A double-blind trial of gabapentin monotherapy for newly diagnosed partial seizures

Dw, Chadwick; Anhut, Henning; Mj, Greiner; Alexander, Jo L.; Gh, Murray; Ea, Garofalo; Mw, Pierce

doi:10.1212/wnl.51.5.1282

Cited by 188 publications

(106 citation statements)

References 11 publications

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“…Gabapentin was initially introduced as an anti-epileptic drug for the treatment of partial seizures with or without secondary generalization [7,9,10,11,12]. Besides epilepsy, it is used for the treatment of migraine, bipolar illness or movement disorders, namely restless legs syndrome, essential tremor or nystagmus [13, 14].…”

Section: Discussionmentioning

confidence: 99%

Gabapentin for the Symptomatic Treatment of Chronic Neuropathic Pain in Patients with Late-Stage Lyme Borreliosis: A Pilot Study

Weissenbacher¹,

Ring²,

Hofmann³

2005

Dermatology

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Background: Chronic neuropathic pain occurs in 10–15% of patients with neuroborreliosis and is difficult to treat. Objective: We evaluated the effect of gabapentin monotherapy on residual pain in patients with neuroborreliosis after intravenous ceftriaxone treatment. Methods: Ten patients with neuroborreliosis and a long-lasting history of neurologic symptoms were treated with gabapentin, starting with 300 mg/day. Doses were raised over a period of 4–12 weeks to the individually effective and tolerated maximum dose (500–1,200 mg). Treatment was maintained until pain disappeared and then gradually reduced in dose over weeks. If symptoms recurred, the doses were raised again. Therapy was maintained over an average of 1–2 years. Results: Pain quality and pain quantity were evaluated using the McGill pain questionnaire and a visual analogue scale. There was an improvement of ‘crawling’ and ‘burning’ pain sensations, neck and radiating lumbar pain in 9/10 (90%) patients as well as a positive effect on mood, general feeling of health and quality of sleep in 5/10 (50%) patients. The average dose leading to a clear-cut pain reduction was 700 mg. Conclusions: In an open pilot study (10 patients), gabapentin monotherapy which has to our knowledge not been published as treatment of chronic neuropathic pain in patients with late Lyme borreliosis is efficacious in treating pain associated with neuroborreliosis and can thus improve quality of life in these patients.

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Section: Discussionmentioning

confidence: 99%

Gabapentin for the Symptomatic Treatment of Chronic Neuropathic Pain in Patients with Late-Stage Lyme Borreliosis: A Pilot Study

Weissenbacher¹,

Ring²,

Hofmann³

2005

Dermatology

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“…Gabapentin (GBP) is a clinically useful antiepileptic drug (AED) as adjunctive and nionotherapy (1)(2)(3)(4). It is useful in the management of neuropathic pain (5).…”

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confidence: 99%

Effects of Gabapentin on Brain GABA, Homocarnosine, and Pyrrolidinone in Epilepsy Patients

et al. 2000

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Summary:Purpose: Gabapentin (GBP) was introduced as an antiepileptic drug (AED) and has been used in the management of neuropathic pain. We reported that daily dosing increased brain y-aminobutyric acid (GABA) in patients with epilepsy. This study was designed to determine how rapidly brain GABA and the GABA metabolites, homocarnosine and pyrrolidinone, increase in response to the first dose of GBP.Methods: In vivo measurements of GABA, homocarnosine, and pyrrolidinone were made of a 14-cc volume in the occipital cortex by using a 'H spectroscopy with a 2.1-Tesla magnetic resonance spectrometer and an 8-cm surface coil. Six patients (four women) were studied serially after the first oral dose (1,200 mg) of GBP. Five patients (three women) taking a standard daily dose (range, 1,200-2,000 mg) of GBP were rechallenged with a single high dose (2,400 mg).Results: The first dose of GBP increased median brain GABA by 1.3 mM (range, 0.4-1.8 mM) within I h. Homocarnosine and pyrrolidinone did not change significantly by 5 h. Daily GBP therapy increased GABA (0.5 mM; 95% CI, 0.2-0.9), homocarnosine (0.3 mM; 95% C1, 0.2-0.4), and pyrrolidinone (0.10 mM; 95% CI, 0.06-0.14). Rechallenging patients taking GBP daily increased median brain GABA by 0.4 mM (range, 0.3-0.5) within 1 h. Conclusions: GBP promptly elevates brain GABA and presumably offers partial protection against further seizures within hours of the first oral dose. Patients may expect to experience the anticonvulsant effects of increased homocarnosine and pyrrolidinone with daily therapy.

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“…These studies concluded that the newer agents were found to be better tolerated than the old AEDs. Chadwick et al (41) reported that the discontinuation rate due to adverse effects in adolescents and adults newly diagnosed with partial or generalized epilepsy was found to be lower in the higher dosed gabapentin treated patients (13.5%) than among carbamazepine treated patients (24%) with dizziness, fatigue and somnolence more frequent in the carbamazepine treated group. Gabapentin doses >1,800 mg/day were as well tolerated as doses less than or equal to 1,800 mg/day and were associated only with asthenia, headache and dizziness in patients of age 12 years and older with a mean age of 37 years (42).…”

Section: Safety and Tolerability Of New Versus Old Aedsmentioning

confidence: 99%

Innovations in Epilepsy Management – An Overview

Abraham

Shaju

2013

J Pharm Pharm Sci

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-In the past twenty years, thirteen new antiepileptic drugs (AEDs) have been introduced, each differing in their efficacy spectrum, mechanism of action, pharmacokinetics, safety and tolerability profiles. These newer AEDs symbolize a welcoming future in the management of epilepsy because they are able to produce a remarkable reduction in seizure frequency in up to 40% to 50% of the patients who had been refractory to old generation drugs. Despite the current availability of these new drugs, only a few patients with truly refractory seizures can be made seizure free. Although the newer agents are not superior to that of the older drugs, some have been shown to be non-inferior in terms of their efficacy. They offer additional advantages like better tolerability, ease of use, reduced interaction profile. Even though in most situations the older generation drugs still represent the best choice, advancing studies show that in many conditions, new generation drugs may be entirely vindicated for initial therapy. This urges a need for the search of novel and more efficacious new antiepileptic drugs in the management of uncontrollable seizures. More direct comparisons of newer versus newer and newer versus older drugs in clinical trials, both for monotherapy and adjunctive therapy must be conducted. More than 20 compounds with promising antiepileptic and neuroprotective properties have been discovered and are under various stages of drug development.

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A double-blind trial of gabapentin monotherapy for newly diagnosed partial seizures

Abstract: Gabapentin at 900 or 1,800 mg/day is effective and safe as monotherapy for patients with newly diagnosed partial epilepsy.

Cited by 188 publications

References 11 publications

Gabapentin for the Symptomatic Treatment of Chronic Neuropathic Pain in Patients with Late-Stage Lyme Borreliosis: A Pilot Study

Gabapentin for the Symptomatic Treatment of Chronic Neuropathic Pain in Patients with Late-Stage Lyme Borreliosis: A Pilot Study

Effects of Gabapentin on Brain GABA, Homocarnosine, and Pyrrolidinone in Epilepsy Patients

Innovations in Epilepsy Management – An Overview

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