Antiepileptikler ve yeni bir antiepileptik olan topiramatın epilepsi tedavisindeki yeri ve önemi

Nöbetler tıbbın bütün alanlarında karşımıza çıkan ve oldukça sık görülen bir durumdur. İnsanların yaklaşık %2’si yaşamları boyunca bir veya daha fazla sayıda nöbet geçirmişlerdir. Kendiliğinden oluşan, tetiklenmeyen ve tekrarlayan nöbetler epilepsinin ana semptomudur. Dünya nüfusunun %1-2’sini etkileyen, oldukça yaygın, nörolojik bir sağlık problemidir. Antiepileptik ilaç uygulaması, epilepsinin genel tedavi yöntemidir. Uygun antiepileptik ilaç seçimi, epilepsinin ve nöbetin tipine, bireysel ilaç karakteristiklerine, farmakokinetiğine, yan etkilerine, doz aralığına ve fiyatına bağlıdır. Antiepileptik ilaçların çoğu (özellikle parsiyal-kısmi nöbetlerde) başlangıç tedavisinde, mevcut tüm antiepileptik ilaçlar ise ek tedavide etkilidir. Topiramat (TPM), lamotrigin ve valproat generalize (tüm vücuda yayılmış) nöbetlerde antiepileptik ilaçlar arasında en çok tercih edilenlerdir. Topiramat, 1990’lı yıllarda üretilen birkaç yeni antiepileptik ilaçtan biridir. TPM’nin etki mekanizması tam olarak anlaşılamamış olmasına rağmen, çok sayıda etki mekanizmasına sahip olduğu bildirilmektedir. Bunlardan bir tanesi α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) ve kainat reseptörleri yoluyla glutamat aktivitesinin inhibisyonudur. Bu nedenle nöbetleri takiben nöroprotektif ajan olarak değerlendirilir. Farklı reseptörler üzerine etki etmesi nedeniyle epilepsi ve farklı hastalıkların tedavisinde TPM’nin etkisi hala pek çok çalışmaya konu olmaktadır. Bu makale epilepsi tedavisinde TPM ile ilgili güncel bilgileri içermektedir.

Anahtar Kelimeler:

yan etkiler, farmakokinetik, sinir sistemi hastalıkları, insan, insan hastalıkları

Antiepileptic drugs and the importance of topiramate which is an new antiepileptic on Epilepsy treatment

Seizures are common and is a symptom encountered in all branches of medicine. Approximately 2% of people will have had one or more seizures during their life. Epilepsy is any disorder in which spontaneous recurrence of unprovoked seizures is the main symptom. It is a common chronic neurologic disorder and affects 1% to 2% of all people. Antiepileptic drug (AED) therapy is the common treatment for epilepsy. Selection of the appropriate AED depends on type of seizure and epilepsy present, individual drug characteristics, including pharmacokinetics, side effects, dosing interval, and cost. All available AEDs are effective as adjunctive therapy and most are effective as initial monotherapy for partial seizures. Topiramate (TPM), lamotrigine and valproate are the most preferred among antiepileptic drugs in generalized seizures. Topiramate is one of several newer antiepileptic drugs that were introduced in the 1990s. Although the mechanism of action of TPM is not fully understood, it has a number of mechanisms of action including inhibition of glutamate activity via on α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) and kainate receptors. Therefore it is considered as a neuroprotective agent following seizures. Due to its activity on different receptors, the effects of TPM in the treatment of epilepsy and different disorders still have been the subject of many studies. This article is embraced the recent data about TPM in the treatment of epilepsy.

Keywords:

adverse effects, pharmacokinetics, nervous system diseases, man, human diseases,

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