The Expert Consensus Guideline Series

Karceski, Steven; Morrell, Martha J.; Carpenter, Daniel

doi:10.1006/ebeh.2001.0283

Cited by 161 publications

(73 citation statements)

References 41 publications

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“…Spike-wave discharges of corticothalamic neurons are in part mediated by T-type channels that produce LTS (93,277,377,387). Ethosuximide is a first-line drug in the treatment of absence epilepsy (193). In vitro studies found that ethosuximide can block T-type channels with little effect of HVA channels in thalamic neurons (86).…”

Section: B Antiepilepticsmentioning

confidence: 99%

Molecular Physiology of Low-Voltage-Activated T-type Calcium Channels

Perez‐Reyes

2003

Physiological Reviews

1,488

1,446

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T-type Ca2+ channels were originally called low-voltage-activated (LVA) channels because they can be activated by small depolarizations of the plasma membrane. In many neurons Ca2+ influx through LVA channels triggers low-threshold spikes, which in turn triggers a burst of action potentials mediated by Na+ channels. Burst firing is thought to play an important role in the synchronized activity of the thalamus observed in absence epilepsy, but may also underlie a wider range of thalamocortical dysrhythmias. In addition to a pacemaker role, Ca2+ entry via T-type channels can directly regulate intracellular Ca2+ concentrations, which is an important second messenger for a variety of cellular processes. Molecular cloning revealed the existence of three T-type channel genes. The deduced amino acid sequence shows a similar four-repeat structure to that found in high-voltage-activated (HVA) Ca2+ channels, and Na+ channels, indicating that they are evolutionarily related. Hence, the α1-subunits of T-type channels are now designated Cav3. Although mRNAs for all three Cav3 subtypes are expressed in brain, they vary in terms of their peripheral expression, with Cav3.2 showing the widest expression. The electrophysiological activities of recombinant Cav3 channels are very similar to native T-type currents and can be differentiated from HVA channels by their activation at lower voltages, faster inactivation, slower deactivation, and smaller conductance of Ba2+. The Cav3 subtypes can be differentiated by their kinetics and sensitivity to block by Ni2+. The goal of this review is to provide a comprehensive description of T-type currents, their distribution, regulation, pharmacology, and cloning.

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Section: B Antiepilepticsmentioning

confidence: 99%

Molecular Physiology of Low-Voltage-Activated T-type Calcium Channels

Perez‐Reyes

2003

Physiological Reviews

1,488

1,446

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“…O questionário -O questionário foi feito baseado no estudo de Karceski et al 16 , com algumas modificações. O número total de questões foi 16, com 510 opções de tratamento, abrangendo três principais cenários clínicos: epilepsia generalizada idiopática, epilepsia focal sintomática e epilepsia generalizada sintomática.…”

Section: Métodosunclassified

“…Nestes estudos, determinada terapia é comparada com um placebo ou com outra terapia previamente estabelecida e considerada útil. A principal desvantagem dos estudos randomizados é que raramente eles comparam dois tratamentos já bem estabelecidos 16 . Alguns autores propõem o uso da meta-análise na tentativa de contornar esse problema.…”

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“…Os guias atualmente disponíveis foram elaborados de acordo com a prática médica norte-americana. Apesar da maioria dos guias estabelecidos pelo consenso destes especialistas para o tratamento das epilepsias 16 serem úteis para a prática clínica diária em locais fora do Estados Unidos e Canadá, alguns deles não são. O tratamento da epilepsia tem muitas variantes e, provavelmente, o custo é uma das mais sérias limitações.…”

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Tratamento de epilepsia: consenso dos especialistas brasileiros

Betting

Kobayashi

Montenegro

et al. 2003

Arq. Neuro-Psiquiatr.

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RESUMO -Epilepsia é uma condição muito freqüente em todo o mundo. Na última década, várias opções terapêuticas surgiram ou foram aprimoradas. O principal método utilizado para decisão terapêutica baseia-se nos estudos randomizados, que representam o maior nível de evidência. Entretanto, mesmo estes estudos são passíveis de críticas e em alguns casos o tratamento de escolha permanece controverso. Nestas situações, a opinião dos especialistas, na área da epileptologia, com maior experiência clínica, passa a ter grande valor. O presente estudo tem como principal objetivo elaborar um consenso de tratamento das epilepsias, através da opinião de experts brasileiros no assunto. Este consenso poderá auxiliar na criação de manuais e estratégias para o tratamento de determinadas síndromes epilépticas, de acordo com os padrões socioeconômicos brasileiros.PALAVRAS-CHAVE: epilepsia tratamento, drogas antiepilépticas, crises. Treatment of epilepsy: consensus of the Brazilian specialistsABSTRACT -Epilepsy is a frequent condition in the world. Recently a study in Brazil showed prevalence of 18/ 1000 inhabitants in São José do Rio Preto, São Paulo State. In the last decade, new therapeutic options were discovered or developed. The main therapeutic decision method is based on randomized clinical trials. This method represents the higher level of evidence. However, even these studies have limitations and in some cases the treatment of choice remains controversial. In these instances, the epilepsy experts' opinions become helpful. In 2001 a similar study had been conducted in USA. The aim of this study is to create guidelines for epilepsy treatment based on the opinion of the Brazilian experts. These guidelines can be used to create manuals and strategies for the treatment of some epileptic syndromes according to Brazilian experts. As compared to the North-American guidelines our study better reflects the resources available in our country.KEY WORDS: epilepsy, treatment, antiepileptic drugs, seizures.Aproximadamente 50 milhões de pessoas no mundo sofrem de epilepsia. Epilepsia é considerada a segunda causa mais frequente de distúrbio neurológico em adultos jovens 1,2 . É um sério problema de saúde acometendo indivíduos de todas as idades, raças e classes socioeconômicas. Na última década observamos um grande avanço no tratamento das epilepsias incluindo as novas drogas descobertas, novas formulações de antigas drogas, estimulação vagal, dieta cetogênica e o tratamento cirúrgico [3][4][5][6][7][8][9][10][11][12][13][14][15] . Apesar do crescente número de publicações cientí-ficas, algumas questões abrangendo o tratamento das epilepsias permanecem sem resposta ou controversas.Os estudos randomizados são considerados como os de maior nível de evidência e de menor tenden- Dr. Carlos A.M. Guerreiro -Departamento de Neurologia -FCM/UNICAMP -Caixa Postal 6111 -13083-970 Campinas SP -Brasil. E-mail: guerreiro@fcm.unicamp.br OS ESPECIALISTAS -Os participantes foram selecionados através dos seguintes critérios: neurologistas clínicos de...

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“…An investigation on medical practice for epilepsy showed that gabapentin is positioned as a second-line therapy for simple partial seizures. 15 In another review, gabapentin is recommended as an adjunctive therapy in refractory epilepsy as well as lamotrigine, tiagabine, topiramate, oxcarbazepine, levetiracetam, zonisamide, and pregabalin. 16 For a comparison of the safety and tolerability of new AED, 1222 patients who were receiving more than 1200 AED regimens were reviewed for the incidence of rash.…”

Section: Discussionmentioning

confidence: 99%

Treatment of partial seizures with gabapentin: Double‐blind, placebo‐controlled, parallel‐group study*

Yamauchi

Kaneko

Yagi

et al. 2006

Psychiatry Clin Neurosci

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This double-blind study was conducted to evaluate the efficacy and safety of gabapentin 1200 mg/ day and 1800 mg/day (t.i.d.) compared to placebo as an adjunctive therapy in patients with refractory epilepsy. Patients were included when they had partial seizures at least eight times during a 12-week baseline period despite treatment with one to two antiepileptic drugs. After baseline, eligible patients were randomized to gabapentin 1200 mg/day, 1800 mg/day, or placebo for 12-week treatment. The primary end-point, response ratio, was derived from seizure frequencies during treatment and baseline period based upon the seizure daily record by a patient. Of the 209 randomized patients, 86 received gabapentin 1200 mg/day, 41 received gabapentin 1800 mg/day, and 82 received placebo. A statistically significant difference was found between each of the two gabapentin groups and placebo for the primary efficacy end-point, response ratio (P < 0.005) with definite doseresponse (P < 0.001). More gabapentin patients reported moderate to marked improvement in seizure frequency and intensity/duration of each seizure than placebo patients. Treatment-related adverse events were reported by approximately 65% of patients receiving gabapentin compared to approximately 46% of patients receiving placebo; somnolence and dizziness were the most common events. Gabapentin 1200 mg/day and 1800 mg/day significantly reduced the frequency of refractory seizures compared to placebo. Favorable tolerability of gabapentin was confirmed also in a Japanese population, consistent with previous global studies.

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The Expert Consensus Guideline Series

Cited by 161 publications

References 41 publications

Molecular Physiology of Low-Voltage-Activated T-type Calcium Channels

Molecular Physiology of Low-Voltage-Activated T-type Calcium Channels

Tratamento de epilepsia: consenso dos especialistas brasileiros

Treatment of partial seizures with gabapentin: Double‐blind, placebo‐controlled, parallel‐group study*

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