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| J Korean Med Assoc > Volume 55(2); 2012 > Article |
Abstract
Epilepsy is one of the most common chronic neurologic conditions. Pharmacologic therapy is by far the most common approach, with the other modalities typically limited to patients with pharmacoresistant epilepsies. A host of new antiepileptic drugs (AEDs) have been introduced over the last 20 years. The AEDs including the conventional ones are more or less equally effective in patients with partial epilepsy. Therefore, relative efficacy is not a useful factor in selecting a particular drug. A conventional AED, valproic acid is regarded as having superior efficacy than the other broad-spectrum AEDs including new ones in patients with generalized epilepsy. However, it can have considerable side effects, such as reproductive dysfunction and teratogenicity to young women with epilepsy. One of the clearest advantages of many new AEDs over the conventional ones has been their more favorable pharmacokinetic and drug-drug interaction profiles compared with the conventional ones involved in the cytochrome P450 enzymatic system, which may change the levels of other antiepileptic and nonantiepileptic drugs, and endogenous substances. Many new AEDs have unique mechanisms of action and slightly better tolerability than the conventional ones. Several new AEDs can allow young women with epilepsy, particularly those with idiopathic generalized epilepsy, to avoid valproic acid treatment. Furthermore, the new AEDs may provide a modest but positive effect in seizure control, particularly as an add-on treatment. The greater variety of AEDs allows better patient tailoring according to patient's characteristics and contributes to improvement in quality of life.
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Table 1
Mechanisms of action of AEDs
AED, antiepileptic drug; GABA, γ-aminobutyric acid.
++, primary action; +, probable action; ?, possible action.
a)Unless otherwise stated, action on high voltage activated calcium channels.
b)Levetiracetam acts by binding to synaptic vesicle protein 2A (SV2A).
c)Retigabine acts by the opening of neuronal voltage-gated potassium channels, enhancing the M-type potassium current.
Table 2
Main routes of elimination of AEDs
AED, antiepileptic drug; CYP, cytochrome P450.
a)Eslicarbazepine acetate is a prodrug, rapidly and extensively reduced in the liver to the major metabolite, S-licarbazepine (eslicarbazepine) by liver esterases. The indicated routes of elimination and enzymes involved refer to S-licarbazepine.
b)Oxcarbazepine is a prodrug, virtually entirely converted by cytosolic aryl-ketone-reductase to the active metabolite, monohydroxycarbazepine (MHD). The indicated routes of elimination and enzymes involved refer to MHD.
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