Biochemistry & Pharmacology: Open Access
Open Access

Mechanisms and Therapeutic Uses of Anticonvulsants

Walter Kraft^{* *}Correspondence: Walter Kraft, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Pennsylvania, USA, Email:

Author info »

About the Study

Anticonvulsants, also known as Antiepileptic Drugs (AEDs), are a class of medications used to prevent and control seizures in individuals with epilepsy and other related conditions. Seizures are caused by abnormal electrical activity in the brain, and anticonvulsants work by modulating this activity to reduce the likelihood or severity of seizures.

Over the years, the development of anticonvulsant medications has significantly improved the management of epilepsy, allowing individuals to lead more productive and fulfilling lives [1].

Mechanisms of action

Anticonvulsants exert their therapeutic effects through various mechanisms, targeting different aspects of the neuronal circuitry involved in seizures. The understanding of these mechanisms has grown significantly in recent years, leading to the development of more targeted and effective anticonvulsant medications [2].

Enhancement of GABAergic inhibition: Several anticonvulsants, such as benzodiazepines (e.g., diazepam) and barbiturates (e.g., phenobarbital), enhance the inhibitory effects of Gamma- Aminobutyric Acid (GABA), the primary inhibitory neurotransmitter in the brain. By increasing GABAergic activity, these medications help reduce neuronal excitability and dampen seizure activity [3].

Inhibition of sodium channels: Many anticonvulsants, including phenytoin, carbamazepine, and lamotrigine, work by blocking voltage-gated sodium channels. By doing so, they prevent the excessive influx of sodium ions into neurons, which is crucial for the generation and spread of seizure activity [4].

Modulation of calcium channels: Certain anticonvulsants, such as ethosuximide and valproate, exert their effects by modulating calcium channels. By reducing the influx of calcium ions into neurons, they decrease the release of excitatory neurotransmitters and prevent the hyperexcitability that underlies seizures [5].

Potassium channel activation: Drugs like retigabine activate voltage-gated potassium channels, leading to hyperpolarization of neuronal membranes. This action stabilizes the resting potential and makes it more difficult for seizures to occur [6].

Therapeutic uses

Anticonvulsants find application in the treatment of various conditions beyond epilepsy. They can be effective in managing seizures associated with different etiologies and have shown potential in the treatment of other neurological and psychiatric disorders. Here are some of the key therapeutic uses of anticonvulsants:

Epilepsy: Anticonvulsants are the cornerstone of epilepsy treatment. They help prevent or reduce the frequency and severity of seizures in individuals with epilepsy, allowing for better seizure control and improved quality of life. Different anticonvulsants are prescribed based on the type of seizures and the patient's specific needs [7].

Neuropathic pain: Certain anticonvulsants, such as gabapentin and pregabalin, are effective in managing neuropathic pain, a type of chronic pain resulting from damage or dysfunction in the nervous system. These medications modulate the transmission of pain signals, providing relief to patients suffering from conditions like diabetic neuropathy and post-herpetic neuralgia [8].

Mood stabilization: Anticonvulsants like valproate and lamotrigine are commonly used as mood stabilizers in the treatment of bipolar disorder. They help stabilize mood swings and prevent both manic and depressive episodes. These medications can be used as monotherapy or in combination with other psychiatric medications to achieve optimal symptom control [9].

Migraine prevention: Some anticonvulsants, such as topiramate and divalproex sodium, have shown efficacy in preventing migraines. They help reduce the frequency, duration, and intensity of migraines, providing relief to individuals who experience frequent or debilitating attacks [10].

Neuropsychiatric disorders: Anticonvulsants have been explored for their therapeutic potential in various neuropsychiatric disorders. For instance, lamotrigine has demonstrated efficacy in the treatment of borderline personality disorder and impulse control disorders. Additionally, some anticonvulsants are used off-label to manage symptoms of conditions such as Post- Traumatic Stress Disorder (PTSD) and anxiety disorders [11].

Seizure prophylaxis: Anticonvulsants are often employed to prevent seizures in high-risk situations, such as during neurosurgery or following a traumatic brain injury. Medications like phenytoin and levetiracetam are commonly used in these cases to provide prophylactic seizure control and minimize the risk of complications [12].

References

1. Bayan L, Koulivand PH, Gorji A. Garlic: a review of potential therapeutic effects. Avicenna J Phytomed . 2014; 4(1):1–14.

   [Google Scholar][PubMed]

2. Benavides GA, Squadrito GL, Mills RW, Patel HD, Isbell TS, Patel RP, et al. Hydrogen sulfide mediates the vasoactivity of garlic. Proc Natl Acad Sci U S A. 2007; 104(46):17977–17982.

   [Crossref][Google Scholar][PubMed]

3. Amagase H. Clarifying the real bioactive constituents of garlic. J Nutr. 2006; 136(3):716S–725S.

   [Crossref][Google Scholar][PubMed]

4. Souza GA, Ebaid GX, Seiva FR, Rocha KH, Galhardi CM, Mani F, et al. N-acetylcysteine an allium plant compound improves high-sucrose diet-induced obesity and related effects. Evid Based Complement Alternat Med. 2011; 2011:1-7.  

   [Crossref][Google Scholar][PubMed]

5. Tran GB, Dam SM, Le NT. Amelioration of single clove black garlic aqueous extract on dyslipidemia and hepatitis in chronic carbon tetrachloride intoxicated Swiss Albino mice. Int J Hepatol.2018;2018:1-9.

   [Crossref][Google Scholar][PubMed]

6. Mikaili P, Maadirad S, Moloudizargari M, Aghajanshakeri S, Sarahroodi S. Therapeutic uses and pharmacological properties of garlic, shallot, and their biologically active compounds. Iran J Basic Med Sci. 2013; 16(10): 1031-1048.

   [Google Scholar][PubMed]

7. Hodge G, Hodge S, Han P. Allium sativum (garlic) suppresses leukocyte inflammatory cytokine production in vitro: potential therapeutic use in the treatment of inflammatory bowel disease. Cytometry.2002; 48(4):209–215.

   [Crossref][Google Scholar][PubMed]

8. Sabitha P, Adhikari PM, Shenoy SM, Kamath A, John R, Prabhu MV, et al. Efficacy of garlic paste in oral candidiasis. Trop Doct. 2005; 35(2): 99-100.

   [Crossref][Google Scholar][PubMed]

9. Fukao H, Yoshida H, Tazawa YI, Hada T. Antithrombotic effects of odorless garlic powder both in vitro and in vivo. Biosci Biotechnol Biochem. 2007; 71(1):84–90.

   [Crossref][Google Scholar][PubMed]

10. Dhawan V, Jain S. Effect of garlic supplementation on oxidized low density lipoproteins and lipid peroxidation in patients of essential hypertension. Mol Cell Biochem. 2004; 266(1-2):109–115.

    [Crossref][Google Scholar][PubMed]

11. Lobo V, Patil A, Phatak A, Chandra N. Free radicals, antioxidants and functional foods: impact on human health. Pharmacogn Rev. 2010; 4(8):118–126.

    [Crossref][Google Scholar][PubMed]

12. Friedman T, Shalom A, Westreich M. Self-inflicted garlic burns: our experience and literature review. Int J Dermatol. 2006; 45(10):1161–1163.

    [Crossref][Google Scholar][PubMed]