLS (six samples) exhibited significant variability in CBD concentrations, ranging from a maximum of 78.5 mg/mL to a minimum of 0.1 mg/mL, with an average of 25.41 mg/mL. The THC concentrations ranged from 0 mg/mL to 2.43 mg/mL with an average of 0.62 mg/mL. The HMS products exhibited even higher variations of CBD concentrations, ranging from 0 to a maximum of 6.6 mg/mL. THC concentrations were even more variable, ranging from 0 mg/mL to 388 mg/mL. SIGNIFICANCE: The medical community and patients involved should be aware that Hemp products are not pure and/or innocuous. HMS are likely to have high levels of THC and very low CBD, far away from therapeutic doses of CBD. CBD used in epilepsy should be restricted to licensed products, especially in children where THC toxicity is much more harmful. PLAIN LANGUAGE SUMMARY: The study analyzed three types of CBD (cannabidiol) oils: homemade, non-licensed, and bioequivalent. Homemade and non-licensed products showed nonacceptable variance of CBD and THC concentration (tetrahydrocannabinol), in some cases with 0 mgs of CBD and many beyond THC maximum accepted. The THC is another component found in cannabis and is responsible for the neurotoxic effects. Only bioequivalent products showed concentrations of CBD and THC acceptable for epilepsy treatment, therefore are the only products recommended for such purpose.
Assuntos
Canabidiol , Epilepsia Resistente a Medicamentos , Humanos , Canabidiol/análise , Chile , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Anticonvulsivantes/uso terapêutico , Anticonvulsivantes/análise , Anticonvulsivantes/efeitos adversos , Cromatografia Líquida de Alta Pressão , Dronabinol/análiseRESUMO
Magnesium sulfate marks 100 years in the medical management of eclampsia. Lazard, starting in May 1924 at the Los Angeles General Hospital, collected clinical evidence of its benefits on the mortality associated with pregnancy convulsions. Doses, regimens, and dilutions were analyzed, revealing therapeutic safety for both mother and fetus. By the end of the 20th century, randomized clinical trials demonstrated the clinical utility of magnesium for the following indications: treatment of eclampsia, prevention of eclampsia, and neurological protection of the brain in preterm infants less than 32 weeks of gestation, among others. This journey has been controversial among many authorities; however, the National University of Colombia and its Department of Obstetrics and Gynecology have defended the Zuspan regimen as the ideal approach for managing these patients since 1982. Through this review, we aim to present all the evidence that has established magnesium as an essential drug for reducing maternal mortality worldwide, especially in developing countries.
El Sulfato de Magnesio completa 100 años en el manejo médico de la eclampsia. Lazard, a partir de mayo de 1924, en el Hospital General de los Ángeles, recogió las evidencias clínicas de sus beneficios sobre la mortalidad de la enfermedad convulsiva del embarazo. Se analizaron dosis, esquemas, diluciones, se encontró seguridad terapéutica para la madre y el feto, y finalizando el siglo XX, se realizaron experimentos clínicos aleatorizados que demostraron la utilidad clínica del magnesio para las siguientes indicaciones: tratamiento de la eclampsia, prevención de la eclampsia, protección neurológica del cerebro del prematuro menor de 32 semanas, entre otras. Todo este camino ha sido controvertido por muchas autoridades; sin embargo, la Universidad Nacional de Colombia y su Departamento de Obstetricia y Ginecología han defendido desde 1982 el esquema Zuspan como el ideal en el manejo de estas pacientes. Con esta revisión queremos mostrar todas las evidencias que han convertido al magnesio en un fármaco indispensable para disminuir la mortalidad materna en todo el mundo, especialmente en los países subdesarrollados.
Assuntos
Eclampsia , Sulfato de Magnésio , Mortalidade Materna , Sulfato de Magnésio/uso terapêutico , Sulfato de Magnésio/história , Sulfato de Magnésio/administração & dosagem , Humanos , Feminino , Gravidez , Mortalidade Materna/história , Eclampsia/história , Eclampsia/tratamento farmacológico , História do Século XX , Ensaios Clínicos Controlados Aleatórios como Assunto/história , Recém-Nascido , Complicações na Gravidez/história , Complicações na Gravidez/tratamento farmacológico , História do Século XXI , Anticonvulsivantes/história , Anticonvulsivantes/uso terapêutico , Anticonvulsivantes/administração & dosagemRESUMO
Cannabidiol oil (CBD) has been approved as an antiseizure medication for the treatment of drug -resistant epilepsy in pediatric patients in 2018 for some special types of epilepsy. Since this time its use was extended to other forms of epilepsy. However, to date, there are few publications on the use of CBD in adult patients with drug-resistant focal epilepsy and psychiatric comorbidities. We conducted a prospective, observational, open cohort study, with a before-after design, in adult patients, we assessed the effectiveness, dosage, and tolerance of adjunctive CBD treatment. Our study concluded that CBD was effective and safe.Our study in line with others examining CBD use in adult patients with drug-resistant epilepsy, omits consideration of psychiatric aspects. The aim of this study was to evaluate, in the same patient population that was part of a previous observational study, depression, quality of life, anxious symptoms and daytime sleepiness before and after CBD treatment. RESULTS: Forty-four patients were enrolled in the study. Prior to CBD treatment, 50 % of participants exhibited symptoms of depression. Following CBD treatment, 95.4 % of these individuals demonstrated a marked improvement (p = 0.001). Among this cohort, 71.5 % of patients reported minimal or no depressive symptoms post-treatment. Moreover, 68 % of patients experienced an enhancement in their overall quality of life. Comparative analysis of BDI-II and QOLIE-10 scores before and after CBD treatment revealed a statistically significant positive correlation (p < 0.036 and < 0.001, respectively). Improvements in depressive symptoms were found to correspond with enhancements in quality of life. In terms of anxiety symptoms, 54.5 % of patients exhibited such symptoms prior to CBD treatment, with 71 % showing improvement post-treatment. Adjunctive CBD treatment in adult patients with drug-resistant focal epilepsy was effective, safe, well tolerated and associated with significant improvement in depressive symptoms, anxiety and quality of life.
Assuntos
Anticonvulsivantes , Canabidiol , Epilepsia Resistente a Medicamentos , Epilepsias Parciais , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Anticonvulsivantes/uso terapêutico , Ansiedade/tratamento farmacológico , Canabidiol/uso terapêutico , Estudos de Coortes , Comorbidade , Depressão/tratamento farmacológico , Depressão/epidemiologia , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Epilepsia Resistente a Medicamentos/psicologia , Epilepsias Parciais/tratamento farmacológico , Epilepsias Parciais/psicologia , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Estudos Prospectivos , Qualidade de Vida , Resultado do TratamentoRESUMO
AIMS: To investigate the association of CYP2C9 metabolic phenotypes with phenytoin plasma concentration ([PTH]) in neurosurgical patients from the Brazilian Public Health System. METHODS: Patients (nâ =â 170) were treated with phenytoin (300â mg/day) perioperatively as prophylaxis for postoperative seizures. Two to 10 days after surgery, a blood sample was collected for quantification of [PTH] and genotyping of CYP2C9*2 and *3 alleles. CYP2C9 metabolic phenotypes, NM (normal), IM (intermediate), and PM (poor) metabolizer, were inferred from CYP2C9 diplotypes. Linear regression modeling was applied to identify predictors of [PTH]. RESULTS: Wide (22-fold) interindividual variation in [PTH] was observed (2.2-47.5â mg/l). [PTH] associated significantly (Kruskal-Wallis Pâ <â 0.005) with CYP2C9 phenotypes and there was a significant trend (Jonckheere-Terpstra test, Pâ <â 0.0001) for [PTH] increase in the order NM < IM < PM. [PTH] was within the target therapeutic range (10-20â mg/l) in 34.7% of patients, while 39.4% and 25.9% had [PTH] below and above the range, respectively. CYP2C9 phenotypes associated significantly (chi-square Pâ =â 0.004) with the distribution of patients in [PHT] therapeutic categories and the Cramér's V test pointed to moderate magnitude of the effect of CYP2C9 phenotypes (Vâ =â 0.211). CONCLUSION: Diplotype-predicted CYP2C9 metabolic phenotypes are associated significantly with [PTH] in neurosurgical Brazilian patients receiving phenytoin for postsurgery seizure prophylaxis. [PHT] increased progressively in the phenotype order NM < IM < PM, and all PM patients had [PHT] above the target therapeutic range, consistent with the CPIC guideline 'strong' recommendation for phenytoin dosing adjustments in PMs.
Assuntos
Anticonvulsivantes , Citocromo P-450 CYP2C9 , Fenótipo , Fenitoína , Humanos , Citocromo P-450 CYP2C9/genética , Fenitoína/sangue , Fenitoína/administração & dosagem , Fenitoína/farmacocinética , Brasil , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Anticonvulsivantes/farmacocinética , Anticonvulsivantes/sangue , Anticonvulsivantes/administração & dosagem , Idoso , Convulsões/tratamento farmacológico , Convulsões/genética , Procedimentos Neurocirúrgicos/efeitos adversos , Adolescente , Genótipo , Adulto JovemRESUMO
Evidence is provided that the glycosylated flavonoid vitexin (apigenin8CbetaDglucopyranoside) attenuates pentylenetetrazole (PTZ)induced acute tonicclonic seizures in rats. However, the effects of chronic and systemic vitexin in PTZkindled rats remain unknown. The aim of this work was to investigate the effect of longterm treatment with vitexin in the PTZkindling model of epilepsy. Male Wistar rats received intraperitoneal injections of PTZ at a subconvulsive dose of 35 mg/kg every other day for 29 days. Either saline containing dimethyl sulfoxide - DMSO 1% (vehicle), diazepam (2 mg/kg; positive control) or vitexin (2.5 mg/kg) was administered intraperitoneally 30 min before each PTZ injection. The behavioral reactions were recorded by 30 min immediately after each PTZ injection. Furthermore, on the 31st day, that is, 48 h after the latter dose of PTZ, the animals were euthanized and renal and hepatic biochemical markers were evaluated in blood serum. Chronic treatment with either diazepam or vitexin attenuated the seizures provoked by PTZ injections. Neither diazepam nor vitexin caused changes in renal levels of creatinine and urea and in hepatic levels of aspartate aminotransferase and alanine aminotransferase. Our findings suggest that chronic administration of vitexin attenuates the progression of PTZinduced kindling without causing side effects on kidneys and liver.
Assuntos
Anticonvulsivantes , Apigenina , Diazepam , Excitação Neurológica , Pentilenotetrazol , Ratos Wistar , Convulsões , Animais , Masculino , Apigenina/farmacologia , Anticonvulsivantes/farmacologia , Excitação Neurológica/efeitos dos fármacos , Diazepam/farmacologia , Convulsões/tratamento farmacológico , Convulsões/induzido quimicamente , Modelos Animais de Doenças , Ratos , Fatores de Tempo , Convulsivantes/toxicidade , Epilepsia/tratamento farmacológico , Epilepsia/induzido quimicamenteRESUMO
Epilepsy is a disorder characterized by a predisposition to generate seizures. Levetiracetam (LEV) is an antiseizure drug that has demonstrated oxidant-antioxidant effects during the early stages of epilepsy in several animal models. However, the effect of LEV on oxidant-antioxidant activity during long-term epilepsy has not been studied. Therefore, the objective of the present study was to determine the effects of LEV on the concentrations of five antioxidant enzymes and on the levels of four oxidant stress markers in the hippocampus of rats with temporal lobe epilepsy at 5.7 months after status epilepticus (SE). The results revealed that superoxide dismutase (SOD) activity was significantly greater in the epileptic group (EPI) than in the control (CTRL), CTRL + LEV and EPI + LEV groups. No significant differences were found among the groups' oxidant markers. However, the ratios of SOD/hydrogen peroxide (H2O2), SOD/glutathione peroxidase (GPx) and SOD/GPx + catalase (CAT) were greater in the EPI group than in the CTRL and EPI + LEV groups. Additionally, there was a positive correlation between SOD activity and GPx activity in the EPI + LEV group. LEV-mediated modulation of the antioxidant system appears to be time dependent; at 5.7 months after SE, the role of LEV may be as a stabilizer of the redox state.
Assuntos
Antioxidantes , Catalase , Epilepsia do Lobo Temporal , Glutationa Peroxidase , Levetiracetam , Estresse Oxidativo , Superóxido Dismutase , Animais , Levetiracetam/farmacologia , Levetiracetam/uso terapêutico , Ratos , Antioxidantes/metabolismo , Antioxidantes/farmacologia , Epilepsia do Lobo Temporal/tratamento farmacológico , Epilepsia do Lobo Temporal/metabolismo , Masculino , Superóxido Dismutase/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Glutationa Peroxidase/metabolismo , Catalase/metabolismo , Anticonvulsivantes/farmacologia , Anticonvulsivantes/uso terapêutico , Oxidantes/metabolismo , Hipocampo/metabolismo , Hipocampo/efeitos dos fármacos , Modelos Animais de Doenças , Peróxido de Hidrogênio/metabolismo , Ratos WistarRESUMO
Levetiracetam (LEV) and carbamazepine (CBZ) are effective monotherapies for focal epilepsy in children. However, the best drug remains controversial. Therefore, we performed a systematic review and meta-analysis comparing LEV and CBZ monotherapy in the management of pediatric focal epilepsy (PFE). We searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) published until February 2024 comparing LEV and CBZ monotherapy in PFE. Statistical analysis was performed using R version 4.2.2, heterogeneity was assessed using I2 statistics, and the risk of bias was evaluated using the RoB-2 tool. Risk Ratios (RR) with p < 0.05 were considered significant. The outcomes of interest were seizure freedom, any adverse events, adverse events leading to treatment discontinuation, dermatologic adverse events, and the frequency of at least one seizure, defined as the proportion of patients experiencing one or more seizures during the treatment period. Four RCTs comprising 381 children with a mean age of 7.32 to 9.28 years were included, of whom 186 (48.8%) received LEV monotherapy. There was no significant difference between groups (RR: 1.15; 95% CI 0.88-1.50; p = 0.31; I2 = 90%) regarding seizure freedom. The frequency of at least one seizure (RR: 0.71; 95% CI 0.52-0.97; p = 0.03; I2 = 8%) and dermatologic adverse events (RR: 0.24; 95% CI 0.09-0.64; p < 0.01; I2 = 0%) were both significantly lower in the LEV group. There were no significant differences in the presence of any adverse events (RR: 0.58; 95% CI 0.33-1.01; p = 0.05; I2 = 36%) or adverse events leading to treatment discontinuation (RR: 0.67; 95% CI 0.13-3.42; p = 0.63; I2 = 30%).Conclusion: In monotherapy, LEV was more advantageous than CBZ for PFE, with a lower frequency of seizures and fewer dermatological adverse events. However, both drugs are equally effective in achieving seizure freedom, adverse events without specification, and those that lead to treatment discontinuation. Our findings have important implications for clinical practice and decision-making in this condition.
Assuntos
Anticonvulsivantes , Carbamazepina , Epilepsias Parciais , Levetiracetam , Criança , Humanos , Anticonvulsivantes/uso terapêutico , Anticonvulsivantes/efeitos adversos , Carbamazepina/uso terapêutico , Carbamazepina/efeitos adversos , Epilepsias Parciais/tratamento farmacológico , Levetiracetam/uso terapêutico , Levetiracetam/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoAssuntos
Anticonvulsivantes , Antineoplásicos Alquilantes , Ifosfamida , Levetiracetam , Humanos , Levetiracetam/uso terapêutico , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/uso terapêutico , Antineoplásicos Alquilantes/efeitos adversos , Ifosfamida/efeitos adversos , Piracetam/análogos & derivados , Piracetam/uso terapêutico , Piracetam/efeitos adversos , Eletroencefalografia , Masculino , Encefalopatias/induzido quimicamente , Encefalopatias/diagnóstico por imagem , Encefalopatias/tratamento farmacológico , FemininoRESUMO
Drug-resistant epilepsy has a high prevalence worldwide despite efforts such as the Epilepsy Therapy Screening Program conducted by the National Institute of Neurological Disorders and Stroke. It is indicated that drug-resistant epilepsy has various manifestations, and each pattern of manifestation can be modeled using precise experimental models. However, the experimental models used to identify new antiseizure medications to control drug-resistant epilepsy to date do not typically take into account various clinical factors associated with this condition. These factors include comorbidities, sex, age, frequency of seizures and neuroinflammation. It is accordingly necessary to identify the proper characteristics of each type of drug-resistant epilepsy to be mimicked in preclinical models. The use of preclinical models mimicking the characteristics of the different patterns of drug-resistant epilepsy will allow identifying new therapeutic strategies to control this disorder. It is also essential to consider the heterogeneity of clinical factors involved in the condition of drug resistance in epilepsy to get the proper preclinical models.
Assuntos
Anticonvulsivantes , Modelos Animais de Doenças , Epilepsia Resistente a Medicamentos , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Animais , Humanos , Anticonvulsivantes/uso terapêuticoRESUMO
This work provides insight into carbamazepine polymorphs (Forms I, II, III, IV, and V), with reports on the cytoprotective, exploratory, motor, CNS-depressant, and anticonvulsant properties of carbamazepine (CBZ), carbamazepine formulation (CBZ-F), topiramate (TOP), oxcarbazepine (OXC), and diazepam (DZP) in mice. Structural analysis highlighted the significant difference in molecular conformations, which directly influence the physicochemical properties; and density functional theory description provided indications about CBZ reactivity and stability. In addition to neuron viability assessment in vitro, animals were treated orally with vehicle 10 mL/kg, as well as CBZ, CBZ-F, TOP, OXC, and DZP at the dose of 5 mg/kg and exposed to open-field, rotarod, barbiturate sleep induction and pentylenetetrazol (PTZ 70 mg/kg)-induced seizure. The involvement of GABAergic mechanisms in the activity of these drugs was evaluated with the intraperitoneal pretreatment of flumazenil (2 mg/kg). The CBZ, CBZ-F, and TOP mildly preserved neuronal viability. The CBZ-F and the reference AEDs potentiated barbiturate sleep, altered motor activities, and attenuated PTZ-induced convulsion. However, flumazenil pretreatment blocked these effects. Additional preclinical assessments could further establish the promising utility of CBZ-F in clinical settings while expanding the scope of AED formulations and designs.
Assuntos
Anticonvulsivantes , Carbamazepina , Carbamazepina/farmacologia , Carbamazepina/análogos & derivados , Animais , Camundongos , Anticonvulsivantes/farmacologia , Convulsões/tratamento farmacológico , Convulsões/induzido quimicamente , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Oxcarbazepina/farmacologia , Diazepam/farmacologia , Masculino , Pentilenotetrazol , Sobrevivência Celular/efeitos dos fármacos , Topiramato/farmacologia , Barbitúricos/farmacologiaRESUMO
A seizure is the manifestation of symptoms or signs produced by excessive or synchronous neuronal activity in the brain. It usually presents as brief, self-limited episodes of involuntary movements that can affect a part or the entire body and that are sometimes accompanied by loss of consciousness and sphincter control. Epilepsy may be considered after a single unprovoked seizure in a patient with a high risk of recurrence. Paroxysmal non-epileptic disorders are defined as episodes of sudden onset and short duration that imitate an epileptic seizure, caused by a brain dysfunction of diverse origin that, unlike epilepsy, is not due to excessive neuronal discharge. Its incidence is much higher than epilepsy and it can appear at any age. It is important for diagnosis to analyze the triggering factors, the details of each episode, physical examination and only proceed to basic complementary tests such as video-electroencephalogram in case of doubt or for diagnostic confirmation. There is a tendency to overdiagnose epilepsy and excessive use of anticonvulsant drugs. Those that can most frequently be confused are syncope, "daydreams" and pseudoseizures.
Una convulsión es la manifestación de signos o síntomas producidos por una actividad neuronal excesiva o sincrónica en el cerebro. Suele presentarse como episodios breves, autolimitados, de movimientos involuntarios que pueden afectar a una parte del cuerpo o su totalidad y que, en ocasiones, se acompañan de pérdida de la conciencia y control de esfínteres. Puede considerarse epilepsia una sola crisis no provocada en un paciente con un elevado riesgo de recurrencia. Los trastornos paroxísticos no epilépticos se definen como episodios de aparición brusca y de breve duración que imitan a una crisis epiléptica, originados por una disfunción cerebral de origen diverso que a diferencia de la epilepsia no obedecen a una descarga neuronal excesiva. Su incidencia es mucho más elevada que la epilepsia y pueden aparecer a cualquier edad. Es importante para el diagnóstico analizar los factores desencadenantes, los pormenores de cada episodio, examen físico y solamente proceder a los exámenes complementarios básicos como video-electroencefalograma en caso de duda o para confirmación diagnóstica. Existe la tendencia a sobrediagnosticar epilepsia y al uso excesivo de fármacos anticonvulsivos. Los que con mayor frecuencia se pueden confundir son los síncopes, ensoñaciones y las pseudocrisis.
Assuntos
Eletroencefalografia , Epilepsia , Humanos , Anticonvulsivantes/uso terapêutico , Diagnóstico Diferencial , Epilepsia/diagnóstico , Epilepsia/tratamento farmacológico , Convulsões/diagnósticoRESUMO
Approximately 30% of people with epilepsy will be refractory. This manuscript reviews current evidencebased non-surgical treatment modalities for pediatric refractory epilepsy, including pharmacological and dietary strategies.
Aproximadamente el 30% de las personas con epilepsia será refractaria. Este manuscrito revisa las modalidades actuales y basadas en la evidencia de tratamientos no quirúrgicos para la epilepsia refractaria pediátrica, incluyendo estrategias farmacológicas y dietéticas.
Assuntos
Anticonvulsivantes , Epilepsia Resistente a Medicamentos , Criança , Humanos , Anticonvulsivantes/uso terapêutico , Dieta Cetogênica/métodos , Epilepsia Resistente a Medicamentos/dietoterapia , Epilepsia Resistente a Medicamentos/tratamento farmacológicoRESUMO
Epilepsy, frequently comorbid with anxiety, is a prevalent neurological disorder. Available drugs often have side effects that hinder adherence, creating a need for new treatments. Potassium channel activators have emerged as promising candidates for treating both epilepsy and anxiety. This study aimed to evaluate the potential anticonvulsant and anxiolytic effects of pinacidil, an ATP-sensitive potassium channel activator used as antihypertensive, in rats. Our results indicate that pinacidil at 10 mg/kg (i.p.) fully protected animals from seizures induced by pentylenetetrazol (PTZ) and provided 85.7%, 100% and 100% protection against pilocarpine-induced seizures at 2.5, 5 and 10 mg/kg (i.p.), respectively. Although the 2.5 and 5 mg/kg (i.p) doses did not significantly protect the animals from PTZ-induced seizures, they did significantly increase the latency to the first seizure. Pinacidil also demonstrated mild anxiolytic activity, particularly at 10 mg/kg (i.p), evidenced by increased time spent in the open or illuminated areas of the Elevated Plus Maze (EPM) and Light-Dark Box (LDB) and increased exploratory activity in the Open Filed, EPM and LDB. Pinacidil did not affect locomotor performance, supporting its genuine anticonvulsant effects. This study holds significant medical and pharmaceutical value by characterizing pinacidil's anticonvulsant and anxiolytic effects and highlighting its potential for therapeutic repositioning.
Assuntos
Ansiolíticos , Anticonvulsivantes , Modelos Animais de Doenças , Pentilenotetrazol , Pinacidil , Convulsões , Animais , Anticonvulsivantes/farmacologia , Anticonvulsivantes/uso terapêutico , Ansiolíticos/farmacologia , Ansiolíticos/uso terapêutico , Masculino , Convulsões/tratamento farmacológico , Convulsões/induzido quimicamente , Camundongos , Ratos , Pinacidil/farmacologia , Reposicionamento de Medicamentos , Ansiedade/tratamento farmacológico , Pilocarpina , Comportamento Animal/efeitos dos fármacos , Ratos WistarRESUMO
The fruit of plant Synsepalum dulcificum (Schumach. & Thonn.) Daniell, is found native to tropical regions of West Africa, and vernacularly recognized as the "Miracle Fruit" by Africans. The property of the plant has traditionally been employed in many food industries, besides its ethnopharmacological significance. The phytochemical analysis from literature reveals that various parts of plant contains many bioactive components including alkaloids, lignans, phenolic acids, glycoproteins and flavonoids. Recent studies exhibit its pharmacological potential such as antidiabetic, antihyperlipidemic, anti-cancer, antimicrobial, antioxidant, anti-hyperuricemia and anti-convulsant properties. Therefore, this review aims to systematically summarizes scientific evidences with the therapeutic, ethnopharmacological and traditional claims found in literature. However, the data acquired is still very imperfect, thus future research is hopeful to discover the precise mechanism of action of its bioactive components to explore chemical constituents, and their nutraceutical and clinical uses of this multipurpose plant to employ its valuable effects on human beings.
El fruto de la planta Synsepalum dulcificum (Schumach. & Thonn.) Daniell, se encuentra de forma nativa en las regiones tropicales del África Occidental, y es reconocida vernáculamente como la "Fruta Milagrosa" por los africanos. La propiedad de la planta ha sido empleada tradicionalmente en muchas industrias alimentarias, además de su significancia etnofarmacológica. El análisis fitoquímico de la literatura revela que varias partes de la planta contienen muchos componentes bioactivos incluyendo alcaloides, lignanos, ácidos fenólicos, glicoproteínas y flavonoides. Estudios recientes exhiben su potencial farmacológico como propiedades antidiabéticas, antihiperlipidémicas, anticancerígenas, antimicrobianas, antioxidantes, anti-hiperuricémicas y anticonvulsivas. Por lo tanto, esta revisión tiene como objetivo resumir sistemáticamente las evidencias científicas con las afirmaciones terapéuticas, etnofarmacológicas y tradicionales encontradas en la literatura. Sin embargo, los datos adquiridos aún son muy imperfectos, por lo que se espera que futuras investigaciones descubran el mecanismo de acción preciso de sus componentes bioactivos para explorar los constituyentes químicos y sus usos nutracéuticos y clínicos de esta planta multiusos para emplear sus valiosos efectos en los seres humanos.
Assuntos
Extratos Vegetais/uso terapêutico , Extratos Vegetais/farmacologia , Synsepalum/química , Frutas/química , Supressores da Gota/farmacologia , Hipoglicemiantes/farmacologia , Anti-Infecciosos/farmacologia , Anticonvulsivantes/farmacologia , Hipolipemiantes/farmacologia , Antineoplásicos/farmacologia , Antioxidantes/farmacologiaRESUMO
INTRODUCTION: Several artisanal and non-regulated cannabis-based products used for the treatment of epilepsy are available and can be easily obtained. Many of these preparations lack proper quality validation and exhibit cannabinoid contents significantly different from those stated on their labels, along with the presence of potentially harmful compounds. This study aims to evaluate the frequency of use and prescription patterns of these products among patients with epilepsy from a low-income population. METHODS: Observational and cross-sectional study. A survey was conducted on patients with epilepsy at a public hospital in Bogotá, Colombia. RESULTS: A total of 380 patients were evaluated, with 10.3 % (n = 39) reporting the use of artisanal and non-regulated cannabis-based products for the treatment of epilepsy. Among these patients, 84.6 % (n = 33) used the product on their own initiative, without a medical recommendation. Only 7.7 % (n = 3) of the patients had a record of the consumption of these products in their medical history. Age (p = 0.002), type of therapeutic response (p = 0.01), number of previous antiseizure medications used (p < 0.01), and non-pharmacological treatment such as vagal nerve stimulation (p < 0.01) showed a statistically significant association with the utilization of these products. CONCLUSION: One in ten patients with epilepsy has used artisanal and non-regulated cannabis-based products for the treatment of their condition. The majority of patients used these products on their own initiative, without a medical recommendation. The prevalence of consuming these products was higher among younger individuals with uncontrolled epilepsy, who had previously used multiple antiseizure medications and other non-pharmacological alternatives such as vagal nerve stimulation.
Assuntos
Anticonvulsivantes , Epilepsia , Maconha Medicinal , Humanos , Masculino , Feminino , Adulto , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Estudos Transversais , Pessoa de Meia-Idade , Adulto Jovem , Anticonvulsivantes/uso terapêutico , Maconha Medicinal/uso terapêutico , Adolescente , Pobreza , Colômbia/epidemiologia , Cannabis , IdosoRESUMO
Anxiety and epilepsy are common worldwide and represent a primary global health concern. Fisetin, a flavonoid isolated from Bauhinia pentandra, has a wide range of biological activities may be a promising alternative to combat diseases related to the central nervous system (CNS). The present study aimed to investigate the anxiolytic and anticonvulsant effects of fisetin on adult zebrafish. Furthermore, molecular docking simulations were performed to improve the results. Fisetin did not present toxicity and caused anxiolytic behavior and delayed seizures in animals. This effect may occur through serotonin neurotransmission at 5-HT3A and/or 5-HT3B receptors. Molecular docking simulations showed that fisetin interacts with the orthosteric site of the 5-HT3A receptor with strong H-bond interactions with the Trp156 residue, with a strong contribution from the catechol ring, a behavior similar to that of the antagonist co-crystallized inhibitor granisetron (CWB). Fisetin may be a promising alternative to combat diseases related to the central nervous system.
Assuntos
Ansiolíticos , Anticonvulsivantes , Bauhinia , Flavonóis , Simulação de Acoplamento Molecular , Peixe-Zebra , Animais , Flavonóis/isolamento & purificação , Flavonóis/farmacologia , Flavonóis/química , Ansiolíticos/farmacologia , Ansiolíticos/química , Ansiolíticos/isolamento & purificação , Anticonvulsivantes/farmacologia , Anticonvulsivantes/química , Anticonvulsivantes/isolamento & purificação , Bauhinia/química , Flavonoides/isolamento & purificação , Flavonoides/farmacologia , Flavonoides/química , Convulsões/tratamento farmacológico , Convulsões/induzido quimicamente , Relação Dose-Resposta a Droga , Estrutura Molecular , Relação Estrutura-AtividadeRESUMO
OBJECTIVE: Timely treatment is one of the most relevant prognostic factors in patients with urgent epileptic seizures. Despite the available evidence, treatment times remain suboptimal. The aim of this study was to demonstrate the impact of the "seizure code" in an emergency department, focusing on both treatment times and hospital outcomes of patients with urgent epileptic seizures. METHODS: An ambispective cohort study was conducted in the emergency department of a public hospital in Bogotá, Colombia. Treatment times and hospital outcomes were evaluated both before and after the implementation of the seizure code. RESULTS: A total of 336 patients were included (94 in the pre-seizure code period and 242 in the post-seizure code period). Both cohorts were comparable in terms of clinical and demographic baseline characteristics. After the implementation of the seizure code, in-hospital treatment times improved among patients with status epilepticus and seizure cluster. For the group of patients with status epilepticus, the time from arrival to the first benzodiazepine decreased from a median of 100.5 min (IQR: 43-152.5) to a median of 20 min (IQR: 10-45) (p = .0063), and the time from arrival to the first non-benzodiazepine antiseizure medication decreased from a median of 155 min (IQR: 49-194) to a median of 39 min (IQR: 25-57) (p = .0071). For the group of patients with seizure cluster, the time from arrival to the first non-benzodiazepine antiseizure medication decreased from a median of 296 min (IQR: 112.5-409) to a median of 72 min (IQR: 46-111) (p < .001). The seizure code significantly decreased the risk of inappropriate benzodiazepine use (p = .0087), in-hospital seizure recurrence (p < .001), in-hospital mortality (p = .0074), and prolonged hospitalizations (more than 48 h) (p = .0475). SIGNIFICANCE: The seizure code shortens the time to treatment, reduces the length of hospital stay, decreases the risk of inappropriate benzodiazepine use, and lowers both the in-hospital seizure recurrence and in-hospital mortality among patients with urgent epileptic seizures.