Carbamazepine-, Oxcarbazepine-, Eslicarbazepine-Associated Movement Disorder: A Literature Review.

BACKGROUND: Carbamazepine (CBZ), oxcarbazepine (OXC), and eslicarbazepine (ESL) acetate belong to the dibenzazepine family. In this context, the aim of this literature review is to evaluate the clinical epidemiological profile, pathological mechanisms, and management of CBZ-, OXC-, and ESL-associated movement disorders (MDs). REVIEW SUMMARY: Relevant reports in 6 databases were identified and assessed by 2 reviewers without language restriction. Reports where the individuals only developed tremor or ataxia after CBZ/OXC/ESL use were not included. A total of 73 reports containing 191 individuals who developed MD associated with CBZ/OXC/ESL were identified. Were found, respectively, the following: 33 patients with myoclonus, 23 with dystonia, 14 with tics, 13 with dyskinesia, 8 with parkinsonism, and 5 with akathisia. In the group not clearly defined, there were 44 with myoclonus, 29 with dyskinesia, 20 with dystonia, 1 with incoordination, and 1 with akathisia. The mean age was 28.53 years. The most frequent sex was male in 52.77% (38/72), and the drug indication was epilepsy in 74.19% (69/93). The mean (SD) CBZ dose when the MD occurred was 692.68 (363.58) mg. The mean time until MD onset was 33.59 days, and the mean recovery period was 8.7 days. The most common form of MD management was drug withdrawal. CONCLUSIONS: The number of cases associated with CBZ is higher than those with OXC + ESL. We believe that the study of CBZ contributes not only to the improvement of this drug but also to the knowledge about the drug-induced MD of OXC and ESL. In the literature, the description of the MD onset and recovery has been poorly reported.

[Assessment of the clinical efficacy and safety of epinastine plus pseudoephedrine vs loratadine plus pseudoephedrine in perennial allergic rhinitis]. / Evaluación de la eficacia y seguridad clínica de epinastina más pseudoefedrina vs loratadina más pseudoefedrina en rinitis alérgica perenne.

BACKGROUND: Several drugs for the treatment of perennial allergic rhinitis and its symptoms have been investigated since some years ago. These drugs are: steroidal-type immunoregulators, immunotherapy and antihistamines. Because of first generation of the last ones originated several side effects, pharmacological research was oriented to the search of formulas with the same of higher efficacy, but with fewer effects on central nervous system. OBJECTIVE: To compare the efficacy and safety of epinastine 10 mg plus pseudoephedrine 120 mg vs loratadine 5 mg plus pseudoephedrine 120 mg, twice a day, in the treatment of perennial allergic rhinitis. MATERIAL AND METHODS: A comparative, random, open, prospective, longitudinal and multicenter study was made in 62 patients with an average age of 26.17 +/- 9.75 years (13-56 years) with diagnosis of perennial allergic rhinitis, who attended to external consultation of the different departments of allergy of the participant institutions. All patients were submitted to: complete clinical history, physical exploration, measurement of vital signs, nasal exploration, qualification of allergic symptoms and record of daily symptoms. Moreover, washout during a week and pharmacological treatment was given during two weeks. Symptoms referred by patient and findings of physical exploration during the different visits, as well as rhinoscopic findings, were assessed by a scale of five parameters of rhinitis. Tolerance grade of drugs was assessed based on frequency and severity of side effects. RESULTS: According to the basal clinical assessment symptoms qualification of patients of groups of epinastine and loratadine was of 9.12 +/- 2.78 and 7.90 +/- 2.7, respectively. Seven side effects appeared: three cases of somnolence, one of sickness and one of anxiety in patients of group of loratadine and one case of somnolence and one of dysmenorrhea in the subjects of group of epinestine. Although it did not have statistically significant difference, it is clinically important for patients. Frequency of side effects was higher in the loratadine group. CONCLUSION: Both drugs are efficient for the treatment of perennial allergic rhinitis.

[Lofepramine: a comparative clinical study with amitriptyline]. / Lofepramina: estudio clínico comparativo con amitriptilina.

Lofepramine, a new tricycle antidepressant, is compared with amitriptyline in a double-blind study. A brief pharmacological description of the drug is made emphasizing its low toxicity and anticholinergic peripheral effects, high plasmatic concentration levels and good tolerance and elimination in comparison with some other known tricycle antidepressants. Sixty depressive outpatients of a Mental Health Service in Lima, 5 male and 55 female, aging 16 to 65, 29 endogenous and 31 neurotic were studied with both drugs in a equimolar dosage. Through the chi square test, no statistical significance was found in maximal therapeutic response, Hamilton Depression Rating Scale scores, type of depression, and side-effects xerostomy which is lesser with lofepramine. A discussion of these results is made and it is concluded that in the present study lofepramine compared with amitriptyline has a similar therapeutic effect. Though not statistically significant, lofepramine seems to be better for neurotic depression and patients sensitive to anticholinergic side-effects.

Elantrine in the treatment of parkinsonism.

A new drug, elantrine, blocks the tremorogenic effect of exotremorine, nicotine and harmine in animals. A double blind study compared elantrine with trinhexyphenidyl and against a baseline placebo period, in a group of Parkinson patients. Both, elantrine and trihexyphenidyl treatment, reduced tremor scores at the conclusion of the respective treatment periods, but closer analysis revealed 65% of patients receiving elantrine had lower tremor scores compared to their baseline (placebo) opposed to only 53% receiving trihexyphenidyl. Both drugs produced aequal effect on rigidity. Another group of Parkinson patients receiving clinically optimal doses of L-dopa were treated with either elantrine or placebo, in blind fashion. Analysis of both tremor and rigidity revealed mean scores significantly lower (P less than 0.05) for those patients receiving elantrine than placebo. Also, there was a statistically significant difference in average total symptom scores favoring the elantrine group. Significant improvement with elantrine administration began after the second week for rigidity and after the third week for tremor. Elantrine is a safe, well tolerated agent which is effective alone in the treatment of parkinsonism but significantly enhances the effectiveness of L-dopa, particularly with respect to tremor and rigidity.

The L-dopa sparing effect of G 31,406 in the treatment of parkinson's disease.

The AA. study 60 cases of Parkinsonism treated with levodopa associated to G31,406 (dibenzazepnic derivative), to amantadine and to a placebo. Drug-associations: 1) L-dopa + G 31.406, of anticataleptic effect, probably because of its anticholinergic activity and adrenergic central and/or dopaminergic stimulating action; 2) L-Dopa + chl. amantadine; 3) L-dopa + placebo. The patients were previously under exclusive use of L-dopa. The assay verifies: a) if there is any benefit with these associations and in what proportions; b) incidence and intensity of side effects; c) comparative study. The assay also intends to evaluate the effect of the G 31.406 on the depression which usually occur in Parkinsonians.

[Combination of tricyclic antidepressants and MAOI in the depressions]. / Asociación de antidepresivos tricíclicos e IMAO en las depresiones

This study was aimed at the assessment of therapeutic and side effects of simultaneous administration of tricyclic antidepressants and MAOI. The sample consisted of 122 patients with depressive syndromes, treated at the "Centro de Psicología Médica San Martín de Tours" (period 1970/1973), with Isocarboxazide and Trimiprimine. All patients received both drugs three times a day. The average daily dose was 20 mg of Isocarboxazide together with 125 mg of Trimiprimine. The average treatment was 70 days long. The study lead to the following conclusions: 1. There were no serious side effects. 2. The scarce side effects registered were not very different from those of the other anti-depressants. 3. The therapeutic doses were lower than those required when each drug is used alone. 4. The speed of action was higher than for each drug separately. 5. The overall percentage of improvement in patients was higher than the percentage obtained for each drug alone. 6. The lack of side effects for a theoretically risky combination of drugs is likely to be attributed to the neuroleptic action of Trimipramine.