Sodium Channel Blockers in the Treatment of Epilepsy

CNS Drugs
Martin J Brodie

Abstract

Sodium channel blockers have been the mainstay of the pharmacological management of focal and generalised tonic-clonic seizures for more than 70 years. The focus of this paper will be on phenytoin, carbamazepine, lamotrigine, oxcarbazepine, rufinamide, lacosamide and eslicarbazepine acetate. All these antiepileptic drugs have similar efficacy and share similar dose-dependent, adverse effect profiles, although phenytoin, carbamazepine and oxcarbazepine are more likely to cause idiosyncratic reactions than the others. With the exception of lamotrigine, rufinamide and lacosamide, all are enzyme inducers and most are minor teratogens; although data on teratogenicity are sparse with lacosamide and eslicarbazepine acetate. There is increasing evidence that these drugs differ mechanistically, with the newer agents, lacosamide and eslicarbazepine acetate, having their major pharmacological effect on the slow inactivation state of the sodium channel, which may be associated with better tolerability at higher dosage, although hard evidence in support of this observation is currently not available. Rufinamide is licensed only for Lennox-Gastaut syndrome in children aged 4 years and above. There is a move away from using enzyme inducers, p...Continue Reading

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Citations

Jan 29, 2019·Therapeutic Drug Monitoring·Margrete Larsen BurnsCecilie Johannessen Landmark
Aug 20, 2020·Expert Opinion on Pharmacotherapy·Adam StrzelczykSebastian Bauer
Apr 4, 2019·Evidence-based Complementary and Alternative Medicine : ECAM·Abdul Waheed KhanMuhammad Saleem
Sep 27, 2018·Neurology and Therapy·Charlotte LawthomVicente Villanueva
Jul 23, 2020·Clinical Case Reports·Masahito MorimotoShojiro Kyotani
Dec 4, 2020·Archives of Toxicology·Dominik LoserUdo Kraushaar
Oct 29, 2020·Nature Reviews. Neurology·Matthew AlsaloumStephen G Waxman
Mar 6, 2021·Journal of Clinical Psychopharmacology·Taro KishiNakao Iwata
May 2, 2021·Pharmacological Research : the Official Journal of the Italian Pharmacological Society·Abdoh TalebFeng Han
Jun 3, 2021·International Journal of Molecular Sciences·Katarzyna Załuska-OgryzekJarogniew J Łuszczki
Jul 28, 2021·Acta Neurologica Scandinavica·Emanuele Cerulli IrelliCarlo Di Bonaventura
Oct 24, 2020·Seizure : the Journal of the British Epilepsy Association·Estevo SantamarinaTeresa Casadevall
Dec 19, 2020·Seizure : the Journal of the British Epilepsy Association·Charlotte Lawthom

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