The neurobiology of antiepileptic drugs for the treatment of nonepileptic conditions

Michael A Rogawski, Wolfgang Löscher

Research output: Contribution to journalArticle

351 Citations (Scopus)

Abstract

Antiepileptic drugs (AEDs) are commonly prescribed for nonepileptic conditions, including migraine headache, chronic neuropathic pain, mood disorders, schizophrenia and various neuromuscular syndromes. In many of these conditions, as in epilepsy, the drugs act by modifying the excitability of nerve (or muscle) through effects on voltage-gated sodium and calcium channels or by promoting inhibition mediated by γ-aminobutyric acid (GABA) A receptors. In neuropathic pain, chronic nerve injury is associated with the redistribution and altered subunit compositions of sodium and calcium channels that predispose neurons in sensory pathways to fire spontaneously or at inappropriately high frequencies, often from ectopic sites. AEDs may counteract this abnormal activity by selectively affecting pain-specific firing; for example, many AEDs suppress high-frequency action potentials by blocking voltage-activated sodium channels in a use-dependent fashion. Alternatively, AEDs may specifically target pathological channels; for example, gabapentin is a ligand of α2δ voltage-activated calcium channel subunits that are overexpressed in sensory neurons after nerve injury. Emerging evidence suggests that effects on signaling pathways that regulate neuronal plasticity and survival may be a factor in the delayed clinical efficacy of AEDs in some neuropsychiatric conditions, including bipolar affective disorder.

Original languageEnglish (US)
Pages (from-to)685-692
Number of pages8
JournalNature Medicine
Volume10
Issue number7
DOIs
StatePublished - Jul 2004
Externally publishedYes

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Neurobiology
Anticonvulsants
Calcium Channels
Sodium Channels
Neuralgia
Sensory Receptor Cells
Mood Disorders
Neurons
Voltage-Gated Sodium Channels
Aminobutyrates
Therapeutics
Somatoform Disorders
Neuronal Plasticity
Wounds and Injuries
Electric potential
GABA-A Receptors
Migraine Disorders
Bipolar Disorder
Chronic Pain
Action Potentials

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

The neurobiology of antiepileptic drugs for the treatment of nonepileptic conditions. / Rogawski, Michael A; Löscher, Wolfgang.

In: Nature Medicine, Vol. 10, No. 7, 07.2004, p. 685-692.

Research output: Contribution to journalArticle

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