PubMed · 15366192
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Anthony Marson, Sridharan Ramaratnam. 2003. Epilepsy.. https://pubmed.ncbi.nlm.nih.gov/15366192/
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A nanostructured matrix, consisting of titania, was designed in such a way that an antiepileptic drug could be encapsulated and released according to a well-defined time release schedule. The titania was synthesized by a sol-gel method in which titanium n-butoxide was used as the precursor for the formation of the sol. The synthesis was optimized to yield a homogeneous particle size with a high porosity and an anatase crystal structure. The antiepilectic drugs, phenytoine or valproic acid, were added during the gelation stage in order to obtain a homogeneous gel phase. The resulting nanostructured matrix including the drug showed only weak attractive forces, such as London forces, dipole-dipole coupling, and in some cases hydrogen bonds. The resulting assembly, referred to as a reservoir, was characterized using conventional FTIR and NMR spectroscopic techniques. Theoretical simulation studies were performed so as to obtain an understanding of the equilibrium electrostatic potential distribution and the relative charges on the titania and the anticonvulsants.
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An expert panel convened to evaluate data and review current clinical practices regarding the novel antiepileptic drug (AED) felbamate. Felbamate has demonstrated efficacy against a variety of refractory seizures types, including seizures associated with Lennox-Gastaut syndrome, but postmarketing experience revealed serious idiosyncratic adverse effects that were not observed during clinical trials. Although felbamate is not indicated as first-line antiepileptic therapy, its utility in treating seizures that are refractory to other AEDs is undisputed, as shown by the number of patients who continue to use it. New exposures to felbamate number approximately 3200-4200 patients annually, and it is estimated that over the past 10 years, approximately 35,000 new starts have occurred. Recommendations by the American Academy of Neurology and a review of felbamate literature were evaluated in conjunction with the clinical experience of the expert panel to determine current medical opinion and practice regarding felbamate. The past 10 years of clinical experience have demonstrated that when used in accordance with existing recommendations and close clinical monitoring, felbamate is an effective treatment for some patients with seizures refractory to other AEDs. This review of clinical data and discussion of the current understanding of the risk:benefit of felbamate therapy supports its use as an important therapeutic option for some patients with refractory epilepsy.