Methsuximide Research Articles

Mechanism of Inhibition of Recombinant GABAA Receptors by Pentylenetetrazole and Its Alleviation by Anticonvulsants

Despite the wide prescription of drugs targeting postsynaptic γ-aminobutyric acid receptors (GABAARs) for seizure and epilepsy, mechanisms by which those drugs exert their effects on GABAAR are poorly understood. This is mainly attributed to the unavailability of crystal structure of the receptor and the various assembly of 19 different subunits (α1- α6, β1-β3, γ1-γ3, δ, e, π, θ, ρ1-ρ3). Here, we studied the effects of two anticonvulsants on the recombinant α1β3γ2 GABAAR using whole-cell current recordings combined with rapid kinetic techniques. Our results showed that pentylenetetrazole (PTZ), a compound used to artificially induce convulsive effect in animal models, is a mixed inhibitor of the receptor. Anticonvulsant ethosuximide (ES) and the major metabolite (α-methyl-α-pheny-succinimide, MPS) of another anticonvulsant methsuximide (MS) were found to alleviate the inhibition of the receptor by PTZ, while MS itself doesn't. Those data suggest that the enhancement of postsynaptic GABAAR response is one of the mechanisms of the anticonvulsant effect of ES and MS. T-type calcium channel was suggested to be one of the targets of ES.Acknowledgement of support: This project was supported by grants from the National Center for Research Resources (5P20RR016467-11) and the National Institute of General Medical Sciences (8P20GM103466-11) from the National Institutes of Health. The content is solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

Symptoms and course of intoxication with mesuximide — A case report

We report on a 31-year-old, female patient who presented with somnolence due to an intoxication by the antiepileptic drug, mesuximide (MSM). The serum concentration of its metabolite n-desmethyl-mesuximide (85.7mg/L) was above the so‐called therapeutic range (10–40mg/L) but below the concentration range that led to an impairment of consciousness in previous cases according to the German SPC (>150mg/L). The symptoms remitted quickly under hemodialysis. In somnolent patients treated with MSM, the treating physicians should be aware of drug intoxication as a possible etiology. Therefore, the serum concentration should be measured early. Due to the, often, long latency until the results are available, treatment initiation may be necessary based on suspicion.

Porphyrogenic activity of methsuximide and its demethylated metabolite.

Porphyrogenic activity of methsuximide and its demethylated metabolite.

Effective and safe but forgotten: methsuximide in intractable epilepsies in childhood

The efficacy and safety of methsuximide (MSM) was evaluated in children with intractable epilepsies in a prospective uncontrolled study. MSM was added to the therapeutic regimen of 112 children with intractable epilepsy under inpatient conditions, all of whom were therapeutically refractory to various first-line antiepileptic drugs (AED) or combinations of other AED. Titration of MSM was performed following a uniform protocol. Administration of MSM resulted in a 50% or greater reduction in seizure frequency in 40 patients after a short-term observation period (mean 9.1 weeks). After a mean of 3.7 years, the rate of seizures and side effects were re-evaluated in 39 patients who were still receiving MSM as part of their antiepileptic regimen. Twenty two of these patients derived long-term benefit from MSM. In patients with good seizure control, fasting plasma levels of N-desmethylmethsuximide, the principal active metabolite of MSM, were 25.3–44.7 mg l−1(mean 36.0 mg l−1). Thus effective plasma levels of N-desmethylmethsuximide in children were found to be higher than previously described. Forty one of 112 patients (28.9%) developed side effects during MSM treatment. No serious or irreversible side effects were seen. Our study demonstrates the value of MSM as an ‘add-on’ drug in intractable epilepsies.

Methsuximide lowers lamotrigine blood levels: A pharmacokinetic antiepileptic drug interaction.

To determine whether methsuximide (MSM) affects lamotrigine (LTG) blood levels and whether any change is of clinical significance. LTG serum levels in 16 patients taking MSM were compared with those before starting or after stopping the MSM. The 16 patients, (11 boys, five girls) were young people (mean age, 15.5 years; range, 9-19 years) with a variety of seizure types and syndromes. In six cases, LTG levels were available both before MSM was started and after it was stopped. The mean LTG serum concentration before starting or after stopping MSM was 13.4 mg/L, and the mean level while taking MSM was 6.3 mg/L. This difference was highly significant (p < 0.0005, paired t test). MSM lowered the LTG serum concentration in every case, with a mean decrease of 53% (range, 36-72%). In some patients this led to a deterioration in seizure control when MSM was added or an improvement in seizure control after MSM was stopped. Although MSM is a valuable add-on, broad-spectrum drug when used in combination with LTG, adjustment of the LTG dose may be necessary when MSM is started or stopped, to allow for the fact that MSM lowers LTG blood levels.

Influence of oxcarbazepine and methsuximide on lamotrigine concentrations in epileptic patients with and without valproic acid comedication: results of a retrospective study.

The aim of this retrospective study was to investigate the influence of oxcarbazepine (OCBZ) and methsuximide (MSM) on lamotrigine (LTG) serum concentrations. The effect of OCBZ compared to carbamazepine (CBZ) and the effect of MSM on LTG serum concentrations were examined in patients with and without valproic acid (VPA) comedication. Altogether, 376 samples from 222 patients were analyzed in routine drug monitoring. Two or more serum samples from the same patient were considered only if the comedication had been changed. For statistical evaluation, regression analytical methods and an analysis of variance were performed. For the analysis of variance, the LTG serum concentration in relation to LTG dose/ body weight--level-to-dose ratio (LDR), in (microg/mL)/(mg/kg)--was calculated and compared for different drug combinations. The nonlinear regression analysis including the LTG dose per body weight, age, gender, and the different kinds of comedication revealed that these variables have a significant influence on LTG serum concentration (r2 = 0.724). The relationship between LTG dose/body weight and serum concentration deviates only slightly from linearity, the LTG concentration was about 18% lower in women than in men, and age had a significant influence. The data indicate that children have significantly lower LTG concentrations than adults on a comparable LTG dose per body weight and that children may be more prone to enzyme induction by comedicated drugs. Methsuximide has a strong inducing effect on the LTG metabolism and decreases the LTG concentrations markedly (about 70% compared to LTG monotherapy). Carbamazepine also reduces the LTG concentrations considerably (by 54%). The inducing effect of OCBZ (29%) was less pronounced but also significant. The inducing effect of MSM, CBZ, and OCBZ was also seen in combination with VPA: VPA alone increases the LTG concentration approximately 211%, whereas in addition to MSM (8%), CBZ (21%), or OCBZ (111%), the increase of LTG was significantly smaller. The analysis of variance confirmed the results of the regression analysis. The effect of MSM on the LTG concentration should be considered if MSM is added or withdrawn in patients treated with LTG. Oxcarbazepine had a less pronounced inducing effect on LTG metabolism compared to CBZ. If CBZ is replaced by OCBZ as comedication, an increase in LTG serum concentrations should be expected.

Acute effects of the antiepileptic succinimides on the urinary tract and potentiation of phensuximide‐induced urotoxicity by phenobarbital

Phensuximide (PSX), methsuximide (MSX) and ethosuximide (ESX) are succinimide antiepileptic agents used worldwide in the treatment of absence seizures. A previous study from our laboratory demonstrated that PSX (0.3 or 0.6 mmol kg-1 day-1, i.p.) induced urotoxicity following daily administration for 5-7 days in Fischer 344 rats, but PSX (1.25 mmol kg-1, i.p.) induced only minimal urotoxicity following acute administration. The purpose of this study was to determine the acute nephrotoxic potential of MSX and ESX in male Fischer 344 rats and if antiepileptic succinimide-induced urotoxicity is potentiated by phenobarbital pretreatment. In one set of experiments, rats (four rats per group) were administered a single intraperitoneal (i.p.) injection of a succinimide (0.4 or 1.0 mmol kg-1) or vehicle (sesame oil, 2.5 ml kg-1), and the renal function was monitored at 24 and 48 h. Neither ESX or MSX induced substantial changes in renal function or morphology, which suggests that neither compound is acutely nephrotoxic. Similar results were obtained with PSX, which supported our earlier findings with this antiepileptic agent. In a second set of experiments, rats (four rats per group) were pretreated for 3 days with phenobarbital (75 mg kg-1 day-1, i.p.) prior to receiving a succinimide (0.4 or 1.0 mmol kg-1, i.p.) or vehicle (sesame oil, 2.5 ml kg-1, i.p.). Renal function was monitored at 24 and 48 h after the last injection. Phenobarbital pretreatment had only minor effects on ESX- or MSX-induced renal effects, with no significant morphological changes detected between treated and pair-fed control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Measurement of methsuximide and N-desmethylmethsuximide using solid-phase extraction and wide-bore capillary gas chromatography

A method for the determination of the anti-epileptic drug methsuximide (MSM) and its active metabolite N-desmethylmethsuximide (NDM) is presented. 5-Methyl-5-phenylhydantoin is used as the internal standard. A simple solid-phase extraction procedure utilizing disposable reversed-phase C18 columns is described. Samples are analyzed by gas chromatography with flame ionization detection using a wide-bore capillary column with a permanently bonded, non-polar stationary phase. The MSM assay possesses linearity to 6.0 micrograms/mL, sensitivity to 0.5 microgram/mL, recovery ranging from 93 to 110%, and precision reflected by a SD of +/- 0.37 microgram/mL. The NDM assay displays linearity up to 80.0 micrograms/mL, sensitivity to 5.0 micrograms/mL, recovery of 90 to 100%, and precision reflected by a SD +/- 0.90 microgram/dL. Lack interference is documented for 6 commonly prescribed anti-epileptic drugs and 4 drugs with similar retention times on this stationary phase; only guaifenesin was found to potentially interfere with the determination of methsuximide. We conclude that the method reported here is ideally suited for monitoring therapeutic and toxic levels of this anti-epileptic drug.

Pharmacological interactions of mesuximide with phenobarbital and phenytoin in hospitalized epileptic patients.

In order to study the pharmacological interactions of the anticonvulsant drugs mesuximide (MSM), phenobarbital (PB), and phenytoin (PHT), serum concentrations of N-desmethyl-mesuximide (N-DESM-MSM, the main metabolite of MSM), PB, and PHT were determined in 94 hospitalized patients suffering from petit mal epilepsy. When MSM was administered to patients on stable PB or primidone therapy, the mean concentrations of PB increased by statistically significant amounts of 38 and 40%, respectively. Similarly, the additional administration of MSM caused the mean concentration of PHT to rise by 78%. The data also indicate that patients with PB and/or PHT comedication have higher N-DESM-MSM serum concentrations than patients without comedication. The pharmacological reasons for these interactions are discussed. These studies demonstrate that the disturbing side effects of MSM are often due to the co-medication. A carefully planned therapeutical dose procedure with regular serum level determinations is proposed to avoid or at least reduce the adverse effects of MSM.