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Phenytoin may accumulate in the cerebral cortex over long periods of time which can cause atrophy of the cerebellum. The degree of atrophy is related to the duration of phenytoin treatment and is not related to dosage of the medication. [23] Phenytoin is known to be a causal factor in the development of peripheral neuropathy. [24]
It is recommended by the World Health Organization (WHO) for the treatment of certain types of epilepsy in developing countries. [8] In the developed world, it is commonly used to treat seizures in young children, [9] while other medications are generally used in older children and adults. [10] It is also used for veterinary purposes. [11]
Similarly, children exposed lamotrigine or phenytoin in the womb do not seem to differ in their skills compared to those who were exposed to carbamazepine. [96] There is inadequate evidence to determine if newborns of women with epilepsy taking anticonvulsants have a substantially increased risk of hemorrhagic disease of the newborn. [94]
Retigabine is quickly absorbed, and reaches maximum plasma concentrations between half an hour and 2 hours after a single oral dose. It has a moderately high oral bioavailability (50–60%), a high volume of distribution (6.2 L/kg), and a terminal half-life of 8 to 11 hours. [14] Retigabine requires thrice-daily dosing due to its short half-life.
Fosphenytoin is approved in the United States for the short-term (five days or fewer) treatment of epilepsy when more widely used means of phenytoin administration are not possible or are ill-advised, [4] such as endotracheal intubation, status epilepticus or some other type of repeated seizures; cluster seizure, vomiting, and/or the patient is unalert or not awake or both.
Levetiracetam is also effective for both generalised seizures and myoclonus. Clonazepam and high-dose piracetam can alleviate myoclonus. Phenytoin can worsen seizures and may speed up neurodegeneration; carbamazepine, oxcarbazepine, tiagabine, vigabatrin, gabapentin and pregabalin may worsen myoclonus and myoclonic seizures. [14]
The usual dose for seizure disorder is titrated from 100-125 mg/day up to a maintenance dose of 750-1,500 mg/day (maximum daily dosage is 2 g). [ 15 ] Open-label case series have suggested that primidone is effective in the treatment of epilepsy.
Approved by the FDA in 2019 for treatment of epilepsy in adults, cenobamate is primarily used to treat patients with focal onset seizures. The mechanism of action of this drug is unclear, but is likely related to the inactivation of Na Channels and action as a GABA modulator. The dosing range for this drug is anywhere from 100-400 mg with a ...
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