Anticonvulsants, also called antiepileptic drugs (abbreviated “AEDs”), are a diverse group of pharmaceutical used in the treatment of epileptic seizures. There has also been an increase in their use with treatment of bipolar disorder, since it seems to act as mood stabiliser.
Gabapentin and Pregabalin both of which are anticonvulsants can be used for chronic pain (especially migraines and neuropathy). They include drugs with very different modes of action, but are also effective for sleeping problems, anxiety and depression.
They can also relieve fatigue, flu-like symptoms, cognitive dysfunction, neurological symptoms, irritable bowel syndrome (IBS), bladder problems, restless legs, muscle tension and multiple chemical sensitivity. Their ability to tackle many symptoms at once has made them one of the most important drugs in the treatment of CFS/ME.
Because anticonvulsants work by different mechanisms, their side effects vary too – obviously these depend on the individual and some people do not get any side effects. The older ones can very rarely cause liver problems and other severe reactions. On the other hand, the newer ones are more prone to causing sedation.
Headaches, dizziness and vision impairment are common side effects. Some anticonvulsants can cause weight gain, but a few (topiramate, vigabatrin and zonisamide) may lead to weight loss.
Gabapentin (Neurontin) is one of the most popular treatments for CFS/ME and fibromyalgia. It can alleviate a wide variety of problems from interstitial cystitis to hot flashes. It is often used for anxiety and mood problems. It is also a popular pain treatment, especially for burning or electric shock-like neuropathy.
Pregabalin (Lyrica) Pregabalin is very similar to gabapentin, but may be slightly better tolerated. It was the first FDA-approved drug for fibromyalgia, though there is no evidence that it is more effective in this use than the less expensive gabapentin.
It is used for treating pain caused by neurologic diseases such as postherpetic neuralgia as well as seizures. It also is used for treating fibromyalgia. The mechanism of action of pregabalin is unknown.
Pregabalin binds to calcium channels on nerves and may modify the release of neurotransmitters (chemicals that nerves use to communicate with each other). Reducing communication between nerves may contribute to pregabalin’s effect on pain and seizures.
pregabalin was shown to provide improvement of pain in patients with fibromyalgia, a chronic and debilitating pain syndrome and is also shown shown to improve sleep and fatigue levels.
Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread musculoskeletal pain that is frequently associated with fatigue and sleep disturbances and is is a complaint that is frequently associated with CFS. It is estimated to affect two percent of the population, or 5.6 million Americans, and occurs most frequently in women.
The double-blind, placebo-controlled monotherapy study involved 529 patients diagnosed with FMS. Patients were randomized to receive placebo or pregabalin (150 mg, 300 mg or 450 mg per day) for eight weeks. The study evaluated the efficacy and safety of pregabalin for the treatment of pain and associated symptoms such as sleep and fatigue. Patients were required to characterise and record their pain on a daily basis in detailed diaries.
Pregabalin-treated patients (450 mg/day) showed statistically significant improvements in pain compared to those who received placebo. Further, 29 percent of pregabalin-treated patients reported at least a 50 percent reduction in pain, compared with a reduction of 13 percent for patients who received placebo, a difference that was statistically significant.
In addition, pregabalin significantly improved sleep quality and fatigue!!
To demonstrate improvements in the core symptoms of pain, sleep and fatigue represents an important advance, particularly as there are no approved treatments for this condition.
The most common dose-related side effects reported by patients were dizziness and drowsiness. Most adverse events were mild to moderate in intensity, and many resolved during the study. Seventy-eight percent of all patients completed the study.
Developed by Pfizer, pregabalin has been studied in an extensive clinical program involving over 8,000 patients worldwide. The company has completed pivotal studies to support the filing of a New Drug Application for pregabalin for the treatment of neuropathic pain and generalized anxiety disorder and as an add-on therapy for epilepsy.
Carbamazepine (Tegretol) Carbamazepine is an old inexpensive anticonvulsant which has sometimes been used in CFS/ME. It is particularly effective for sharp and stabbing neuropathic pain. It can cause liver damage and other serious problems, so safer alternatives have mostly surpassed it and is not in widespead use today.
Oxcarbazepine (Trileptal) is a newer derivative of carbamazepine with similar efficacy and uses, but it may be less likely to cause some of the serious adverse reactions.
Lamotrigine (Lamictal) Lamotrigine affects many neurotransmitters and receptors in the brain. It also has some antiviral activity against HHV-6, a herpes virus which has been associated with CFS/ME. Some people with CFS/ME have found it extremely useful.
Unfortunately lamotrigine can cause a life-threatening rash. This is very rare, but up to 10% of the patients develop some sort of a rash (usually harmless), so the drug is often discontinued just in case.
Levetiracetam (Keppra) Levetiracetam may be the antidepressant with best tolerability and fewest side effects. It is often useful in RLS and migraine (especially migraine with aura). It may also help refractory cases of chronic pain and PTSD.
Clonazepam (Klonopin) Clonazepam belongs to benzodiazepines, a class of tranquilizer drugs. It is sometimes used for sleeping problems and for its muscle relaxing properties. It is also an anticonvulsant. Many CFS/ME and fibromyalgia experts believe that in low doses clonazepam is one of the best treatments for these illnesses.
Other Alternatives Topiramate (Topamax) is often used in migraine prophylaxis (prevention) and may also help neuropathic pain, but it is quite prone to causing cognitive impairment. Tiagabine (Gabitril) is good for anxiety and sleep and a preliminary study found it effective in fibromyalgia. Zonisamide (Zonegran) is currently being tried for the combination of fibromyalgia and migraine in a clinical trial.
Reader aware!! Please note that I am not a medical profession and that this article is being used as a means to promote my website which is involved in the bringing about an awareness of Chronic fatigue Syndrome. I do however have significant experience with the disease itself and am concerned deeply by the effects that it has on anyone suffering from it.
My wife Amanda has CFS and suffers immensely and it is my experience with her and my subsequent research into CFS that is the basis of the information above.
If you are interested in discussing issues related to CFS & ME we have a web-site that tries to help people, organises events to promote awareness and raises funds through various means.