Centre d'Evaluation et de Traitement de la douleur, Hôpital Ambroise Paré, 9 avenue Charles de Gaulle, 92 100 Boulogne, France.
Expert Rev Neurother. 2001 Nov;1(2):199-206. doi: 10.1586/14737175.1.2.199.
Antiepileptic drugs were initially designed to treat epileptic seizures, but are increasingly used in the treatment of neuropathic pain. Efficacy of the newer antiepileptic drugs has been confirmed in placebo-controlled studies for trigeminal neuralgia, postherpetic neuralgia, painful polyneuropathy and central poststroke pain. While standard antiepileptic drugs act as sodium channel blockers, the newer antiepileptics display additional mechanisms of action, including a potentiation of GABAergic inhibition, specific binding on a subtype of calcium channels, a reduced release of glutamate and a blockade of AMPA/kainate receptors. These mechanisms could account for their antiallodynic and antihyperalgesic effects demonstrated in animal models of neuropathic pain and also suggested for gabapentin and lamotrigine in humans. Additional studies are required to compare efficacy of newer versus standard antiepileptic drugs and to better define their place in comparison with other analgesics in the treatment of neuropathic pain.
抗癫痫药物最初是为治疗癫痫发作而设计的，但现在越来越多地用于治疗神经性疼痛。在三叉神经痛、带状疱疹后神经痛、痛性多发性神经病和卒中后中枢性疼痛的安慰剂对照研究中，新型抗癫痫药物的疗效已得到证实。虽然标准的抗癫痫药物作为钠离子通道阻滞剂，但新型抗癫痫药物具有其他作用机制，包括增强 GABA 能抑制、对特定钙通道亚型的结合、减少谷氨酸释放以及阻断 AMPA/KA 受体。这些机制可以解释它们在神经性疼痛动物模型中表现出的抗痛觉过敏和抗痛觉过敏作用，也被认为是加巴喷丁和拉莫三嗪在人类中的作用机制。需要进一步的研究来比较新型与标准抗癫痫药物的疗效，并更好地确定它们在治疗神经性疼痛方面与其他镇痛药相比的地位。
