항발작약물의 발작 외 신경계 질환 사용

초록

Antiseizure medications (ASMs), originally developed for epilepsy, are increasingly used across non-epileptic neurological disorders. They modulate excitatory -inhibitory balance, nociceptive sensitization, neuroplasticity, trigeminal activation, and sleep-wake regulation through actions on voltage-gated ion channels, GABAergic and glutamatergic transmission, and synaptic vesicle proteins. These mechanisms underlie their broader therapeutic potential. In migraine, topiramate and valproate reduce attack frequency and chronification risk, and remain first- or second-line preventive options in current guidelines. In neuropathic pain, gabapentin and pregabalin alleviate peripheral and central sensitization and are effective in diabetic neuropathy, postherpetic neuralgia, and trigeminal neuralgia, improving pain and sleep though requiring cautious use in older or opioid-treated patients. ASMs enhance slow-wave sleep and are now preferred first-line therapy for restless legs syndrome, offering lower augmentation risk than dopamine agonists. In movement disorders, primidone and topiramate reduce tremor severity in essential tremor, while carbamazepine and oxcarbazepine effectively prevent attacks in paroxysmal kinesigenic dyskinesia. Lamotrigine, valproate, and carbamazepine are established mood stabilizers in bipolar disorder, while gabapentinoids may be cautiously used as adjuncts in anxiety disorders or post-traumatic stress disorder. While ASMs provide valuable alternatives for refractory or intolerant patients, safety concerns, including cognitive impairment, respiratory depression, and severe skin reactions, necessitate individualized selection, monitoring, and informed consent. Future research should clarify their long-term safety and enable biomarker-guided, personalized use beyond epilepsy.

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