New developments in the treatment of partial-onset epilepsy

Frank MC Besag,1,2 Philip N Patsalos3,41South Essex Partnership University NHS Foundation Trust (SEPT), Mid Beds Clinic, Bedford, Bedfordshire, UK; 2Institute of Psychiatry, London, UK; 3Pharmacology and Therapeutics Unit, Department of Clinical and Experimental Epilepsy, UCL-Institute of Neurology,...

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Autores principales:	Besag FM, Patsalos PN
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2012
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/5cdebd519024465bbb0ab4296ec12a53
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spelling	oai:doaj.org-article:5cdebd519024465bbb0ab4296ec12a532021-12-02T04:14:48ZNew developments in the treatment of partial-onset epilepsy1176-63281178-2021https://doaj.org/article/5cdebd519024465bbb0ab4296ec12a532012-10-01T00:00:00Zhttp://www.dovepress.com/new-developments-in-the-treatment-of-partial-onset-epilepsy-a11293https://doaj.org/toc/1176-6328https://doaj.org/toc/1178-2021Frank MC Besag,1,2 Philip N Patsalos3,41South Essex Partnership University NHS Foundation Trust (SEPT), Mid Beds Clinic, Bedford, Bedfordshire, UK; 2Institute of Psychiatry, London, UK; 3Pharmacology and Therapeutics Unit, Department of Clinical and Experimental Epilepsy, UCL-Institute of Neurology, London, UK; 4Epilepsy Society, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, UKAbstract: Although most people presenting with partial-onset seizures will achieve control with antiepileptic medication, a considerable minority will have difficult-to-treat epilepsy that is resistant to existing medication. Over the last few years, a large number of new antiepileptic drugs have been developed. Some of these have a novel mode of action. Many of the older antiepileptic drugs act through sodium channels or by enhancement of gamma amino butyric acid (GABA). Lamotrigine has sodium-channel blocking properties but also has other important modes of action, indicated by efficacy in treating not only partial-onset but also generalized seizures. Vigabatrin and tiagabine both increase GABA activity, by inhibiting GABA transaminase and limiting GABA reuptake, respectively. The main mode of action of gabapentin and pregabalin is not via GABA but through a selective inhibitory effect on voltage-gated calcium channels containing the &alpha;2&delta;-1 subunit. Levetiracetam inhibits the recycling of SV2A (synaptic vesicle protein 2A) neurotransmitter vesicles but also has other effects, including inhibition of voltage-dependent calcium channels. Some drugs, eg, felbamate, zonisamide, and topiramate, have multiple modes of action. In many cases, although the main mode of action may have been identified, other modes of action also play a role. Two recently developed antiepileptic drugs appear to have completely novel primary modes of action; retigabine (ezogabine) and perampanel act on the potassium channel and on AMPA (&alpha;-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) receptors, respectively. The hope is that antiepileptic drugs with a novel mode of action will be effective where previous drugs have failed and will not have unacceptable adverse effects. However, experience with these medications is too limited to allow any conclusions to be drawn at present.Keywords: partial-onset seizures, difficult-to-treat epilepsy, antiepileptic drugsBesag FMPatsalos PNDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2012, Iss default, Pp 455-464 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Besag FM Patsalos PN New developments in the treatment of partial-onset epilepsy
description	Frank MC Besag,1,2 Philip N Patsalos3,41South Essex Partnership University NHS Foundation Trust (SEPT), Mid Beds Clinic, Bedford, Bedfordshire, UK; 2Institute of Psychiatry, London, UK; 3Pharmacology and Therapeutics Unit, Department of Clinical and Experimental Epilepsy, UCL-Institute of Neurology, London, UK; 4Epilepsy Society, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, UKAbstract: Although most people presenting with partial-onset seizures will achieve control with antiepileptic medication, a considerable minority will have difficult-to-treat epilepsy that is resistant to existing medication. Over the last few years, a large number of new antiepileptic drugs have been developed. Some of these have a novel mode of action. Many of the older antiepileptic drugs act through sodium channels or by enhancement of gamma amino butyric acid (GABA). Lamotrigine has sodium-channel blocking properties but also has other important modes of action, indicated by efficacy in treating not only partial-onset but also generalized seizures. Vigabatrin and tiagabine both increase GABA activity, by inhibiting GABA transaminase and limiting GABA reuptake, respectively. The main mode of action of gabapentin and pregabalin is not via GABA but through a selective inhibitory effect on voltage-gated calcium channels containing the &alpha;2&delta;-1 subunit. Levetiracetam inhibits the recycling of SV2A (synaptic vesicle protein 2A) neurotransmitter vesicles but also has other effects, including inhibition of voltage-dependent calcium channels. Some drugs, eg, felbamate, zonisamide, and topiramate, have multiple modes of action. In many cases, although the main mode of action may have been identified, other modes of action also play a role. Two recently developed antiepileptic drugs appear to have completely novel primary modes of action; retigabine (ezogabine) and perampanel act on the potassium channel and on AMPA (&alpha;-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) receptors, respectively. The hope is that antiepileptic drugs with a novel mode of action will be effective where previous drugs have failed and will not have unacceptable adverse effects. However, experience with these medications is too limited to allow any conclusions to be drawn at present.Keywords: partial-onset seizures, difficult-to-treat epilepsy, antiepileptic drugs
format	article
author	Besag FM Patsalos PN
author_facet	Besag FM Patsalos PN
author_sort	Besag FM
title	New developments in the treatment of partial-onset epilepsy
title_short	New developments in the treatment of partial-onset epilepsy
title_full	New developments in the treatment of partial-onset epilepsy
title_fullStr	New developments in the treatment of partial-onset epilepsy
title_full_unstemmed	New developments in the treatment of partial-onset epilepsy
title_sort	new developments in the treatment of partial-onset epilepsy
publisher	Dove Medical Press
publishDate	2012
url	https://doaj.org/article/5cdebd519024465bbb0ab4296ec12a53
work_keys_str_mv	AT besagfm newdevelopmentsinthetreatmentofpartialonsetepilepsy AT patsalospn newdevelopmentsinthetreatmentofpartialonsetepilepsy
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New developments in the treatment of partial-onset epilepsy

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