1. ANTICONVULSANT DRUGS Edward D. French, Ph.D. Department of Pharmacology University of Arizona College of Medicine

4. SIMPLISTIC VIEW OF SEIZURES All that separates a normal brain from an epileptic seizure is the control of excitation. The normal neuronal network is kept in balance between fast, inherently dangerous, excitatory events and inhibitory suppression of those events.

5. General Principles of AEDs Sites of Action °Decrease Na+ channel-mediated excessive depolarization that propagates excitability within and without a brain region. °Increase neuronal inhibition. °Reduce neuronal excitation evoked by an excitatory amino acid. °Reduce activity of T-type (low-threshold) calcium channels.

6. Sodium Channels As A Site of Action for Some AEDs Action potentials from increased sodium conductance: open-inactivated-closed-open –with seizure activity: sustained depolarization AEDs that act on sodium channels show: –voltage dependence (membrane potential more positive) –use dependence (frequency of action potentials increased)

9. Increasing Neuronal Inhibition: The GABA Connection Increasing GABA-mediated chloride conductance, resulting in an increase inside the neuron of a negatively charged ion. Increasing GABA synthesis and release Attenuating GABA uptake and metabolism Result: greater hyperpolarization of neuronal membrane potential

10. GABA Receptors GABA receptors-- , ,  subunit assemblies GABA-A and GABA-B receptors –GABA-A: chloride ionophore –GABA-B: G-protein coupled potassium channel: how would potassium efflux affect excitability? Receptor composition may differ in different brain regions. GABA-A receptor has binding sites for GABA, barbiturates, benzodiazepines, neurosteroids, ethanol and picrotoxin.

11. GABA-A Receptor Ionophore Benzodiazepines bind to a BZD binding site on the  - subunit of the GABA-ionophore. BZD’s increase the frequency of GABA-mediated channel openings, but not mean open time. Barbiturates affect GABA-A receptors irrespective of subunit composition. BARBS increase channel mean open times but not open frequency.

12. The Glutamate Connection Glutamate receptors: –AMPA, Kainate & NMDA receptor subtypes: ion- channel complexes –Metabotropic: second messenger coupled NMDA ionophore--voltage/use dependent, modulated by glycine (non-strychnine), polyamines, & phencyclidine.

13. THE IDEAL ANTIEPILEPTIC DRUG Known mechanism of action Fully effective in monotherapy in a variety of seizure types without tolerance No serious side effects No dose-related neurotoxicity within the therapeutic range High therapeutic index Non-teratogenic No long-term adverse tissue effects or cognitive impairment Favorable/predictable pharmacokinetics without drug interactions Low cost

26. Toxic epidermal necrolysis