Antikonvulsivum

Antikonvulsivum, or anticonvulsants, are a class of medications used to prevent and control seizures in epilepsy. They are also prescribed for neuropathic pain, mood stabilization in bipolar disorder, and prophylaxis of migraines. Selection depends on seizure type, comorbidity, and drug interactions.

Mechanisms vary by drug but often aim to reduce neuronal excitability. Common actions include enhancing GABAergic inhibition, blocking voltage-gated sodium or calcium channels, or reducing excitatory glutamatergic transmission. Some drugs have multiple mechanisms.

Major agents and classes include older drugs such as phenytoin, carbamazepine, valproate, phenobarbital, and ethosuximide; newer agents include lamotrigine, levetiracetam, topiramate, gabapentin, pregabalin, oxcarbazepine, and zonisamide. Most are used as monotherapy or polytherapy, tailored to seizure type and tolerability.

Administration and interactions involve regular dosing and monitoring. Serum levels are needed for certain drugs (phenytoin, valproate, carbamazepine) due to narrow therapeutic windows and interactions. Enzyme-inducing agents can alter levels of concomitant medications. Pregnancy requires careful planning; valproate carries high teratogenic risk, others vary.

Safety considerations cover adverse effects ranging from sedation and dizziness to cognitive impact, skin reactions (such as lamotrigine rash), hematologic effects, and weight changes. Long-term use requires assessment of bone health and liver function; withdrawal should be gradual to reduce seizure worsening.