Anticonvulsants in neuropathic pain: rationale and clinical evidence

摘要: Neuropathic pain, whether of peripheral or central origin, is characterized by a neuronal hyperexcitability in damaged areas the nervous system. In neuropathic nerve endings exhibit abnormal spontaneous and increased evoked activity, partly due to an novel expression sodium channels. although not explored detail, pain allodynia are also best explained hyperexcitability. The series molecular changes at level nociceptor, dorsal root ganglia, horn spinal cord, brain. These include channels, activity glutamate receptor sites, gamma-aminobutyric acid (GABA-ergic) inhibition, alteration calcium influx into cells. corresponding have many features common with cellular certain forms epilepsy. This has led use anticonvulsant drugs for treatment pain. Carbamazepine phenytoin were first anticonvulsants be used controlled clinical trials. Studies shown these agents relieve painful diabetic neuropathy paroxysmal attacks trigeminal neuralgia. Subsequent studies gabapentin effective neuropathy, mixed neuropathies, postherpetic Lamotrigine, new anticonvulsant, neuralgia, post-stroke Other anticonvulsants, both old, currently undergoing testing. most adverse effects sedation cerebellar symptoms (nystagmus, tremor incoordination). Less side-effects haematological cardiac arrhythmia carbamazepine. introduction mechanism-based classification together more specific pharmacological action, may lead rational individual patient