Antiepileptikus

Antiepileptikus, or antiepileptic drugs (AEDs), are a diverse group of medications used to prevent or control epileptic seizures and to treat other conditions such as neuropathic pain and certain mood disorders. They work by reducing abnormal brain excitability through multiple mechanisms.

Most AEDs act on neuronal membranes or neurotransmitter systems. Common mechanisms include stabilization of voltage-gated sodium channels to dampen high-frequency firing (for example, carbamazepine, oxcarbazepine, phenytoin, lamotrigine), enhancement of GABAergic inhibition (phenobarbital, benzodiazepines, valproate), and, in some drugs, inhibition of excitatory transmission (ethosuximide targets T-type calcium channels; levetiracetam acts via SV2A; newer agents may affect AMPA receptors or other targets).

Indications and use vary by seizure type. AEDs are the mainstay of treatment for focal seizures and generalized tonic-clonic seizures, and ethosuximide or valproate is commonly used for absence seizures. Many AEDs have additional indications, including neuropathic pain, migraine prevention, and, in some cases, mood stabilization.

Safety and monitoring are important. Side effects can include sedation, dizziness, cognitive effects, and rash, with specific risks such as teratogenicity (notably valproate) and liver or hematologic toxicity for certain drugs. Drug interactions are common due to effects on liver enzymes; dosing is individualized and some drugs require plasma level monitoring. Pregnancy planning typically favors agents with lower fetal risk, and folic acid supplementation is advised.

Discontinuation of an AED should be gradual and supervised to minimize relapse risk. Ongoing research continues to develop targeted therapies with improved efficacy and tolerability.