Definition
Carbamazepine is a drug that is mainly used to treat epilepsy. Carbamazepine has also been shown to be effective in certain forms of pain – particularly so-called neuropathic pain, which is caused by damage to nerve cells – and in mental disorders such as mania, schizophrenia, bipolar disorder or borderline personality disorder. This paper, however, focuses mainly on the use of carbamazepine in epilepsy.
Use in epilepsy
Epilepsy is a disease characterized by frequent epileptic seizures. Such an epileptic seizure can manifest itself in many different ways: the spectrum ranges from simple twitches in certain muscle areas, through complete mental absence of several seconds (so-called “absences”) or olfactory hallucinations with subsequent fainting and convulsions, to sudden falls with complete loss of tension in all muscles. Despite the different forms, the origin is always the same: the electrical currents normally prevailing in the brain are replaced by uncontrolled, increased electrical discharges.
As a result, disorders of consciousness, muscles, movements, thinking, memory or various perceptions occur. Which disturbances begin depends on the exact location of these discharges – they can either be limited to a very specific area of the brain or spread to the whole brain and thus lead, for example, to loss of consciousness. Epileptic seizures usually last only a few seconds to minutes.
An exception is the “status epilepticus”, in which a series of such seizures lasts for more than 30 minutes. These are usually seizures that involve convulsions and are life-threatening due to respiratory paralysis or circulatory problems. In general, drugs used to treat epilepsy are called “anticonvulsants” or “antiepileptic drugs”.
The aim of therapy for epilepsy – including treatment with carbamazepine – is to prevent or at least reduce the number of epileptic seizures. It is important to note that certain forms of epileptic seizures trigger changes in the brain which can promote further seizures. It is therefore important for the long-term course of the disease to start treatment early.
The later the treatment is started, the less likely it is that the seizures will last. However, this does not necessarily mean that treatment should be started immediately after the first epileptic seizure – because many people have such seizures once in their life without having an epilepsy. Typically, treatment is only given from the 2nd seizure onwards, when the diagnosis of “epilepsy” is confirmed.
After several years of freedom from seizures, an attempt can be made to slowly reduce the dose of the anticonvulsant or the combination of drugs and finally to discontinue them. Renewed seizures then occur in about 40% of adults and 20% of children, with relapse rates varying greatly between the different forms of epilepsy and depending on the duration of the illness before treatment. Carbamazepine is also used in non-epileptics when they are going through alcohol or drug withdrawal. This prevents possible seizures that may be triggered by withdrawal.
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