• 대한소아신경학회지
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• 제26권4호
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• pp.269-271
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• 2018

목적: 항경련제 사용은 골밀도 감소와 같은 부작용을 일으킬 수 있고 지속적으로 성장하는 소아에서 주의가 필요하다. 단일 요법으로 치료하는 뇌전증 환자에서 항경련제가 골밀도에 미치는 영향의 차이를 알아보고자 하였다. 방법: 2013년 1월부터 2017년 12월까지 부천성모병원에서 뇌전증 치료를 하는 소아 환자 60명에 대해 후향적으로 살펴 보았다. Dual photo absorptiometry로 골밀도를 6개월마다 측정하였다. 결과: 전체 60명 중 Oxcarbazepine, Valproate, Levetiracetam으로 치료한 환자는 각각 31, 16, 13명이었다. Oxcarbazepine 치료 환자 31명 중 8명(25.8%, P=0.10), Valproate 치료 환자 16명 중 9명(56.3%, P=0.04), Levetiracetam 치료 환자 13명 중 4명(30.8%, P=0.50)에서 골밀도 감소가 관찰되었다. 결론: Valproate 투여 환자들에서 다른 항경련제 치료 환자보다 골밀도가 유의하게 감소되었다. 항경련제 치료를 하는 소아 뇌전증 환자의 골밀도에 대한 관심이 필요할 것으로 생각된다.

• Archives of Pharmacal Research
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• 제19권4호
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• pp.312-316
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• 1996

A series of N-Cbz${alpha}$-aminosucinimides (1), combining common moieties of various anticonvulsants such as N-CO-C-N and cyclic imide in a single molecule, were synthesized from the corresponding (R)- and (S)-N-Cbz-aspartic acid (2). And their in vivo anticonvulsant evaluations in MES and PTZ test were investigated. And also the rotorod test for neurotoxicity was investigated. All the tested compounds (1), except 1c and 1f, showed significant anticonvulsant activities in both MES and PTZ test. And the most active compound among them in MES test was (R)-N-Cbz-${alpha}$-amino-N-methylsuccinimide (1b) $(ED_50/=52.5 mg/kg)$ and (S)-N-Cbz-aminosuccinimide((1d) was most active in PTZ test $(ED_50/=78.1 mg/kg)$. And the $TD_50$ values of the tested compounds were above 117.5 mg/kg. These pharmacological data were comparable to those of currently available anticonvulsants. And also we found that the pharmacological effects were dependent on their N-substituted alkyl chains and their stereochemistry.

• The Korean Journal of Pain
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• 제31권4호
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• pp.235-243
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• 2018

Postherpetic neuralgia (PHN) is the most troublesome side effect of Herpes Zoster (HZ), which mainly affects the elderly and immunocompromised populations. Despite the current advancement of treatments, PHN persists in many individuals influencing their daily activities and reducing their quality of life. Anticonvulsants, antidepressants, topical therapies including lidocaine and capsaicin, and opioids, are the most widely used therapies for the treatment of PHN. These medications come with their adverse effects, so they should be used carefully with the elderly or with patients with significant comorbidities. Other measures like botulinum toxin, nerve blocks, spinal cord stimulation, and radiofrequency have also contributed significantly to the management of PHN. However, the efficacy, safety, and tolerability of these invasive methods need to be carefully monitored when administering them. Early diagnosis and early initiation of treatment can reduce the burden associated with PHN. The zoster vaccine has effectively reduced the incidence of HZ and PHN. In this article, we discuss the treatment options available for the management of PHN, mainly focusing on the efficacy and safety of different therapeutic modalities.

• Journal of Korean Neurosurgical Society
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• 제41권1호
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• pp.65-68
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• 2007

Objective : A new point of view on the chronic back pain proposed which is, named neuropathic back pain[NBP]. Some proposed a certain pain scale as an useful diagnostic tool. Before scientific verification, some doctors prescribed a new anticonvulsant for the NBP. We investigated diagnostic tools for NBP by a review of the literature. Methods : A comprehensive computer search of the English literature concerning neuropathic low back pain was performed using the key words such as neuropathic back pain and diagnosis in the PubMed. Results : In 1998, the term NBP was first used in a patient with lung cancer. In the English literature, there were two diagnostic methods for the NBP, Neuropathic pain scale[NPS] and a pharmacological test. NPS is a pain questionnaire, which depends on the patients' subjective reports on the given questions, such as 'how hot is your pain feel'. By the pharmacological test, NBP was defined as 50% or more decrease of pain on intravenous lidocaine and on local anesthetic epidurally. It also depends on the patients' subjective response to the therapy. Conclusion : There were still no reliable objective diagnostic criteria for the NBP. It seems to be better to reserve the new anticonvulsants for the NBP till scientific approval.

• The Korean Journal of Physiology
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• 제30권1호
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• pp.97-104
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• 1996

Different neural substrates have been reported to be implicated in analgesic mechanisms in the acute phasic and the sustained tonic pains. To explore the differential antinociceptive action of diphenylhydantoin (DPH) and carbamazepine (CBZ) on the acute phasic and the tonic pains, changes in tail flick latency, hot plate latency and the formalin-induced nociceptive score were assessed prior to and after intraperitoneal administration of DPH (20 & 40 mg/Kg) and CBZ (20 mg/Kg). In 11 rats, CBZ was administered repeatedly for 6 days at the dose of 20 mg/Kg/day. Also studied were the effects of strychnine and picrotoxin (1 mg/Kg, i.p.) on the CBZ-produced changes in the formalin-induced pain behaviors. The tail flick and hot plate ltencies were not changes after administration of DPH and CBZ. However DPH strongly suppressed the formalin-induced tonic pain. A single and the repeated administration of CBZ inhibited both the early phasic and the late tonic pain responses to formalin in n similar manner. On the other hand, the antinociceptive actions of CBZ were not altered by strychnine or picrotoxin. These experimental findings lead to the conclusion that DPH and CBZ have differential antinociceptive action on the acute and the tonic pains and that their antinociceptive actions are independent of the GABA- and glycine-receptors.

• The Korean Journal of Pain
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• 제27권2호
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• pp.103-111
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• 2014

Nefopam (NFP) is a non-opioid, non-steroidal, centrally acting analgesic drug that is derivative of the nonsedative benzoxazocine, developed and known in 1960s as fenazocine. Although the mechanisms of analgesic action of NFP are not well understood, they are similar to those of triple neurotransmitter (serotonin, norepinephrine, and dopamine) reuptake inhibitors and anticonvulsants. It has been used mainly as an analgesic drug for nociceptive pain, as well as a treatment for the prevention of postoperative shivering and hiccups. Based on NFP's mechanisms of analgesic action, it is more suitable for the treatment of neuropathic pain. Intravenous administration of NFP should be given in single doses of 20 mg slowly over 15-20 min or with continuous infusion of 60-120 mg/d to minimize adverse effects, such as nausea, cold sweating, dizziness, tachycardia, or drowsiness. The usual dose of oral administration is three to six times per day totaling 90-180 mg. The ceiling effect of its analgesia is uncertain depending on the mechanism of pain relief. In conclusion, the recently discovered dual analgesic mechanisms of action, namely, a) descending pain modulation by triple neurotransmitter reuptake inhibition similar to antidepressants, and b) inhibition of long-term potentiation mediated by NMDA from the inhibition of calcium influx like gabapentinoid anticonvulsants or blockade of voltage-sensitive sodium channels like carbamazepine, enable NFP to be used as a therapeutic agent to treat neuropathic pain.

• Childhood Kidney Diseases
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• 제23권1호
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• pp.48-52
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• 2019

The ketogenic diet (KD) has been used as an effective antiepileptic therapy for intractable childhood epilepsy. However, various adverse effects have been reported with use of the KD. We report a case of a child who developed acute tubular necrosis subsequent to therapy with KD. A 5-year-old girl had myoclonic epilepsy with developmental delay. She was under the treatment with antiepileptic drugs since the age of 3 months and on the KD during the past 18 months. Proteinuria persisted intermittently with the initiation of the KD and subsequently increased in the past 2 months. She was admitted with intermittent mild fever, vomiting, and lethargy for the past 3-4 weeks. At the time of admission, she presented with hypertriglyceridemia, heavy proteinuria, renal Fanconi syndrome, and acute kidney injury. Renal sonography showed a marked increase in the size and parenchymal echogenicity of both kidneys. A renal biopsy revealed acute tubular necrosis accompanied by early interstitial fibrosis. After the withdrawal of the KD and supportive therapy, without changing other anticonvulsants and their dosages, improvement of renal function was observed. Proteinuria had disappeared after 1 month and kidney size returned to normal after 8 months. It is hypothesized that the KD can induce and/or aggravate the renal tubulointerstitial injury in some patients who are under the treatment with anticonvulsants.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권6호
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• pp.403-408
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• 2020

Trigeminal neuralgia (TN) involves chronic neuropathic pain, characterized by attacks of repeating short episodes of unilateral shock-like pain, which are abrupt in onset and termination. Anticonvulsants, such as carbamazepine, are the gold standard first-line drugs for pharmacological treatment. Microvascular decompression (MVD) surgery is often the course of action if pharmacological management with anticonvulsants is unsuccessful. MVD surgery is an effective therapy in approximately 83% of cases. However, persistent neuropathic pain after MVD surgery may require reintroduction of pharmacotherapy. This case report presents two patients with persistent pain after MVD requiring reintroduction of pharmacological therapy. Although MVD is successful for patients with failed pharmacological management, it is an invasive procedure and requires hospitalization of the patient. About one-third of patients suffer from recurrent TN after MVD. Often, alternative treatment protocols, including the reintroduction of medications, may be necessary to achieve improvement. This case report presents two cases of post-MVD recurrent pain. Further research is lacking on the success rates of subsequent medication therapy after MVD has proven less effective in managing TN.

• 약학회지
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• 제48권3호
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• pp.182-188
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• 2004

This study aimed to synthesize new anticonvulsive agents as potential dual acting prodrugs. For the synthesis of ester or amide prodrug types, p-hydroxybenzaldehyde or valproic acid was coupled with clinically usable anticonvulsants or GABAmimetics with use of DCC/DMAP coupling methods. Also their anticonvulsive activities were evaluated.

• 대한약학회:학술대회논문집
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• 대한약학회 2003년도 Proceedings of the Convention of the Pharmaceutical Society of Korea Vol.2-2
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• pp.183.1-183.1
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• 2003

The synthesis of various cyclic carbamate compounds and amino alcohols has attracted attention in the past because of their potential as antibiotics, antitumor, analgenics, anticonvulsants. Several methods for the preparation of cyclic carbamate compounds have previously been reported including the use of heterocumulenes. We have recently described the novel synthetic method for N-protected amines from various ethers using Chlorosulfonyl isocyanate(CSI) and found that the mechanism of our CSI reaction is a competitive reaction of $S_N1$ and $S_ Ni$ mechanisms according to the stability of carbocation intermediates. (omitted)