[Neurophysiologic and neurochemical principles of the effect of anticonvulsants].
This article surveys neurophysiological and neurochemical findings on the mechanism of action of clinically useful antiepileptics. Two mechanisms appear to be particularly important: reducing the hyperexcitability of the cell membranes by a direct action at ion channels; changes in synaptic transmission by means of an intervention in neurotransmitter systems; it seems that in this regard an important neurotransmitter is the inhibitory gamma-aminobutyric acid GABA. With these mechanisms as basis, antiepileptics can be classified into several groups. In anticonvulsively effective concentrations, phenytoin and carbamazepine will stabilise the cell membranes and thus inhibit their hyperexcitability. This effect seems to be due to a blocking effect on Na+ permeability. If administered in anticonvulsively effective concentrations, phenobarbital and benzodiazepines enhance the GABAerg inhibition by direct attachment to the GABA receptor chloride ionophore complex of the postsynaptic neuronal membrane. In addition, phenobarbital produces a reduction of the postsynaptic effect of glutamic acid which is an excitatory neurotransmitter. In higher concentrations, barbiturates and benzodiazepines produce direct changes in ion conductivity, and this seems to be an important factor determining the sedative/hypnotic effects of these substances. Primidone seems to act mainly (in long-term treatment) via its active metabolite phenobarbital. Valproic acid will lead both to a stabilisation of the membranes and to an amplification of the GABAerg transmission; in this connection, both presynaptic and postsynaptic sites of action are discussed. On the other hand, ethosuximide, given in anticonvulsively effective concentrations, does not affect membrane excitability and synaptic transmission. It can be expected that clarification of the mechanisms of action of clinically effective antiepileptics results in a stricter on-target search for new active substances.
D000818:Animals; D000927:Anticonvulsants / Q000627:therapeutic use*; D001921:Brain / Q000187:drug effects*; D004573:Electrolytes / Q000378:metabolism; D004827:Epilepsy / Q000188:drug therapy*; D006801:Humans; D007473:Ion Channels / Q000187:drug effects; D008564:Membrane Potentials / Q000187:drug effects; D009474:Neurons / Q000187:drug effects; D018377:Neurotransmitter Agents / Q000378:metabolism*; D011963:Receptors, GABA-A / Q000187:drug effects; D013570:Synaptic Membranes / Q000187:drug effects; D009435:Synaptic Transmission / Q000187:drug effects*
D000927:Anticonvulsants; D004573:Electrolytes; D007473:Ion Channels; D018377:Neurotransmitter Agents; D011963:Receptors, GABA-A
Neurophysiologische und neurochemische Grundlagen der Wirkung von Antiepileptika.