The Experts below are selected from a list of 267 Experts worldwide ranked by ideXlab platform
Despina Contopoulos Ioannidis - One of the best experts on this subject based on the ideXlab platform.
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The Cochrane Library - Anticonvulsants for alcohol withdrawal
The Cochrane database of systematic reviews, 2005Co-Authors: Anastasia Polycarpou, Panagiotis Papanikolau, John P. A. Ioannidis, Despina Contopoulos IoannidisAbstract:Background Alcohol withdrawal syndrome is a cluster of symptoms that occurs in alcohol-dependent people after cessation or reduction in alcohol use. This systematic review focuses on the evidence of Anticonvulsants' use in the treatment of alcohol withdrawal symptoms. Objectives To evaluate the effectiveness and safety of Anticonvulsants in the treatment of alcohol withdrawal. Search strategy We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004); MEDLINE (1966 to October 2004); EMBASE (1988 to October 2004) and EU-PSI PSI-Tri database with no language and publication restrictions and references of articles. Selection criteria All randomized controlled trials examining the effectiveness, safety and overall risk-benefit of an anticonvulsant in comparison with a placebo or other pharmacological treatment or another anticonvulsant were considered. Data collection and analysis The authors independently assessed trial quality extracted data. Main results Forty-eight studies, involving 3610 people were included. Despite the considerable number of randomised controlled trials, there was a variety of outcomes and of different rating scales that led to a limited quantitative synthesis of data. For the anticonvulsant versus placebo comparison, therapeutic success tended to be more common among the anticonvulsant-treated patients (relative risk (RR) 1.32; 95% confidence interval (CI) 0.92 to 1.91), and anticonvulsant tended to show a protective benefit against seizures (RR 0.57; 95% CI 0.27 to 1.19), but no effect reached formal statistical significance. For the anticonvulsant versus other drug comparison, CIWA-Ar score showed non-significant differences for the Anticonvulsants compared to the other drugs at the end of treatment (weighted mean difference (WMD) -0.73; 95% CI -1.76 to 0.31). For the subgroup analysis of carbamazepine versus benzodiazepine, a statistically significant protective effect was found for the anticonvulsant (WMD -1.04; 95% CI -1.89 to -0.20), p = 0.02), but this was based on only 260 randomised participants. There was a non-significant decreased incidence of seizures (RR 0.50; 95% CI 0.18 to 1.34) favouring the patients that were treated with Anticonvulsants than other drugs, and side-effects tended to be less common in the anticonvulsant-group (RR 0.56; 95% CI 0.31 to 1.02). Authors' conclusions It is not possible to draw definite conclusions about the effectiveness and safety of Anticonvulsants in alcohol withdrawal, because of the heterogeneity of the trials both in interventions and the assessment of outcomes. The extremely small mortality rate in all these studies is reassuring, but data on other safety outcomes are sparse and fragmented.
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Anticonvulsants for alcohol withdrawal
Cochrane Database of Systematic Reviews, 2005Co-Authors: Anastasia Polycarpou, Panagiotis Papanikolau, John P. A. Ioannidis, Despina Contopoulos IoannidisAbstract:Background Alcohol withdrawal syndrome is a cluster of symptoms that occurs in alcohol-dependent people after cessation or reduction in alcohol use. This systematic review focuses on the evidence of Anticonvulsants' use in the treatment of alcohol withdrawal symptoms. Objectives To evaluate the effectiveness and safety of Anticonvulsants in the treatment of alcohol withdrawal. Search strategy We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004); MEDLINE (1966 to October 2004); EMBASE (1988 to October 2004) and EU-PSI PSI-Tri database with no language and publication restrictions and references of articles. Selection criteria All randomized controlled trials examining the effectiveness, safety and overall risk-benefit of an anticonvulsant in comparison with a placebo or other pharmacological treatment or another anticonvulsant were considered. Data collection and analysis The authors independently assessed trial quality extracted data. Main results Forty-eight studies, involving 3610 people were included. Despite the considerable number of randomised controlled trials, there was a variety of outcomes and of different rating scales that led to a limited quantitative synthesis of data. For the anticonvulsant versus placebo comparison, therapeutic success tended to be more common among the anticonvulsant-treated patients (relative risk (RR) 1.32; 95% confidence interval (CI) 0.92 to 1.91), and anticonvulsant tended to show a protective benefit against seizures (RR 0.57; 95% CI 0.27 to 1.19), but no effect reached formal statistical significance. For the anticonvulsant versus other drug comparison, CIWA-Ar score showed non-significant differences for the Anticonvulsants compared to the other drugs at the end of treatment (weighted mean difference (WMD) -0.73; 95% CI -1.76 to 0.31). For the subgroup analysis of carbamazepine versus benzodiazepine, a statistically significant protective effect was found for the anticonvulsant (WMD -1.04; 95% CI -1.89 to -0.20), p = 0.02), but this was based on only 260 randomised participants. There was a non-significant decreased incidence of seizures (RR 0.50; 95% CI 0.18 to 1.34) favouring the patients that were treated with Anticonvulsants than other drugs, and side-effects tended to be less common in the anticonvulsant-group (RR 0.56; 95% CI 0.31 to 1.02). Authors' conclusions It is not possible to draw definite conclusions about the effectiveness and safety of Anticonvulsants in alcohol withdrawal, because of the heterogeneity of the trials both in interventions and the assessment of outcomes. The extremely small mortality rate in all these studies is reassuring, but data on other safety outcomes are sparse and fragmented.
Anastasia Polycarpou - One of the best experts on this subject based on the ideXlab platform.
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The Cochrane Library - Anticonvulsants for alcohol withdrawal
The Cochrane database of systematic reviews, 2005Co-Authors: Anastasia Polycarpou, Panagiotis Papanikolau, John P. A. Ioannidis, Despina Contopoulos IoannidisAbstract:Background Alcohol withdrawal syndrome is a cluster of symptoms that occurs in alcohol-dependent people after cessation or reduction in alcohol use. This systematic review focuses on the evidence of Anticonvulsants' use in the treatment of alcohol withdrawal symptoms. Objectives To evaluate the effectiveness and safety of Anticonvulsants in the treatment of alcohol withdrawal. Search strategy We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004); MEDLINE (1966 to October 2004); EMBASE (1988 to October 2004) and EU-PSI PSI-Tri database with no language and publication restrictions and references of articles. Selection criteria All randomized controlled trials examining the effectiveness, safety and overall risk-benefit of an anticonvulsant in comparison with a placebo or other pharmacological treatment or another anticonvulsant were considered. Data collection and analysis The authors independently assessed trial quality extracted data. Main results Forty-eight studies, involving 3610 people were included. Despite the considerable number of randomised controlled trials, there was a variety of outcomes and of different rating scales that led to a limited quantitative synthesis of data. For the anticonvulsant versus placebo comparison, therapeutic success tended to be more common among the anticonvulsant-treated patients (relative risk (RR) 1.32; 95% confidence interval (CI) 0.92 to 1.91), and anticonvulsant tended to show a protective benefit against seizures (RR 0.57; 95% CI 0.27 to 1.19), but no effect reached formal statistical significance. For the anticonvulsant versus other drug comparison, CIWA-Ar score showed non-significant differences for the Anticonvulsants compared to the other drugs at the end of treatment (weighted mean difference (WMD) -0.73; 95% CI -1.76 to 0.31). For the subgroup analysis of carbamazepine versus benzodiazepine, a statistically significant protective effect was found for the anticonvulsant (WMD -1.04; 95% CI -1.89 to -0.20), p = 0.02), but this was based on only 260 randomised participants. There was a non-significant decreased incidence of seizures (RR 0.50; 95% CI 0.18 to 1.34) favouring the patients that were treated with Anticonvulsants than other drugs, and side-effects tended to be less common in the anticonvulsant-group (RR 0.56; 95% CI 0.31 to 1.02). Authors' conclusions It is not possible to draw definite conclusions about the effectiveness and safety of Anticonvulsants in alcohol withdrawal, because of the heterogeneity of the trials both in interventions and the assessment of outcomes. The extremely small mortality rate in all these studies is reassuring, but data on other safety outcomes are sparse and fragmented.
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Anticonvulsants for alcohol withdrawal
Cochrane Database of Systematic Reviews, 2005Co-Authors: Anastasia Polycarpou, Panagiotis Papanikolau, John P. A. Ioannidis, Despina Contopoulos IoannidisAbstract:Background Alcohol withdrawal syndrome is a cluster of symptoms that occurs in alcohol-dependent people after cessation or reduction in alcohol use. This systematic review focuses on the evidence of Anticonvulsants' use in the treatment of alcohol withdrawal symptoms. Objectives To evaluate the effectiveness and safety of Anticonvulsants in the treatment of alcohol withdrawal. Search strategy We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004); MEDLINE (1966 to October 2004); EMBASE (1988 to October 2004) and EU-PSI PSI-Tri database with no language and publication restrictions and references of articles. Selection criteria All randomized controlled trials examining the effectiveness, safety and overall risk-benefit of an anticonvulsant in comparison with a placebo or other pharmacological treatment or another anticonvulsant were considered. Data collection and analysis The authors independently assessed trial quality extracted data. Main results Forty-eight studies, involving 3610 people were included. Despite the considerable number of randomised controlled trials, there was a variety of outcomes and of different rating scales that led to a limited quantitative synthesis of data. For the anticonvulsant versus placebo comparison, therapeutic success tended to be more common among the anticonvulsant-treated patients (relative risk (RR) 1.32; 95% confidence interval (CI) 0.92 to 1.91), and anticonvulsant tended to show a protective benefit against seizures (RR 0.57; 95% CI 0.27 to 1.19), but no effect reached formal statistical significance. For the anticonvulsant versus other drug comparison, CIWA-Ar score showed non-significant differences for the Anticonvulsants compared to the other drugs at the end of treatment (weighted mean difference (WMD) -0.73; 95% CI -1.76 to 0.31). For the subgroup analysis of carbamazepine versus benzodiazepine, a statistically significant protective effect was found for the anticonvulsant (WMD -1.04; 95% CI -1.89 to -0.20), p = 0.02), but this was based on only 260 randomised participants. There was a non-significant decreased incidence of seizures (RR 0.50; 95% CI 0.18 to 1.34) favouring the patients that were treated with Anticonvulsants than other drugs, and side-effects tended to be less common in the anticonvulsant-group (RR 0.56; 95% CI 0.31 to 1.02). Authors' conclusions It is not possible to draw definite conclusions about the effectiveness and safety of Anticonvulsants in alcohol withdrawal, because of the heterogeneity of the trials both in interventions and the assessment of outcomes. The extremely small mortality rate in all these studies is reassuring, but data on other safety outcomes are sparse and fragmented.
Jolanta Obniska - One of the best experts on this subject based on the ideXlab platform.
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Design, synthesis, and anticonvulsant activity of N-phenylamino derivatives of 3,3-dialkyl-pyrrolidine-2,5-diones and hexahydro-isoindole-1,3-diones.
Bioorganic & medicinal chemistry, 2008Co-Authors: Krzysztof Kamiński, Jolanta ObniskaAbstract:In the present study on the development of new Anticonvulsants, the library of differently substituted N-phenylamino pyr- rolidine-2,5-dione and hexahydro-isoindole-1,3-dione derivatives was synthesized. The anticonvulsant activity of all the compounds was evaluated using the maximal electroshock (MES) and pentylenetetrazole (scPTZ) screens, which are the most widely employed seizure models for early identification of candidate Anticonvulsants. Their neurotoxicity was determined applying the rotorod test. The pharmacological results revealed that the majority of compounds were effective in electrical (MES) and/or pentylenetetrazole induced seizure (scPTZ) models. The quantitative in vivo anticonvulsant evaluation of N-phenylamino-3,3-dimethyl-pyrrolidine- 2,5-dione (15), conducted at the time of peak pharmacodynamic activity (TPE), showed the MES ED50 value of 69.89 mg/kg in rats. The median toxic dose (TD50) was 500 mg/kg, providing compound 15 with a protective index (TD50/ED50) of 7.15 in the MES test. � 2008 Elsevier Ltd. All rights reserved.
Minsoo Park - One of the best experts on this subject based on the ideXlab platform.
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design and synthesis of 6 amino 1 4 oxazepane 3 5 dione derivatives as novel broad spectrum Anticonvulsants
Bioorganic & Medicinal Chemistry Letters, 2008Co-Authors: Gitalee Sharma, Jin Yup Park, Minsoo ParkAbstract:Based on the structural estimations of the typical anticonvulsant drugs, a series of 6-amino-1,4-oxazepane-3,5-dione derivatives, novel structures of 7-membered heterocyclic imides, which were hybridized with pharmacophores such as cyclic imide and N-CO-C-N group in their molecule were designed and synthesized. Their anticonvulsant activities were evaluated by the maximal electroshock induced seizure (MES) and subcutaneous pentylenetetrazole (PTZ) tests. Almost all the designed compounds except 1c and 1f showed comparable anticonvulsant activities in at least one of the anticonvulsant tests. Moreover, some of the tested compounds exhibited moderate anticonvulsant activities in both MES and PTZ tests. From these results, 6-amino-1,4-oxazepane-3,5-dione derivatives could be recommended as novel structures of broad spectrum Anticonvulsants.
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Synthesis and anticonvulsant evaluation ofN-Cbz-α-amino-N-alkoxysuccinimides
Archives of Pharmacal Research, 2004Co-Authors: Aesun Byun, Minjeong Kim, Jongwon Choi, Kyung Ho Moon, Chung Kyu Lee, Minsoo ParkAbstract:In previous studies for the development of new Anticonvulsants, we found that N-Cbz -α-amino- N -alkylsuccinimides exhibited significant anticonvulsant activities in the Maximal electroshock seizure (MES) and Pentylenetetrazol induced seizure (PTZ) tests, and also their anticonvulsant activities were dependent on the N -alkyl substituents existent in their structures. Based on these estimations, N-Cbz -α-amino- N -hydroxysuccinimide and various N-Cbz -α-amino- N -alkoxysuccinimides were prepared in order to develop more active Anticonvulsants and to examine the effects of N -hydoxy or N -alkoxy groups on their anticonvulsant activities. The ( R )-or (S)- N-Cbz -α-amino- N -hydroxysuccinimide and N-Cbz -α-amino- N -alkoxysuccinimides were prepared from the corresponding ( R )- or ( S )- N-Cbz -aspartic acid through the known synthetic procedures. Their anticonvulsant activities in the MES and PTZ test were evaluated. All of these compounds except 3a showed significant anticonvulsant activities against the PTZ test, but these compounds were not active in the MES test. The most active compound in the PTZ test was ( R )- N-Cbz -α-amino- N -benzyloxysuccinimide (ED_50=62.5 mg/kg). In addition, the anticonvulsant activities of these compounds were dependent on their N-substited groups. The order of anticonvulsant activity against the PTZ test, as judged from the ED_50 values for ( R ) series was N -benzyloxy > N -hydroxy > N -isopropoxy > N -methoxy > N -ethoxy; for the ( S ) series N -ethoxy > N -benzyloxy > N -methoxy > N -isopropoxy.
Troels S. Jensen - One of the best experts on this subject based on the ideXlab platform.
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Anticonvulsants in central pain.
Expert opinion on pharmacotherapy, 2002Co-Authors: Nanna B. Finnerup, Hanne Gottrup, Troels S. JensenAbstract:Treatment of central neuropathic pain (CP) following lesions of the CNS is a great challenge to the clinician. Preclinical and clinical studies indicate that neuronal hyperexcitability in damaged areas of the central nervous system plays a major role in the development of CP. Anticonvulsants are thought to act by increasing gamma-aminobutyric acid-mediated inhibition, decreasing abnormal neuronal hyperexcitability by modulating sodium and calcium channels or by inhibiting excitatory amino acid actions. The resulting inhibition of excess neuronal activity is thought to be the basis for the use of Anticonvulsants in epilepsy as well as neuropathic pain. Both first-generation anticonvulsant drugs (e.g., phenytoin, benzodiazepines, valproate and carbamazepine) and second-generation anticonvulsant drugs (e.g., lamotrigine, gabapentin and topiramate) are used in CP conditions. However, few randomised controlled trials on the treatment of this condition have been published. Present suggestions for anticonvulsant treatment of CP are lamotrigine as the first choice, followed by gabapentin or carbamazepine/oxcarbazepine. These compounds are considered as effective as the antidepressant amitriptyline.
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Anticonvulsants in neuropathic pain rationale and clinical evidence
European Journal of Pain, 2002Co-Authors: Troels S. JensenAbstract:Neuropathic pain, whether of peripheral or central origin, is characterized by a neuronal hyperexcitability in damaged areas of the nervous system. In peripheral neuropathic pain, damaged nerve endings exhibit abnormal spontaneous and increased evoked activity, partly due to an increased and novel expression of sodium channels. In central pain, although not explored in detail, the spontaneous pain and evoked allodynia are also best explained by a neuronal hyperexcitability. The peripheral hyperexcitability is due to a series of molecular changes at the level of the peripheral nociceptor, in dorsal root ganglia, in the dorsal horn of the spinal cord, and in the brain. These changes include abnormal expression of sodium channels, increased activity at glutamate receptor sites, changes in gamma-aminobutyric acid (GABA-ergic) inhibition, and an alteration of calcium influx into cells. The neuronal hyperexcitability and corresponding molecular changes in neuropathic pain have many features in common with the cellular changes in certain forms of epilepsy. This has led to the use of anticonvulsant drugs for the treatment of neuropathic pain. Carbamazepine and phenytoin were the first Anticonvulsants to be used in controlled clinical trials. Studies have shown these agents to relieve painful diabetic neuropathy and paroxysmal attacks in trigeminal neuralgia. Subsequent studies have shown the anticonvulsant gabapentin to be effective in painful diabetic neuropathy, mixed neuropathies, and postherpetic neuralgia. Lamotrigine, a new anticonvulsant, is effective in trigeminal neuralgia, painful peripheral neuropathy, and post-stroke pain. Other Anticonvulsants, both new and old, are currently undergoing controlled clinical testing. The most common adverse effects of Anticonvulsants are sedation and cerebellar symptoms (nystagmus, tremor and incoordination). Less common side-effects include haematological changes and cardiac arrhythmia with phenytoin and carbamazepine. The introduction of a mechanism-based classification of neuropathic pain, together with new Anticonvulsants with a more specific pharmacological action, may lead to more rational treatment for the individual patient with neuropathic pain.