L

TABLE 32.2 Categorization of Anticonvulsants by Their Proposed Mechanism

Class Description Drugs

Type I

Type II

Type III

Type IV Noncategorized

Block SRF by enhancing sodium channel inactivation

Multiple actions: enhance GABAergic inhibition, reduce T-calcium currents, and possibly block SRF

Block T-calcium currents only Only enhances GABAergic inhibition

Has no known effect on SRF, GABAergic inhibition, or T-calcium currents

Phenytoin

Carbamazepine

Oxcarbazepine

Lamotrigine

Felbamate"

Valproic acid

Benzodiazepines

Phenobarbital

Primidone

Ethosuximide

Trimethadione

Vigabatrin

Gabapentin4

Adapted with permission from designation of classes described by Macdonald RL and Meldrum BS. In Levy RH et al. (eds.). Antiepileptic

"Felbamate probably possesses other actions.

4The mechanisms of action of gabapentin are unknown.

SRF, sustained high-frequency repetitive firing.

vance, since compounds in a particular category are often used for the same clinical indication. For a proposed mechanism of action to be considered relevant for a given drug, the effect must occur at concentrations similar to those that are likely to be achieved therapeuti-cally.

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