Il ruolo dei farmaci antiepilettici nel trattamento dell'emicrania e delle neuropatie dolorose

The antiepileptic drugs are emerging as promising candidates for their potential as migraine preventives. Their mechanism of action in migraine may be related to sodium channel stabilization, calcium channel modulation, effects on glutamate receptor activity, and/or GABAmediated inhibition. Antiepileptic drugs may be particularly useful when migraine coexists with seizure disorders or mania. The efficacy of antiepileptic drugs in placebo-controlled trials suggest that they may be valuable therapeutic options for patients who need migraine prevention. On the other hand, due to the variety of mechanisms of action of antiepileptic drugs, they results in either a reduction in excitatory synaptic transmission or an enhancement of inhibitory synaptic transmission, which ultimately leads to an increase in refractory period for the cell membrane, hence a slower rate of firing of action potentials in the damaged neurons. A number of double-blind controlled clinical trials have been conducted on the efficacy of antiepileptic drugs for neuropathic pain. The most convincing have been carried out in trigeminal neuralgia and diabetic neuropathy.