Cerebellar Atrophy Decreases the Threshold of Carbamazepine Toxicity in Patients With Chronic Focal Epilepsy

Abstract

Cerebellar atrophy occurs in a considerable percentage of patients with chronic focal epilepsy and obviously increases the susceptibility for cerebellar AEs of carbamazepine.

Neurological adverse events of new generation sodium blocker antiepileptic drugs. Meta-analysis of randomized, double-blinded studies with eslicarbazepine acetate, lacosamide and oxcarbazepine

“…Since neurological AEs are dose-dependent, 3,7,8 we considered that tolerability profile of the AEDs under analysis should be performed at equi-effective dosages. However, equally effective dosages are not available in the literature and therefore we decided to compare the tolerability profiles taking mainly into account the recommended daily dosages of each agent for the treatment of POS in adults, based on the approved summary of product characteristics (SPC).…”

Cerebellar volumes in newly diagnosed and chronic epilepsy

“…Cerebellar atrophy has been reported as a common finding in patients suffering from epilepsy [1][2][3][4][5][6][7][8][9]. Although the exact cause is unknown, the atrophy is often attributed to either the seizure activity itself or antiepileptic medication [6,7].…”

“…The relationship of atrophy to chronic anti-epileptic medication is less clear, as analysis is often confounded by the fact that those with severe epilepsy are often on higher doses of medication and the occurrence of seizures might itself result in atrophy [4,6,17]. Most reports about cerebellar atrophy have been in highly selected patient groups treated at secondary or tertiary referral centres and therefore are likely to be relatively more severely disabled and medically intractable [1,3,4,9,[15][16][17]. Furthermore, many of these patients will have had episodes of drug intoxication [15,18,19].…”

“…This diagnosis does not necessarily imply a pathological process but may reflect normal inter-individual variability or ageing [20][21][22][23]. Owing to a lack of well defined criteria this diagnosis is often made on a subjective basis [1,3,6,24]. Radiologists often take into account indirect signs such as widening of CSF-filled spaces, the size of the ventricles, and the distance between brain and surrounding tissue (skull or tentorium).…”

Lamotrigine in trigeminal neuralgia secondary to multiple sclerosis

“…Although not dramatically evident in the large population of young patients who receive CBZ for epilepsy with no obvious neurological deficits, such side effects can be devastating in patients who are neurologically impaired. There are reports of CBZ being responsible for an exacerbation of weakness in MS patients [3] and of a possible correlation between cerebellar atrophy and CBZ side effects in non-MS subjects [8]. The essential form of TN typically affects elderly patients, who suffer from a pseudophysiological decline in some neurological functions (coordination being one of the most relevant).…”