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Practical Neurology Oct 2021Trigeminal neuralgia (TN) is a highly disabling disorder characterised by very severe, brief and electric shock like recurrent episodes of facial pain. New diagnostic... (Review)
Review
Trigeminal neuralgia (TN) is a highly disabling disorder characterised by very severe, brief and electric shock like recurrent episodes of facial pain. New diagnostic criteria, which subclassify TN on the basis of presence of trigeminal neurovascular conflict or an underlying neurological disorder, should be used as they allow better characterisation of patients and help in decision-making regarding medical and surgical treatments. MR imaging, including high-resolution trigeminal sequences, should be performed as part of the diagnostic work-up. Carbamazepine and oxcarbazepine are drugs of first choice. Lamotrigine, gabapentin, pregabalin, botulinum toxin type A and baclofen can be used either alone or as add-on therapy. Surgery should be considered if the pain is poorly controlled or the medical treatments are poorly tolerated. Trigeminal microvascular decompression is the first-line surgery in patients with trigeminal neurovascular conflict while neuroablative surgical treatments can be offered if MR imaging does not show any neurovascular contact or where patients are considered too frail for microvascular decompression or do not wish to take the risk.
Topics: Anticonvulsants; Carbamazepine; Humans; Magnetic Resonance Imaging; Oxcarbazepine; Trigeminal Neuralgia
PubMed: 34108244
DOI: 10.1136/practneurol-2020-002782 -
Seizure Dec 2020Epilepsy is one of the most common neurological disorders, affecting approximately 50 million people worldwide. Despite a dramatic increase in treatment options over the... (Review)
Review
Epilepsy is one of the most common neurological disorders, affecting approximately 50 million people worldwide. Despite a dramatic increase in treatment options over the past 30 years, it still ranks fourth in the world's disease burden. There are now close to 30 antiepileptic drugs (AEDs), with more than two thirds introduced to the market after carbamazepine (CBZ) and one third after its derivative, oxcarbazepine (OXC). Following the introduction of these newer AEDs, the role of CBZ and OXC in the therapeutic armamentarium for seizure control and effective epilepsy management needs to be reviewed. The main guidelines list both CBZ and OXC as first-line options or second-line alternatives for the treatment of focal-onset epilepsy and primary generalized tonic-clonic seizures. While evidence suggests that overall AEDs have similar efficacy, some newer AEDs may be better tolerated than CBZ. In line with this, there have been changes in treatment patterns, with many variations across different countries. However, CBZ remains among the two or three most prescribed drugs for focal epilepsy in many countries, and is widely used across Europe, Africa, South America, and Asia, where it represents a good compromise between cost, availability, and effectiveness. OXC is among the first-choice options for the initial treatment of focal-onset seizures in several countries, including the US and China, where the oral suspension is commonly prescribed. This review provides guidance on the optimal use of these two drugs in clinical practice, including in children, the elderly, and in pregnancy.
Topics: Anticonvulsants; Carbamazepine; Epilepsy; Epilepsy, Generalized; Humans; Oxcarbazepine; Topiramate
PubMed: 33334546
DOI: 10.1016/j.seizure.2020.10.018 -
Seizure Dec 2020
Topics: Anticonvulsants; Benzodiazepines; Carbamazepine; Humans
PubMed: 33334545
DOI: 10.1016/j.seizure.2020.10.025 -
Neurosciences (Riyadh, Saudi Arabia) Apr 2015Trigeminal neuralgia is a syndrome of unilateral, paroxysmal, stabbing facial pain, originating from the trigeminal nerve. Careful history of typical symptoms is crucial... (Review)
Review
Trigeminal neuralgia is a syndrome of unilateral, paroxysmal, stabbing facial pain, originating from the trigeminal nerve. Careful history of typical symptoms is crucial for diagnosis. Most cases are caused by vascular compression of the trigeminal root adjacent to the pons leading to focal demyelination and ephaptic axonal transmission. Brain imaging is required to exclude secondary causes. Many medical and surgical treatments are available. Most patients respond well to pharmacotherapy; carbamazepine and oxcarbazepine are first line therapy, while lamotrigine and baclofen are considered second line treatments. Other drugs such as topiramate, levetiracetam, gabapentin, pregabalin, and botulinum toxin-A are alternative treatments. Surgical options are available if medications are no longer effective or tolerated. Microvascular decompression, gamma knife radiosurgery, and percutaneous rhizotomies are most promising surgical alternatives. This paper reviews the medical and surgical therapeutic options for the treatment of trigeminal neuralgia, based on available evidence and guidelines.
Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Carbamazepine; Humans; Neuralgia; Oxcarbazepine; Pain Management; Radiosurgery; Trigeminal Neuralgia
PubMed: 25864062
DOI: 10.17712/nsj.2015.2.20140501 -
Acta Clinica Croatica Sep 2022Trigeminal neuralgia causes severe to excruciating pain that often cannot be successfully reduced with current forms of treatment. The International Association for the... (Review)
Review
Trigeminal neuralgia causes severe to excruciating pain that often cannot be successfully reduced with current forms of treatment. The International Association for the Study of Pain (IASP) defines trigeminal neuralgia as a sudden, usually unilateral, powerful, short, stabbing, recurrent episode of pain in the distribution of one or more branches of the trigeminal nerve. Trigeminal neuralgia can be caused by vascular compression of the trigeminal nerve or a tumor process. Pressure on the nerve itself causes nerve demyelination, which is the cause of abnormal depolarization, resulting in the development of ectopic impulses. Pain can be provoked by brushing teeth, shaving, eating, cold, heat, etc. After diagnosing trigeminal neuralgia, magnetic resonance imaging should be performed to rule out multiple sclerosis, a tumor process that can secondarily cause trigeminal neuralgia. The drug of choice for treating trigeminal neuralgia is still carbamazepine. If pharmacological treatment fails, invasive surgical microvascular decompression, stereotactic radiation therapy (gamma knife), percutaneous balloon micro compression, percutaneous glycerol rhizolysis, and percutaneous radiofrequency (RF) may be used.
Topics: Humans; Trigeminal Neuralgia; Carbamazepine; Trigeminal Nerve; Neuralgia; Neoplasms
PubMed: 36824641
DOI: 10.20471/acc.2022.61.s2.12 -
Medicina (Kaunas, Lithuania) Apr 2021This review is dedicated to the use of carbamazepine and its derivatives oxcarbazepine and eslicarbazepine in bipolar disorder and their relative strengths in treating... (Review)
Review
This review is dedicated to the use of carbamazepine and its derivatives oxcarbazepine and eslicarbazepine in bipolar disorder and their relative strengths in treating and preventing new depressive or manic episodes. This paper will discuss the evidence of their efficacy relative to the polarity of relapse from controlled acute and maintenance/relapse prevention studies in bipolar patients. A Medline search was conducted for controlled acute and maintenance studies with carbamazepine, oxcarbazepine, and eslicarbazepine in bipolar disorder. In addition, abstracts reporting on controlled studies with these medications from key conferences were taken into consideration. Information was extracted from 84 articles on the acute and prophylactic efficacy of the medications under consideration. They all appear to have stronger efficacy in treating acute mania than depression, which also translates to better protection against manic than depressive relapses for carbamazepine. Still, there is a paucity of controlled acute studies on bipolar depression for all and, with the exception of carbamazepine, a lack of long-term monotherapy maintenance data. For eslicarbazepine, the efficacy in bipolar disorder remains largely unknown. Especially with carbamazepine, tolerability issues and drug-drug interactions need to be kept in mind. Two of the medications discussed in this review, carbamazepine and oxcarbazepine, match Class A criteria according to the criteria proposed by Ketter and Calabrese, meaning acute antimanic efficacy, prevention of manic relapses, and not causing or worsening depression.
Topics: Antimanic Agents; Benzodiazepines; Bipolar Disorder; Carbamazepine; Humans; Oxcarbazepine
PubMed: 33946323
DOI: 10.3390/medicina57050433 -
The Journal of Applied Laboratory... Mar 2020Carbamazepine is an effective drug for treating seizures and trigeminal neuralgia. Therapeutic drug monitoring of free carbamazepine in serum can be useful in situations...
BACKGROUND
Carbamazepine is an effective drug for treating seizures and trigeminal neuralgia. Therapeutic drug monitoring of free carbamazepine in serum can be useful in situations that drug--protein binding is altered to guide regimen adjustment and to aid in the diagnosis of clinical toxicity.
METHODS
Separation of the nonprotein bound carbamazepine was achieved via ultrafiltration through a molecular weight cut-off filter. A method for free carbamazepine measurement was developed on the automated cobas chemistry analyzers (Roche Diagnostics) by modifying the Carbamazepine Gen 4 assay (Roche Diagnostics). Assay performance characteristics were established including precision, accuracy, reportable range, analytical specificity, and stability.
RESULTS
The intra- and inter-assay imprecision was 0%-1.4% and 2.4%-5.1%, respectively. The lower limit of quantitation was 0.3 µg/mL, and the assay was linear up to 10.0 µg/mL. A spike recovery study, using reference standard material, showed recovery was 93.5%--101.3% across the analytical measurement range. Method comparison with a reference laboratory method demonstrated equivalent performance with a slope of 1.01, intercept of 0.09, and correlation coefficient of 0.9948.
CONCLUSION
This assay provides a simple and accurate method for monitoring free carbamazepine with a fast turnaround time.
Topics: Anticonvulsants; Automation; Carbamazepine; Drug Monitoring; Humans; Reference Values; Reproducibility of Results; Sensitivity and Specificity
PubMed: 32445379
DOI: 10.1093/jalm/jfz003 -
Epilepsia 1999The success of carbamazepine (CBZ) as a broad-spectrum antiepileptic drug (AED) has led to its use as first-line therapy in children and adults for partial and... (Comparative Study)
Comparative Study Review
The success of carbamazepine (CBZ) as a broad-spectrum antiepileptic drug (AED) has led to its use as first-line therapy in children and adults for partial and generalized tonic-clonic seizures. The limitations of CBZ include toxicity in sensitive individuals, autoinduction, which requires dose adjustment when therapy is initiated, and chronic hepatic induction, producing drug interactions when CBZ is used with AEDs and other drugs that undergo hepatic metabolism. One of two main products of CBZ microsomal metabolism, CBZ-10,11-epoxide (formed by oxidation of the double bond between C-10 and C-11), appears to provide antiepileptic efficacy but contributes significantly to clinical toxicity. The most common adverse effects of CBZ are central nervous system (CNS) symptoms, followed by gastrointestinal, hepatic, endocrine disturbances, and teratogenic effects. Oxcarbazepine (OXC) was developed to provide a compound chemically similar enough to CBZ to mimic its efficacy and overall safety while improving its side-effect profile. Biotransformation of OXC does not involve formation of an epoxide metabolite. Compared with the parent compound, hepatic microsomal enzyme induction and autoinduction are greatly reduced. The clinical efficacy of OXC compares favorably with CBZ in clinical trials. Clinical development of OXC began in Europe. Results of Phase I trials started to appear in the early 1980s. Controlled clinical trials, reported in the mid- to late 1980s, led to approval of OXC in many European countries, and now in over 50 nations around the world. United States multicenter clinical trials have recently been completed, and at this writing the drug is awaiting approval by the FDA. This article reviews the pharmacology, animal data, outcomes of published controlled clinical trials, postmarketing data, adverse experiences, and current recommendations for clinical use of OXC.
Topics: Adult; Animals; Anticonvulsants; Biological Availability; Biotransformation; Carbamazepine; Controlled Clinical Trials as Topic; Disease Models, Animal; Drug Administration Schedule; Drug Interactions; Epilepsy; Humans; Oxcarbazepine; Phenytoin; Treatment Outcome
PubMed: 10530693
DOI: 10.1111/j.1528-1157.1999.tb00918.x -
The Journal of Applied Laboratory... Mar 2020
Topics: Anticonvulsants; Automation; Carbamazepine; Drug Interactions; Drug Monitoring; Humans
PubMed: 32445373
DOI: 10.1093/jalm/jfz023 -
American Family Physician Jul 2016
Review
Topics: Analgesics, Non-Narcotic; Carbamazepine; Electrocoagulation; Humans; Microvascular Decompression Surgery; Radiosurgery; Trigeminal Neuralgia
PubMed: 27419329
DOI: No ID Found