Advancements in neuroactive peptides in seizures.

INTRODUCTION: Neuroactive peptides are peptides produced by neurons and released through controlled mechanisms that bind to specific receptors on nerve, glial, or other cell types, causing biochemical response(s) within these cells. AREAS COVERED: This article summarizes and interprets recent advancements in our knowledge of neuroactive peptides with pro- or anti-convulsant action, and about new drugs that use the molecular machinery of neuroactive peptides to suppress seizures. EXPERT OPINION: According to the results of preclinical and limited clinical investigations to date, the highest potential to become anti-epileptic drugs with marketing authorization belongs to non-peptide agonists of melanocortin receptors, thyrotropin-releasing hormone receptors, ghrelin receptors, galanin receptors, somatostatin and cortistatin receptors, oxytocin receptors, cholecystokinin receptors, and opioid kappa receptors, followed by non-peptide antagonists of the renin-angiotensin system, corticotropin-releasing hormone receptors, NK1 receptors for substance P, arginine-vasopressin receptors, and opioid delta receptors.

Novel and emerging therapeutics for genetic epilepsies.

INTRODUCTION: Disease-specific treatments are available only for a minority of patients with genetic epilepsies, while the rest are treated with anticonvulsants, which are ineffective in almost one-third of patients. AREAS COVERED: Recently approved and the most effective emerging therapeutics under development for the treatment of genetic epilepsies are overviewed after systematic search and analysis of relevant literature. EXPERT OPINION: New and emerging drugs for genetic epilepsies exploit one of the two approaches: inhibiting hyperactive brain foci through blocking excitatory or augmenting inhibitory neurotransmission, or correcting the underlying genetic defect. The first is limited by insufficient selectivity of available compounds, and the second by imperfection of currently used vectors of genetic material, unselective and transient transgene expression. Besides, the treatment may come too late, after structural abnormalities and epilepsy deterioration takes place. However, with recent improvements, we can expect to see soon gradual decline in the number of patients with therapy-resistant genetic epilepsies.