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DOI: 10.1055/s-0038-1626345
Wann ist Gabapentin zur Behandlung von Epilepsien vorteilhafter als Carbamazepin?
In which cases is gabapentin more advantageous than carbamazepine in the treatment of epilepsy?Publication History
Publication Date:
15 January 2018 (online)
Zusammenfassung
Nach inzwischen langjährigem Einsatz von Gabapentin in der praktischen Epilepsiebehandlung lassen sich die positiven Erfahrungen wie folgt zusammenfassen: Wirksamkeit in Mono-und Kombinationstherapie, sehr gute Verträglichkeit ohne Exanthem-Risiko, leichte Steuerbarkeit ohne Notwendigkeit einer langwierigen Eindosierung und kein klinisch relevantes Interaktionsrisiko bei medikationspflichtiger Multimorbidität, da Gabapentin weder enzymhemmend noch -induzierend ist. Gegenüber älteren Präparaten wie Carbamazepin bietet Gabapentin erhebliche Vorteile in der Langzeit-Verträglichkeit, sodass es speziell bei älteren und nebenwirkungsempfindlichen Patienten mit fokalen Anfällen nach Abwägung der individuellen Gegebenheiten bevorzugt eingesetzt werden sollte.
Summary
During many years of clinical use gabapentin has been shown to have the following benefits: Efficacy in monoand combination therapy, very good tolerability without risk of rashes, and easy handling without the need for slow titration. Furthermore, gabapentin has a low interaction risk when it is given in combination therapy or with other medication in patients with multimorbidity, since it is neither an enzyme inducer nor an inhibitor. Compared to old drugs such as carbamazepine, gabapentin offers significant advantages in long-term tolerability. As a consequence, after careful consideration of all relevant factors, gabapentin should be preferred particularly in the elderly and those prone to suffer from adverse effects of other AEDs.
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Literatur
- 1 Bowley C, Kerr M. Epilepsy and intellectual disability. J Intellect Disabil Res 2000; 44: 65-75.
- 2 Brodie MJ. et al. Gabapentin versus Lamotrigine monotherapy: a double-blind comparison. Epilepsia 2002; 43 (09) 993-1000.
- 3 Chadwick DW. et al. A double-blind trial of gabapentin monotherapy for newly diagnosed partial seizures. Neurology 1998; 51: 1282-8.
- 4 Crawford P, Brown S, Kerr M. et al. A randomized open-label study of gabapentin and lamotrigine in adults with learning disability and resistant epilepsy. Seizure 2001; 10: 107-15.
- 5 DeToledo JC. et al. Changes in body weight with chronic, high-dose gabapentin therapy. Ther Drug Monit 1997; 19: 394-6.
- 6 Deutsche Gesellschaft für Neurologie. Leitlinien: Epilepsien im Erwachsenenalter. 2002 http://www.dgn.org/leitl.html.
- 7 Elger CE, Schmidt D. Aktuelle Epilepsietherapie: kurzgefasst. München: Zuckschwerdt; 2003.
- 8 Farhat G, Yamout B, Mikati MA. et al. Effect of antiepileptic drugs on bone density in ambulatory patients. Neurology 2002; 58: 1348-53.
- 9 Gillberg C, Soderstrom H. Learning disability. Lancet 2003; 362: 811-21.
- 10 Khurana DS. et al. Efficacy of gabapentin therapy in children with refractory partial seizures. J Pediatr 1996; 128: 829-33.
- 11 Leach JP. et al. Gabapentin and cognition: a double-blind, dose ranging, placebo controlled study in refractory epilepsy. J Neurol Neurosurg Psychiat 1997; 62: 372-6.
- 12 Martin R. et al. Cognitive effects of topiramate, gabapentin, and lamotrigine in healthy young adults. Neurology 1999; 52 (02) 321-7.
- 13 Meador KJ, Loring DW, Ray PG. et al. Differential cognitive effects of carbamazepine and gabapentin. Epilepsia 1999; 40: 1279-85.
- 14 Mikati MA, Choueri R, Khurana DS. et al. Gabapentin in the treatment of refractory partial epilepsy in children with intellectual disability. J Intellect Disabil Res 1998; 42 (Suppl. 01) 57-62.
- 15 Morrell M. Reproductive and metabolic disorders in women with epilepsy. Epilepsia 2003; 44 (Suppl. 04) 11-20.
- 16 Pack AM, Morrell M. Adverse effects of antiepileptic drugs on bone structure. CNS Drugs 2001; 15 (08) 633-42.
- 17 Pellock JM, Morton JD. Treatment of epilepsy in the multiple handicapped. Ment Retard Dev Disabil Res Rev 2000; 06: 309-23.
- 18 Platt D. Altersmedizin. Stuttgart: Schattauer-Verlag; 1997.
- 19 Schmidt D, Elger CE. Praktische Epilepsiebehandlung, 2. Auflage. Stuttgart: Thieme; 2002.
- 20 Schmidt D, Elger CE, Brandl U. et al. Empfehlungen zur Behandlung fokaler Epilepsien mit Gabapentin – ein Konsens. Nervenheilkunde 2001; 20: 580-5.
- 21 Schmidt D, Stefan H, Elger CE. Praktische Erfahrungen mit der Gabapentin-Monotherapie. Nervenheilkunde 2001; 20: 321-5.
- 22 Stefan H. Epilepsien: Diagnose und Behandlung, 3. Auflage. Stuttgart: Thieme; 1999.
- 23 Stefani A, Spadoni F, Giacomini P. et al. The effects of gabapentin on different ligand-and voltage-gated currents in isolated cortical neurons. Epilepsy Research 2001; 43: 239-48.
- 24 Steffenburg S, Gillberg C, Steffenburg U. Psychiatric disorders in children and adolescents with mental retardation and active epilepsy. Arch Neurol 1996; 53: 904-12.
- 25 Strolin-Benedetti M. Enzyme induction and inhibition by new antiepileptic drugs: a review of human studies. Fundamental and Clinical Pharmacology 2000; 14 (04) 301-9.