Vernon M Neppe MD, PhD
The use of anticonvulsants have primary indications for epilepsy. They have become complicated enough for the development of the specialty of epileptology to have developed. They are not homogeneous in action, structure, mechanism and indication. These drugs have become a frequent generally non-approved addition to the armamentarium of the psychiatrist. Their psychiatric applications may apply to as much as half of their use. The anticonvulsants are not interchangeable and they differ considerably in side-effects and the specific subtypes of seizure disorder that they control. They also vary in possible use in the non-epileptic setting as well. Frequently these neuropsychiatric conditions are not well-defined in the context of diagnostic framework for aggression in the Diagnostic and Statistical Manual III revision or DSM-IV.
Anticonvulsants can be divided into two major functional groups:
Carbamazepine has potential in the non-indicated management of episodic disorders particularly those linked with hostility. Preliminary research suggests its use is particularly apposite in "Paroxysmal Neurobehavioral Disorders" as a proto type organic illness with epilepsy like phenomena. The mechanism may be via a limbic antikindling effect. Its use in conditions as mania and neuralgic pain may be via different mechanisms.
Valproate is the broadest spectrum anticonvulsant that we know of and the one which has the least side-effects of the first line anticonvulsants: less sedation, hemopoetic consequences and neurotoxicity than carbamazepine and an effectiveness in both grand mal and petit mal seizures. It is effective in both partial and generalized seizures. Psychiatrically its the only anticonvulsant approved for any condition - in this instance mania, and its use in headache particularly refractory headache and migraine are exciting possibilities.
© Copyright 1997 Pacific Neuropsychiatric Institute.