Acetazolamide in Treatment of Epilepsy

Ansell, Barbara M.; Clarke, Edwin

doi:10.1136/bmj.1.4968.650

Cited by 66 publications

(32 citation statements)

References 5 publications

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“…The add‐on group showed similar results. This study demonstrated the problem of tolerance, which has been reported in other studies with AZM (31,32). Another study reported the addition of AZM to treat a group of 178 patients with seizures that included 14 patients with 30‐Hz spike‐and‐wave activity on EEG (33).…”

Section: Childhood Absence Epilepsysupporting

confidence: 80%

Evidence‐based Treatment of Idiopathic Generalized Epilepsies with Older Antiepileptic Drugs

Hitiris

Brodie

2005

Epilepsia

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Summary:Older antiepileptic drugs continue to play a major role in the treatment of the idiopathic generalized epilepsies. Comparative studies of ethosuximide and valproate have demonstrated equivalence in the treatment of childhood absence epilepsy. Valproate can be regarded as the recommended first-line treatment for juvenile myoclonic epilepsy based on case series reports. Studies in patients with generalized tonicclonic seizures have not separated out idiopathic from secondary generalized events. Treatment for the other idiopathic generalized epilepsy syndromes lacks evidence other than a few case reports and diverse expert opinion. Further randomized controlled trials of older antiepileptic drugs are recommended to solidify the evidence-based treatment of the idiopathic generalized epilepsies.

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Section: Childhood Absence Epilepsysupporting

confidence: 80%

Evidence‐based Treatment of Idiopathic Generalized Epilepsies with Older Antiepileptic Drugs

Hitiris

Brodie

2005

Epilepsia

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“…Effectiveness at doses of 250–500 mg daily administered from 3–7 days before menses has been reported. 65,66 …”

Section: Endogenous Hormones and Catamenial Epilepsymentioning

confidence: 99%

Neuroendocrine considerations in the treatment of men and women with epilepsy

Harden

Pennell

2013

The Lancet Neurology

115

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Complex, multidirectional interactions between hormones, seizures, and the medications used to control them can present a challenge for clinicians treating patients with epilepsy. Many hormones act as neurosteroids, modulating brain excitability via direct binding sites. Thus, changes in endogenous or exogenous hormone levels can affect the occurrence of seizures directly as well as indirectly through pharmacokinetic effects that alter the concentrations of antiepileptic drugs. The underlying structural and physiological brain abnormalities of epilepsy and the metabolic activity of antiepileptic drugs can adversely affect hypothalamic and gonadal functioning. Knowledge of these complex interactions has increased and can now be incorporated in meaningful treatment approaches for men and women with epilepsy.

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“…Catamenial epilepsy, in many cases, is assumed to be an acquired disorder and currently there is no clear evidence of genetic components. A variety of mechanisms such as fluctuations in antiepileptic drug levels, changes in water and electrolyte balance, and physiological variation in ovarian hormone secretion have been proposed as causes for catamenial epilepsy (McQuarrie and Peeler, 1931; Ansell and Clarke, 1956; Shavit et al, 1984; Rosciszewska et al, 1986; Kumar et al, 1988; Narbone et al, 1990; Herzog, 1991; Herkes et al, 1993; Rodriguez-Macias, 1996; Harden et al, 1999; Tuveri et al, 2008). Overall, cyclical changes in the circulating levels of estrogens and progesterone are now widely accepted to play a central role in the development of this condition (Fig.…”

Section: Pathophysiology Of Catamenial Epilepsymentioning

confidence: 99%

“…Carbonic anhydrase is also present in the brain. Acetazolamide has been used empirically for years for the treatment of refractory (focal and generalized) and catamenial epilepsy (Ansell and Clark, 1956; Ross, 1958). However, there are few direct studies of its effectiveness in the management of catamenial seizures.…”

Section: The Hormonal and Non-hormonal Treatment Of Catamenial Epilepsymentioning

confidence: 99%

The role of neurosteroids in the pathophysiology and treatment of catamenial epilepsy

Reddy¹

2009

Epilepsy Research

148

180

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SUMMARYCatamenial epilepsy is a multifaceted neuroendocrine condition in which seizures are clustered around specific points in the menstrual cycle, most often around perimenstrual or periovulatory period. Generally, a two-fold or greater increase in seizure frequency during a particular phase of the menstrual cycle could be considered as catamenial epilepsy. Based on this criteria, recent clinical studies indicate that catamenial epilepsy affects 31 -60% of the women with epilepsy. Three types of catamenial seizures (perimenstrual, periovulatory and inadequate luteal) have been identified. However, there is no specific drug available today for catamenial epilepsy, which has not been successfully treated with conventional antiepileptic drugs. Elucidation of the pathophysiology of catamenial epilepsy is a prerequisite to develop specific targeted approaches for treatment or prevention of the disorder. Cyclical changes in the circulating levels of estrogens and progesterone play a central role in the development of catamenial epilepsy. There is emerging evidence that endogenous neurosteroids with anticonvulsant or proconvulsant effects could play a critical role in catamenial epilepsy. It is thought that perimenstrual catamenial epilepsy is associated with the withdrawal of anticonvulsant neurosteroids. Progesterone and other hormonal agents have been shown in limited trials to be moderately effective in catamenial epilepsy, but may cause endocrine side effects. Synthetic neurosteroids, which enhance the tonic GABA-A receptor function, might provide an effective approach for the catamenial epilepsy therapy without producing hormonal side effects.

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Acetazolamide in Treatment of Epilepsy

Cited by 66 publications

References 5 publications

Evidence‐based Treatment of Idiopathic Generalized Epilepsies with Older Antiepileptic Drugs

Evidence‐based Treatment of Idiopathic Generalized Epilepsies with Older Antiepileptic Drugs

Neuroendocrine considerations in the treatment of men and women with epilepsy

The role of neurosteroids in the pathophysiology and treatment of catamenial epilepsy

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