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Background. Epilepsy is one of the serious neurological diseases characterized by seizures that affect about 1% of people worldwide (65 million), and therefore, epilepsy can be considered as a disease of civilization. Although seizures are controllable with antiepileptic drugs (AEDs) in about 70% of cases, it remains still about 30% of epilepsy patients inadequately medicated with these AEDs, who need a full control of their seizure attacks. One of the treatment options in these patients is application of two or three AEDs in combination. The aim of this study was to characterize the anticonvulsant effects of a combination of three AEDs (i.e., carbamazepine [CBZ], lacosamide [LCM] and phenobarbital [PB]) at the fixed-ratio of 1:1:1 in the mouse maximal electroshock (MES)-induced seizure model. Materials and methods. Tonic hind limb extension (seizure activity) was evoked in adult male albino Swiss mice by a current (sine-wave, 25 mA, 500 V, 50 Hz, 0.2 s stimulus duration) delivered via auricular electrodes. Type I isobolographic analysis was used to analyze the three-drug combination. Results. Type I isobolographic analysis revealed that the combination of CBZ, LCM and PB (at the fixed-ratio of 1:1:1) exerted additive interaction with a slight tendency towards antagonism in the mouse MES-induced seizure model. Conclusions. A special caution is advised to patients taking LCM in combination with CBZ and PB because this three-drug combination offered additive interaction with a slight tendency towards antagonism in the mouse MES model.
The aim of the present study was to characterize the anticonvulsant effects of levetiracetam in combination with ethosuximide in the mouse 6 Hz psychomotor seizure model. Limbic (psychomotor) seizure activity was evoked in albino Swiss mice by a current (32 mA, 6 Hz, 3 s stimulus duration) delivered via ocular electrodes; type II isobolographic analysis was used to characterize the consequent anticonvulsant interactions between the drug combinations for fixed-ratios of 1:1, 1:2, 1:5 and 1:10. With type II isobolographic analysis, the combinations of levetiracetam with ethosuximide for the fixed-ratios of 1:5 and 1:10 were supra-additive (synergistic; P<0.05 and P<0.01, respectively) in terms of seizure suppression, while the combinations for the fixed-ratios of 1:1 and 1:2 were additive in the mouse 6 Hz psychomotor seizure model. The combinations of levetiracetam with ethosuximide for the fixed-ratios of 1:5 and 1:10 appear to be particularly favorable combinations exerting supra-additive interaction in the mouse 6 Hz psychomotor seizure model. Finally, it may be concluded that because of the synergistic interactions between levetiracetam and ethosuximide, the combination might be useful in clinical practice.
Background. It is estimated that approximately 1% of people worldwide suffer from epilepsy. Currently available antiepileptic drugs (AEDs) are able to control epileptic seizures in about 70% of cases. In the remaining patients (30%), the application of two or three AEDs in combination is necessary for effective seizure management. The goal of this work was to characterize the interaction of three AEDs: lacosamide (LCM), carbamazepine (CBZ) and valproate (VPA) at the fixed-ratio of 1:1:1 in the mouse tonic-clonic seizure model. Material and methods. Male albino Swiss mice, after receiving a combination of LCM, CBZ and VPA, were challenged with electric current to evoke tonic hind limb extension (seizure activity). Protection of the mice from tonic-clonic seizures was assessed by isobolographic analysis to determine the type of interaction occurring between these drugs. Results. Type I isobolographic analysis revealed that the combination of LCM, CBZ and VPA produced infra-additive (antagonistic) interaction in the mouse tonic-clonic seizure model. Conclusions. Since the three-drug mixture of LCM, CBZ a nd VPA exerted an antagonistic interaction in the tonic-clonic seizure test in mice, we would caution physicians against treating epilepsy patients with this unfavorable combination.
Background. Search for beneficial combinations of antiepileptic drugs (AEDs) that can be used in patients with pharmacoresistant epilepsy, is still conducted both empirically and rationally, based on molecular mechanisms of AEDs’ action. This study was aimed at characterizing the interaction profiles for the combination of two AEDs (i.e., retigabine [RTG] and phenytoin [PHT]) in the maximal electroshock-induced seizures (MES) and chimney test (motor performance) in adult male albino Swiss mice. Material and methods. Type I isobolographic analysis was used to determine interactions for the combination of RTG with PHT (at three fixed-ratios of 1:3, 1:1 and 3:1) with respect to its anticonvulsant and acute neurotoxic effects in the MES and chimney tests, respectively. Total brain concentrations of RTG and PHT were estimated to exclude any pharmacokinetic interaction between AEDs. Results. The combination of RTG with PHT at the fixed-ratios of 1:3, 1:1 and 3:1 produced additive interactions in both, the MES and chimney tests. RTG and PHT did not affect each other their total brain concentrations in mice, confirming pharmacodynamic interaction between the investigated drugs. Conclusions. The combination of RTG with PHT was neutral suggesting that this two-drug combination might occur favorable in some patients with refractory epilepsy.
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