Introduction
Epileptic drugs are highly effective in the treatment of epilepsy. However, the new drugs developed have been observed to also treat other diseases. This is a discussion on the wide use of the drugs.
Non-epileptic Uses
Antiepileptic drugs can be used to treat several other diseases apart from epilepsy. The drugs can be used to treat mood and anxiety disorders. It has been ascertained that certain syndromes of bipolar disorders that respond poorly to lithium which is the dominant drug used to treat the disease. The patients responding poorly are those with rapid cycling and mixed bipolar states. Over the years, the use of antiepileptic drugs has increased and the use of lithium has decreased. The new AEDs such as lamotrigine have recorded great levels of efficacy against bipolar depression. It has acute and prophylactic effects. Topiramate although less studied by clinical officers, has also shown positive effects on the bipolar patients in open trials.
Levetiracetam has also been proven to offer relief for bipolar patients who experience mania, rapid cycling and depression. Gapabentin has positive effects on patients who experience social phobia, panic disorder and opiate withdrawal. AEDs have also been used in the treatment of schizophrenia. Lamotrigine in combination with clozapine has been used in the treatment of patients with refractory schrizophrenia. Clinical officers have observed that there are glutamatergic mechanisms in these patients. Lamotrigine and clozapine have anti-glumatergic effects on the patients. Borderline personality disorder is a condition that is considered highly dangerous as one of the symptoms is a 10% suicidal tendency. The patient also uses a lot of mental health resources.
Carbamazepine causes the patients to have lesser levels of impulsivity. Divalproex and lamotrigine are other AEDs that have showed positive results in patients with aggression and mood instability. AEDs have also been used in the treatment of demented elderly patients. They also show positive results in children who have learning disorders. Divalproex shows a neuroprotective role for these patients. These drugs are prescribed by the clinical officers as alternatives to the antipsychotics. It has been observed that they are less toxic. When the new AEDs came into the market, clinical officers started focusing on the people who have gained weight due to the use of psychiatric drugs. There are also those patients who gain weight due to insulin resistance, elevated blood pressure and abdominal obesity.
The older AEDs could not be used to treat weight gain. Drugs such as divalproex were observed to cause fatty livers. However, the new drugs such as lamotrigine, levetiracetam, topiramate and zonisamide are weight neutral and actually cause loss of weight in the patients. Topiramate is especially good for the patients who are suffering from Bulimia. For those patients who gain weight due to the use of psychiatry drugs have been using Zonisamide which has helped them loose a lot of weight. There are women who have reproductive endocrine disorders. These disorders are common in women who have experienced epileptic pregnancies.
AEDs such as valproate have been observed to produce elevated levels of androgen hormones in these women. In the men who are epileptic it has also been observed that the AEDs such as carbamazepine, oxcarbazepine and valproate alter the sexual hormones and the sperm functions. The AED drugs may also be used to treat mood disorders and aggression in children (Kaizad & Tanya, 2010). The use of AEDs in the treatment of pain conditions such as neuropathic pain has increased over the years (Titik & Tonkik, 2008). Of particular interest is the lamotrigine drug which has been administered with positive effect on the patients. lamotrigine has two specific antinociceptive properties. When administered to the patient, it blocks the activation of the sodium channels which are voltage sensitive. Secondly, it inhibits the production of glutamate. When the drug is administered, it is quickly and completely absorbed at the gastrointestinal tract. It binds itself to the plasma proteins. The drug is conjugated with glucuronic acid and metabolized in the body. A study conducted in the journals available at the medline data bases showed that the drug showed positive results in the patients consistently (Pappagalo, 2003).
The research was on the peer reviewed articles where clinical trials had been conducted. Lamotrigine has been used in the treatment of central post stroke pain. Oral lamotrigine administered in the doses of 200ml daily has showed positive results in the patients. In patients with multiple sclerosis it has been observed that they suffer from trigeminal and dysesthatic pain (Rozan, 2001). Carbamezipine and lamotrigine have proved effective in the treatment of these patients by blocking the sodium channels. There are people who experience cluster headaches which come for duration of fifteen minutes to three hours. The pain is usually episodic and it surrounds one of the eyes of the patient (Cutrer, 2001).
Lamotrigine has aslo shown positive effects in patients suffering from these headaches. The SUNCT headache causes a lot of pain to the first division of the trigeminal nerve. Lamotrigine can be administered in high doses to the patients over a prolonged period of time. More research should be carried out by clinical officers to ascertain whether the new AEDs are effective in the treatment of spinal cord injury pain, migraines and neuralgia after nerve section.
The AEDs drugs have been used in treating childhood epilepsy over the years. Clinical officers have found out that between 0.5 to 1% of children have epilepsy. There are children who start manifesting epilepsy from birth. There are challenges in diagnosing and classifying the epilepsy in the child before the physician can start administering the drugs. There are those children who do not respond well to the traditional therapy methods. The clinical officers have therefore been turning to the new AEDs to assist in the treatments. Felbamate was introduced in the market in 1993 in the United States. It has been proven to have positive effects in the treatment of partial seizures in the adults. It has also been used in the treatment of the partial seizures in the children.
It is recommended that the children should be given doses of 15-45mg per day depending on the seizures in the particular child. There are children who have been given higher doses of the drug as high as 90mg as this is the dose which has proven to be effective for them. In a study conducted in 73 patients between the ages of four and thirty six years, Felbamate helped the patients show greater seizure control and improved quality of life. The patients were being given either placebo or Felbamate. There were given doses of 45mg per day for a period of two weeks.
Gabapentin is a new AED drug that has a high popularity due to its positive characteristics. It has mild adverse effects and it can be titrated quickly by the patient. It also does not alter the patient’s enzymes. It also has no drug to drug interactions in the patient’s body. It is a great anticonvulsant, antinociceptive and neuroprotective agent. It has been used in the treatment of partial and generalized seizures. It is administered at higher doses to the children and adults than Felbamate. Gabapentin is administered in doses of between 30 and 90mg per day. In children who experience refractory childhood epilepsy it may be administered at higher doses.
Lamotrigine is another new popular AED drug that has been used in the treatment of childhood epilepsy. However caution has to be exercised. This is because it has certain side effects. It has been observed to give children a life threatening rash. The rash has been observed in the children who are receiving the lamotrogine in conjuction with valproate. The children who receive rapid tritation of the lamotrogine in the initial doses have also been getting the dangerous rash. The drug is administered in lower doses of 1 to 15mg per day. When the drug is administered with valproate it has less powerful effects.
The valproate inhibits or slows down the conversion of the lamotrigine drug. Its life is also shortened by the AEDs which are enzyme producing such as phenytoin, carbamazepine and phenobarbital. However, it is an important drug for the children who exhibit lennox-gastaut syndrome. It has also been playing an instrumental role in the treatment of juvenile myoclonic epilepsy, infantile spasms and absence seizures. In five open trials, the clinical officers administered the drug to children who are between the years of one and thirteen years. The drug was administered to 285 children. The results showed that the children demonstrated a 50% decrease in the epilepsy occurrences. This was observed at 12 weeks. However there were children who showed a 41% decrease at the 48th week. The drug showed better results for children who had absence and atypical conditions.
Tiagabine has also shown positive effects of reducing partial seizures. It is a great drug especially when administered as a monotherapy. However, caution has to be observed as it has been observed that higher doses of the drug may cause mood swings in the patients. It also has other side effects such as somnolence, dizziness and headaches. The drug is administered in doses as low as 0.1 mg per day. In adults it can be administered at higher doses of 32-56mg per day. In certain tests it has been seen that the patients experience a 90% decrease in the seizures after being on treatment for a period of six months. The drug is also great in treating infantile spasms. This is because it increases the amount of GABArgetic tone in the body (Pellock & Appleton, 1999).
Conclusion
The newer Antiepileptic drugs are proving to be quite effective in the treatment of many diseases. More research should be conducted in the area by clinical officers.
References
Cutrer, F. (2001). Antiepileptic drugs: How they work in headaches. Chicago: Routledge.
Kaizad, M. & Tanya, O. (2010). The use of Anti-epileptic drugs for the treatment of pediatric aggression and mood disorders. Pharmaceuticals, 3, 2986-3004
Pappagallo, M. (2003). Newer antiepileptic drugs: Possible uses in the treatment of migraine and neuropathic pain. Clinical Therapeutics, 29(10), 2506-2538.
Pellock, J. & Appleton, R. (1999). The use of new Anti-epileptic drugs in the treatment of childhood epilepsy. Epilepsia, 40(6), 29-38
Rozan, T. (2001) Antiepileptic drugs in the management of cluster headache and trigeminal neuralgia. Headache, 25(1), 25-32
Tiltik, M. & Tonkic, A. (2008). Lamotrigine in the treatment of pain syndromes and neuropathic pain. Bratisl Les Lisky, 109(9), 421-424.
