Treatment strategies for focal epilepsy

Bauer, Jürgen; Bös, Monika; Reuber, Markus

doi:10.1517/14656560902772328

Cited by 12 publications

(6 citation statements)

References 61 publications

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“…MMA epilepsy is preeminently focal and symptomatic. For newly diagnosed focal seizures, currently, carbamazepine and lacosamide are often first-line treatment options; levetiracetam, valproic acid, and lamotrigine can be considered too [94]. Medication tolerability, interactions, and potential pregnancy planning are significant factors to be considered in drug selection.…”

Section: Epilepsy Managementmentioning

confidence: 99%

“…Medication tolerability, interactions, and potential pregnancy planning are significant factors to be considered in drug selection. In poststroke epilepsy, despite similar efficacy, lamotrigine was observed to be superior to carbamazepine regarding tolerability; due to a lower rate of drug interactions, levetiracetam is, however, the most commonly prescribed AED [94,95]. Lamotrigine and levetiracetam have a lower fetal risk; particularly, lamotrigine is usually the first choice for fertile women [41].…”

Section: Epilepsy Managementmentioning

confidence: 99%

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Clinical Management of Moyamoya Patients

Canavero

Vetrano

Zedde

et al. 2021

JCM

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Moyamoya angiopathy (MMA) is a peculiar cerebrovascular condition characterized by progressive steno-occlusion of the terminal part of the internal carotid arteries (ICAs) and their proximal branches, associated with the development of a network of fragile collateral vessels at the base of the brain. The diagnosis is essentially made by radiological angiographic techniques. MMA is often idiopathic (moyamoya disease-MMD); conversely, it can be associated with acquired or hereditary conditions (moyamoya Syndrome-MMS); however, the pathophysiology underlying either MMD or MMS has not been fully elucidated to date, and this poor knowledge reflects uncertainties and heterogeneity in patient management. MMD and MMS also have similar clinical expressions, including, above all, ischemic and hemorrhagic strokes, then headaches, seizures, cognitive impairment, and movement disorders. The available treatment strategies are currently shared between idiopathic MMD and MMS, including pharmacological and surgical stroke prevention treatments and symptomatic drugs. No pharmacological treatment able to reverse the progressive disappearance of the ICAs has been found to date in both idiopathic and syndromic cases. Antithrombotic agents are usually prescribed in ischemic MMA, although the coexisting hemorrhagic risk should be considered. Surgical revascularization techniques, which are currently the best available treatment in symptomatic MMA, are associated with good long-term outcomes and reduced ischemic and hemorrhagic risks. Given the lack of dedicated randomized clinical trials, current treatment is mainly based on observational studies and physicians’ and surgeons’ expertise.

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Section: Epilepsy Managementmentioning

confidence: 99%

Section: Epilepsy Managementmentioning

confidence: 99%

Clinical Management of Moyamoya Patients

Canavero

Vetrano

Zedde

et al. 2021

JCM

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“…Carbamazepine (CBZ), a dibenzazepine derivative, has widely been used in the treatment of epilepsy and neuropathic pain for the past five decades [6]. It acts by selectively binding to voltage-gated sodium channels and blocking its repetitive activation.…”

Section: Introductionmentioning

confidence: 99%

Hot liquid extrusion assisted drug-cyclodextrin complexation: a novel continuous manufacturing method for solubility and bioavailability enhancement of drugs

Manne

Hegde

Raut

et al. 2020

Drug Deliv. and Transl. Res.

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In this study, drug-cyclodextrin (CD) complexes were prepared using hot liquid extrusion (HLE) process with an aim to improve solubility and bioavailability of carbamazepine. Saturation solubility studies of CBZ in water and different pH media showed a pH-independent solubility. Phase solubility studies of CBZ at different molar concentrations of beta-cyclodextrin (β-CD) and hydroxypropyl beta-cyclodextrin (HP-β-CD) indicated AL-type solubility profile with stability constants of 574 M−1 and 899 M−1 for β-CD and HP-β-CD. Drug-β-CD and drug-HP-β-CD complexes were prepared using HLE process and conventional methods (such as physical mixture, kneading method, and solvent evaporation) as well. Optimized complexes prepared using HLE viz. CBP-4 and CHP-2 showed a solubility of 4.27 ± 0.09 mg/mL and 6.39 ± 0.09 mg/mL as compared to plain CBZ (0.140 ± 0.007 mg/mL). Formation of drug-CD inclusion complexes was confirmed using DSC, FTIR, and XRD studies. Drug release studies indicated highest release of CBZ from CHP-2 (98.69 ± 2.96%) compared to CBP-4 (82.64 ± 2.45%) and plain drug (13.47 ± 0.54%). Complexes prepared using kneading showed significantly lesser drug release (KMB 75.52 ± 2.68% and KMH 85.59 ± 2.80%) as that of CHP-2 and CBP-4. Pre-clinical pharmacokinetic studies in Wistar rats indicated a significant increase in Cmax, Tmax, AUC, and mean residence time for CHP-2 compared to KMH and plain CBZ. All these results suggest that HLE is an effective method to increase the solubility of poorly water-soluble drugs.

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“…

Carbamazepine, (CBZ) is a sodium channel blocker recommended for the treatment of epilepsy and trigeminal neuralgia for over 40 years [1][2][3] . Cyclodextrins are the most suitable candidate for the inclusion of CBZ due to the dimension of the internal cavity in which the active drug can fit properly.

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mentioning

confidence: 99%