Title: ?????????? ??????????????
1?????????? ?????????????? ??????????????? ?
???????? ??????????? ???????
- ?????? ???????
- 30 ??. ?????? (2010)
2?????????
- ?? ?????????????, ???????? ?????????? ?? ??????
? ???????? ?????????, ?????????? ?? ? ?????????
?? ????????, ????? ????? ?? ??????????? ??
????????? ?? ??????????. - ?? ? ???? ?? ???-??????? ??????????? ?? ????????
??????? 4-10 ?? 1000 ???? ????????? - ???????? ????????
- ???????????? ???????
- ????????????? ? ?????? ??????? - 50 ?? 10
??????? ???????, ? 70 ?? 20 ???. - ??????? ?? ????????, ????????, ? ??????????????
??????? ?? ????????? ??????????, ?????? ??
???????, ???????? ??? ???????????? ???????. - ????????????? ?? ??????? ????? ?? ????????
?????????? ????? (excitotoxicity).
3?????????
4?????????
- ????????????? ???????-???????? ???????? (grand
mal) - ????? ???????? ??????????,
??????????????? ????????? ?? ??????????.
????????? ???? ??????, ?????? ? ??????? ?, - ???? ???? ????????? ?????????? ????????? ? ???.
- ?????? (petit mal) - ?????????????? ?????????,
???????? ? ?????? ???????, ??? ????????, ??? ????
?????? ??????, ??????? ?? ????? ? ? ??????????? ?
????? ?? ?????????? ????????????.. - ??????????? (???????) ????????. ?? ?? ??????????
?? ???????????? ?????????, ???????? ???? ????
???? ?? ??????, ??? ?? ?? ???????????. ?
?????????? ?? ???? ??? ???? ?? ?????? ?
?????????, ?????????? ?? ????????. ???? ??
???-????? ????????? ???????? ??? ???????????
????????.
5??????? ?? ??
- ?????? ????? ????????? ?????????? ?????????
(EPSP) ? ??????????? ?????????????? ?????????
(IPSP). - ??? ?? ????????? ????????? ?? ??????????
???????????????? ? ????????????????? ??
????????????? ??????? ?? ??????????????? ??????.
- ?????????? ??????????????
- ??????????? Phenobarbital (1912)
- ?????????? Phenytoin (1938)
- ???????????????? Trimethadione
- ??????????? Ethosuximide
- ???????????? Carbamazepine, Oxcarbazepine
- ?????????????? Diazepam, Clonazepam,
Clorazepate - ????????? Valproic acid, Sodium valproate
- Vigabatrin
- Gabapentin
- Lamotrigine
- Felbamate
- Tiagabine
- Topiramate
- Levetiracetam
????
6????????? ?? ????????
- ??????????? ?? GABA ??????
- - ????????????? ????
- - ?????????? ?? GABA ??????????????
- - ?????????? ????????
- ?????????? ?? Na ????? Phenytoin,
Carbamazepine,Valproate,Lamotrigine - ????????? ?? T-(???????????? ?????????) ? L-???
???????? ?????? Ethosuximide (T-???), Gabapentin
(L-???)? - ????????? ?? ??????????? ???????? NMDA (N
-methyl-D-aspartate) ?????? (????
??????-??????????? ?????) felbamate, valproic
acid ? AMPA/Kainate ?????? topiramate? - ???? ????????? (levetiracetam, zonisamide),
???????? ?? ?????, ?????????? ?????????.
????????? ?? ?????????? ?? ???????????
??????????? ??????? 2A, ????? ??? ???? ?
??????-????????? ?????? ?? ????????????? ??
???????????????.
Barbiturates (Phenobarbital) Benzodiazepines
Vigabatrin Tiagabine Gabapentin
7????????????? ?? ??????????? ???????????? ??
????????? ????? ? ????????? ?? ??????-??????????
?????????? ??????????.
????????? ?? ????????
?-???????? ?? ????????? ?? ??????????
??????????? ??????????? ? ????????????????? ???
? ?????????????? ?? ?????????.
8??????????? ???????? ?? GABA-A ?????????
?????????????? (? ????? Cl-????? ? ???????),
??????????? (? ????????? ?? ???????? ?? ??????),
Ganaloxone????????? ?? ???????? ??????
Tiagabine?????????? ?? GABA ?????????????
Vigabatrine?????????? ?? ???????????????????????
Gabapentin, Valproate????????????? Progabide
????????? ?? ????????
GABA-A-?????????? ?????? ????????? ????????
??????? ???????? ?? (Cl-) ? ???? ??
???????????????.
9A????????????????????? ????????
???????-???????? ???????(grand mal) carbamazepine, oxcarbazepine, phenytoin, valproate, vigabatrin, lamotrigin, gabapentin, topiramate
??????? (petit mal) ethosuximide, valproate, lamotrigine, clonazepam
??????? ?? ???????????? ?? carbamazepine, oxcarbazepine, valproate clonazepam, topiramate, phenytoin, lamotrigine
?? ?????? diazepam i.v. per rectum, diazepam, clonazepam i.v.
???????????? ????? carbamazepine, gabapentin
????????????? ?? ???????????? carbamazepine, valproate, lamotrigine
10????????? ???????? ??? ??? ?? ?????? ?? ???
Carbamazepine ??????, ?????????, ??????, ?????????????, ?????, ?????? ???????????, ????????? ??? ?????? ???????, ??????????, ????????
Ethosuximide ??????, ????????? ????????? ?? ????, ???????????, ??????????????
Felbamate ??????, ?????????, ?????????, ?????????? ????????, ?????????, ??????????, ???????
Gabapentin - ?????????, ???????????, ???????
Lamotrigine ?????????, ?????? ???????????, ??????????
Levetiracetam ???????? ?????, ?????????, ???????????, ?????????????
Oxcarbazepine ??????, ?????????, ???????????? ???????, ??????????, ?????????, ???????, ?????? ???????
Phenytoin ??????????? ?? ???????, ??????????, ??????, ?????????????? ????????, ??????? ?????, ?????? ???????, ???????, ??????????
Pregabalin ??????????? ???????????, ??????????, ???????
Primidone, phenobarbital ??????, ?????? ?????????? ?? ????, ???????, ????????, ???????????? ???????, ??????????????, ???????, ????????, ??????????
Tiagabine - ???????????, ????? ?? ???????, ?????????, ??????, ????????, ??????, ?????? ????????????, ??????? ?????
Topiramate ?????? ?? ?????, ???????? ??????, ?????????? Fatigue, nervousness, difficulty concentrating, confusion, depression, anorexia, language problems, anxiety, mood problems, tremor
Valproate ??????? ?? ?????, ??????, ?????????, ????????, ????????? ??? ??????????? ??????
11PHENYTOIN
Antiepileptic Drugs Author Juan G Ochoa
CARBAMAZEPINE
LAMOTRIGINE
ETHOSUXIMIDE
DIAZEPAM
1. Katzung BG. Bacis and clinical pharmacology,
11th ed. 2009 2.Ochoa JG. Antiepileptic drugs.
Available from http//emedicine.medscape.com/arti
cle/1187334-overview 3.Tripathi KD. Essential of
medical Pharmacology, 5th ed. 2004 4.
???????????? ??? ?????????? ?? ??. ?????? ? ?.
?????????