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 MELEPSIN USE IN PEDIATRIC NEUROLOGY PRACTICE 
GIA NATRIASHVILI, PhD, MD,
Scientific-practical Head of Georgian National University (GNU) Clinic,
Professor of GNU,
Consultant at David Tatishvili Medical Center

Melepsin (carbamazepine) is antiepileptic medication from one of the basic anticonvulsant drug groups (dibenzepines). In addition to anticonvulsive actions, it has normothymic and thymoleptic effects. It also decreases synaptic impulse transmission and therefore has analgesic effects in neuropathies and neuralgias. Activation of GABA-ergic system in brain via increasing GABA concentration by Melepsin causes neuronal membrane stabilization, suppression of anxiety, aggressiveness and other deviant behaviors. From everything mentioned above, it is obvious the wide spectrum of pathologic states were Melepsin can be highly beneficial. Relative to other anticonvulsant drugs Melepsin has less toxicity and during increment dosing of this medication development of side effects is minimal. This is very important factor for long-term treatment options. Children and adults have high degree of adaptation toward this medication, and its 200 mg pill form makes it comfortable to divide it into pieces for pediatric patients.
 
Melepsin was being used for the following diseases: epilepsy (325 cases), night terrors (pavor nocturna) (73), enuresis (46), hypothalamic crises (45), migraine (38), prosopalgia, glossalgia - during facial nerve (CN VII) neuropathy (16 cases), trigeminal neuralgia (CN V) (11 cases).
 
In case of epilepsy monotherapy with Melepsin is effective for complex partial (with altered consciousness), visceral and opercular (temporal lobe) seizures, also in sleep psychomotor seizure with secondary generalization starting or finishing with vegeto-visceral manifestations. In these cases Melepsin monotherapy was given with doses of 15-20 mg/kg divided 3 times daily; dose increment was from 5 to 10 mg and thenas the situation requires to 15 mg, finally achieving 20 mg daily. Seizure development timing was also taken into account , when it was possible and higher dose of the medication was given 1-2 hours before seizure development.
 
We state that daily doses of Melepsin must be divided into 3 parts considering its half-life (T - 1/2). Exception to this is sleep psychomotor convulsion where only once night dose of 10 mg/kg can be given, two times dosing is also possible, if seizures develop during daytime sleep (in these cases the effective dose can increase to 10-15 mg/kg daily).
 
Melepsin is effective during polymorphic seizures, if seizure is associated with generalized akinetic convulsion then Melepsin should be given in combination with valproates, phenobarbital. During convulsive seizures with absence episodes Melepsin combination with suximides and benzodiazepines (clonazepam, diazepam) is recommended, where dose of Melepsin is 8-10 mg/kg daily.
 
In case of West and Lennox- Gastaut syndromes high doses (its obvious that age of such patients is 0-4 years) (25mg/kg daily) of Melepsin monotherapy was prescribed with gradually increasing the dose. In case the therapy was ineffective which was quite common , Melepsin doses were reduced to 10-15 mg/kg and another anticonvulsant valproate was added in parallel with hormonal therapy.
 
Duration of Melepsin therapy is determined by main criteria of anticonvulsant therapy duration in each individual case.
 
Despite Melepsin is well tolerated, in case of dose increments it is advisable to determine plasma Melepsin  (carbamazepine) concentration .
 
In case of nightmares (pavor nocturna) and enuresis Melepsin was prescribed only before bed-time if amitriptiline for night terrors and melipramine for enuresis was ineffective. At that Melepsin dose is 10 mg/kg; in plenty of cases combination with these drugs is used if monotherapy is ineffective. Melepsin therapy for anxiety sleep disorders lasts 3-5 months.
 
For hypothalamic crises Melepsin is only second line treatment after MAO inhibitors and β-blockers, in combination therapy. Optimal dose is 10 mg/kg divided 2-3 times daily.
 
For migraine headaches Melepsin is effective in simple and to a greater extentinassociated forms, especially during revealing paroxysmal activities on EEG. In such cases dosing regimen of Melepsin is the same as for epilepsy, only duration is be less and can comprise 6-18 months, with concrete data taken into account.
 
In case of prosopalgy (trigeminal neuralgia) and facial neuralgias Melepsin relieves pain more effectively and abruptly than analgesics and NSAIDs, but this doesn’t exclude use of NSAIDs in combination with physiotherapeutic measures. For various algic syndromes  Melepsin is given with 10 mg/kg doses divided 3 times daily for 1-3 months.
Finally, it is important to mention that during treatment periods with Melepsin in addition to abolishing clinical manifestations of the main pathology effectively ceased emotional instability (migraine, neuralgias, enuresis) , anxiety and increased excitability (nightmares, hypothalamic crises), behavioral deviations and aggression (epilepsy).
Because of high effectiveness, low toxicity, well tolerance, few side effects, easy accessibility and adequate cost: we give our best recommendation to Melepsin (World Medicine, England) to be widely used in pediatric neurology practice for all the disorders mentioned above.