Neurology Medications

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton, Vidya Acharya and Rachael Lowe  

Introduction

Neurologic medicines are classified into disease-specific categories (antimigraine, antiepileptic, and antiparkinsonism) along with essential medicines for infectious and neoplastic diseases . There are other medicines used to treat neurologic disorders that are classified by pharmacologic effect (antihypertensive, anticholinesterase, diuretic, antithrombotic, lipid-lowering medicines.

Medications

Drugs often prescribed by neurologists include:

• Anticonvulsants, or antiepileptic drugs: prevent /treat abnormal electrical activity in the brain. Many people have active epilepsy, and lots of the common drugs prescribed by neurologists treat epilepsy or similar disorders.
• Drugs to treat patients with dementia or Parkinson’s disease.
• Antidepressants, beta blockers, and blood thinners.  

Some of the more commonly medications neurologists prescribe include:

• Levetiracetam: a medicine used to treat epilepsy.
• Gabapentin: used to treat partial seizures, nerve pain from shingles and restless leg syndrome.

• Topiramate: an anticonvulsant medication used to treat epilepsy, migraine headaches, and off-label to treat various mood and eating disorders and helps in substance abuse therapy.
• Lamotrigine: anti-seizure/anti-epilepsy drug. Used to treat the eg. partial seizures, primary generalized tonic-clonic seizures, bipolar I disorder maintenance. Off-label uses eg. treating acute bipolar depression, fibromyalgia, schizophrenia, and unipolar depression.
• Carbidopa-Levodopa: used in the management and treatment of Parkinson disease (PD). Carbidopa is indicated for combination use with levodopa (L-dopa) for the treatment of motor symptoms occurring in Parkinson disease (PD) and post-encephalitic parkinsonism.
• Donepezil Hcl: used to treat dementia associated with mild, moderate, or severe Alzheimer's disease, and it can improve cognition and behavior, thereby alleviating certain symptoms. Donepezil Hcl is a centrally acting, rapid, reversible acetylcholinesterase inhibitor. It prevents acetylcholinesterase (an enzyme that breaks down acetylcholine) binding reversibly to acetylcholinesterase, and preventing acetylcholine hydrolysis, thereby increasing the availability of acetylcholine and enhancing nervous transmissions.
• Sumatriptan Succinate: used to treat migraine headaches. Used when headache symptoms first start, not used to prevent headaches.
• Oxcarbazepine: used to treat epilepsy (partial siezures)
• Amitriptyline Hcl: belongs to group called tricyclic antidepressants. It works on your central nervous system to increase the level of specific chemicals in your brain, which improves your depression.
• Memantine Hcl: Used in Alzheimer’s disease treatment as a non-competitive modern-affinity strong voltage-dependent N-methyl-D-aspartate receptor antagonist. The therapeutic abilities of memantine are now being applied for the treatment of various psychiatric illnesses eg autism spectrum disorder, binge eating disorder, and attention-deficit/hyperactivity disorder.

Future of Medications

In neurology, recently developed/or developing medicines are expected for various diseases, including novel migraine therapies, rare neurological diseases, and therapies for Alzheimer’s and Parkinson’s disease.

Precision medicine: Developments such as accelerated genomic discovery are making a new type of medicine, precision medicine. The goal here delivery of optimally targeted and timed interventions that are made specifically for an individual’s molecular disease drivers. Neurological diseases are well suited models for precision medicine as growth in our understanding of genetics, phenotypic classification, the development of biomarkers and the potential modifying treatments occurs.

Rehabilitation Implications

Physical therapists and occupational therapists should screen patients' medications as certain medications significantly influence patients' ability to mobilise. The therapist must be aware of potential adverse effects and monitor or alter therapy appropriately. A pre-exercise subjective assessment should be carried out to see if side effects from the drugs impact the treatment. Adverse effects of each of these drug classes should ne monitored. Being aware of them helps the therapist to modify the plan of treatment without compromising the patient's safety. Also, knowing the medication schedule might facilitate the coordination of the mobility session with the optimal therapeutic effect of that medicine.

Read: Parkinson's Medication and Physiotherapy Implications