ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1996.tb06033.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1996.tb01813.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Summary:Novel antiepileptic drugs (AEDs) are thought to act on voltage‐sensitive ion channels, on inhibitory neurotransmission or on excitatory neurotransmission. Two successful examples of rational AED design that po tentiate GABA‐mediated inhibition are vigabatrin (VGB) by irreversible inhibition of GABA‐transaminase, and ti‐agabine (TGB) by blocking GAB A uptake. Lamotrigine (LTG) prolongs inactivation of voltage‐dependent sodium channels. The anticonvulsant action of remacemide (RCM) is probably largely due to blockade of NMDA receptors and prolonged inactivation of sodium channels induced by its desglycinated metabolite. Felbamate (FBM) apparently blocks NMDA receptors, potentiates GABA‐mediated responses, blocks L‐type calcium channels, and possibly also prolongs sodium channel inactivation. Similarly, to piramate (TPM) has multiple probable sites of action, including sodium channels, GABA receptors, and glutamate (AMPA) receptors. Gabapentin (GBP) apparently has a completely novel type of action, probably involving potentiation of GABA‐mediated inhibition and possibly also inactivation of sodium channels. The therapeutic advantages of the novel AEDs are as yet only partially explained by our present understanding of their. Mecha

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1996.tb06038.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1996.tb01814.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Summary:We studied mRNA levels for neurotrophic factors using the amygdaloid kindling model of epilepsy. One hour after stage 5 kindled seizures, there were four‐to fivefold increases in brain‐derived neurotrophic factor (BDNF) mRNA in rat dentate gyrus and perirhinal cortex. Nerve growth factor (NGF) mRNA levels were increased bilaterally in some (but not all) limbic areas. There were no detectable changes in acidic fibroblast GF (aFGF) mRNA or basic fibroblast GF (bFGF) mRNA for 24 h after the kindled seizures. During kindling, levels of BDNF mRNA in the dentate gyrus correlated with projection to generalized seizures, whereas NGF mRNA in the limbic regions continued to increase during seizure development. These results indicate that the induction of mRNAs for neurotrophic factors, especially for BDNF mRNA in the dentate gyrus, corresponds to the increases in metabolic and electrical ictal discharge associated with kindled seizures. The persistent increase observed in NGF mRNA may be related to enhanced synaptic efficacy during kindling, but aFGF and bFGF are presumed to have little relation to the kindling proc

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1996.tb00504.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Summary:Antiepileptic drugs (AEDs) in broad use today have a number of pharmacokinetic liabilities, including a propensity for clinically meaningful drug interactions. Therefore, new AEDs with improved pharmacokinetic characteristics would be welcomed. The pharmacokinetic proftles of six newer AEDs—topiramate (TPM), gaba‐pentin (GBP), vigabatrin (VGB), lamotrigine (LTG), ox‐carbazepine (OCBZ), and felbamate—were reviewed. Some of these AEDs offer an improvement in one or more pharmacokinetic parameters compared with traditional AEDs, with TPM, GBP, VGB, and OCBZ demonstrating the most advantageous overall pharmacokinetic p

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1996.tb06032.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Summary:Neuroimaging techniques have advanced the diagnosis, management, and understanding of the patho‐physiology underlying the epilepsies. High‐resolution ultrasound is an important and useful technique in the investigation of prematures and neonates with seizures. Computed tomography (CT) scans have a diminishing role in the investigation of patients with epilepsy, but in the absence of magnetic resonance imaging (MRI), CT may detect gross structural pathology. MRI is the technique of choice for investigation of patients with seizure disorders. MRI provides excellent anatomic information and tissue. Contrast, resulting in high sensitivity. MRI studies should be customized to answer the appropriate clinical question. Functional imaging techniques including single photon emission computed tomography (SPECT), positron emission tomography (PET), magnetic resonance spectroscopy, and functional MRI are becoming increasingly important in the investigation and management of patients with seizures. These techniques permit noninvasive assessment of the epileptic substrate, functional status, ictal activity, blood flow changes, metabolism, and neuroreceptors. Application of these new techniques promises to advance our understanding and treatment of seizures in child

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1996.tb06017.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Summary:This article surveys the pharmacokinetic parameters for the new antiepileptic drugs (AEDs): felba‐mate, gabapentin, lamotrigine, oxcarbazepine, tiagabine, topiramate, and vigabatrin. Compared to the pharmaco kinetics of standard AEDs, these new AEDs have progressed in terms of (a) longer half‐lives, permitting once‐or twice‐daily dosing, (b) greatly reduced potential for drug interactions, thus increasing ease of treatment, and (c) general lack of hepatic enzyme induction, which facilitates polytherapy as well as other aspects of tr

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1996.tb06034.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Summary:Although most children with epilepsy have a good prognosis, a small but significant minority have seizures that either do not respond to conventional antiepileptic drugs (AEDs) or have significant adverse reactions to AEDs. Many children may benefit from epilepsy surgery. Surgical treatment of epilepsy is becoming a well‐established therapy for infants and young children with severe, medically intractable seizures. As in older children and adults, the presurgical evaluations of possible surgical candidates typically consist of a detailed history, neurologic and neuropsychologic examination, and anatomic and functional neuroimaging. The “gold standard” test, however, is the recording of ictal events by using simultaneous EEG and videomonitoring. Although temporal lobe resection is the most commonly performed surgery in older children and adults, nontemporal lobe resection, corpus callosotomy, and hemispherectomy are commonly performed in younger children. Efficacy of surgery in children compares favorably with results from adult patients. In addition, because the immature brain is more plastic than the mature brain, recovery of function is often greater after surgery in children than in adults. Early surgery in children with intractable epilepsy is recomm

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1996.tb01815.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Summary:We studied the distribution of felbamate (FBM) in rat brain using a brain imaging scanner to analyze thaw‐mount autoradiographs. After intravenous injection of [14C]FBM in rats, the autoradiographic distribution of isotope labeling patterns in brain was captured on x‐ray film. Densitometric differences on the x‐ray film were converted into color‐code variations representing the different concentrations of FBM in regions of the brain. We demonstrated that relatively uniform concentrations of FBM were detected throughout the brain. In all brain regions examined, there were no specifically high or low concentrations of FBM. We conclude that the FBM distributes un

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1996.tb00505.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY