Selected classical and novel antiepileptic drugs - mechanisms of action, neuroprotection, and effectiveness in epileptic and non-epileptic conditions

Abstract

Introduction. One of the most common neurological disorders is epilepsy, characterised by recurrent spontaneus seizures. Although not fully efficient in ca 30% of patients, pharmacologic treatment of epilepsy plays an important therapeutic approach not only against epilepsy. Aim. To provide data on the mechanism of action, activity and neuroprotective efficacy in experimental conditions, clinical efficacy against epilepsy and non-epileptic diseases of major, classical and newer antiepileptic drugs (AEDs – lamotrigine, topiramate, levetiracetam, valproate and carbamazepine). Methods. A literature search for publications written in English, preferably published within a period of the last fifteen years, using the key words listed below. Review. The majority of AEDs possess more than one mechanism of action. They exert their effect by acting on various receptors (different types of glutamatergic and mainly GABA A receptors), neurotransmitters (mainly glutamate or GABA) and voltage-gated ion channels (sodium or calcium ion channels). All reviewed AEDs possess neuroprotective activity, the weakest being carbamazepine. Apart from epilepsy, AEDs may be also used in the pharmacotherapy of migraine, neuropathic pain, spasticity, psychiatric disorders and Parkinsons's or Alzheimer's diseases. Conclusions. As highlighted above, around 30% of epileptic patients do not substantially benefit from AEDs. It is possible that rational combinations of AEDs, based upon experimental studies, could improve this outcome. The neuroprotective effects of AEDs may point to their disease-modifying activity.