<abstract><title style='display:none'>Summary</title> Closure of skins and soft tissue defects is a mainstream procedure in the field of reconstructive plastic surgery. Nowadays plenty of reconstructive options exists in the armamentarium of the specialty. The “keystone island perforator flap” is a relatively new conception which consists of taking skin and superficial fascia in a keystone pattern adjacent to the defect that needs to be covered. This technique is based on the most contemporary knowledge of the vascularization and three-dimensional vascular architecture of the skin and soft tissue overlying the bones - the so called angiosomes and perforasomes concepts. In the present article a brief review of the main keystone fl ap types and on their predecessor - the Bezier flap, was made. Two clinical cases with difficult defects on the limbs are presented and discussed in order to illustrate the application of that approach. The keystone perforator island flaps is a sophisticated and relatively easy option for defect closure. However, this surgical concept still remains unpopular in the Bulgarian practice and science of plastic surgery. To the best of our knowledge this paper is the first one focused on the topic.</abstract>

FEBOPARS, Department of Plastic Reconstructive and Aesthetic Surgery, MHAT “Uni Hospital”, Bg - 4500 Panagyurishte,

Department of Diagnostic Imaging, University Hospital “Alexandrovska” – Sofia,

Department of Dermatovenereology and Allergology, Military Medical Academy – Sofia,

4Department of Orthopedic, Traumatology And Reconstructive Surgery, Military Medical Academy – Sofia,

The Keystone Perforator Flap Concept – A Useful Tool in the Armamentarium of Plastic Surgery

<abstract><title style='display:none'>Summary</title>According to the World Health Organization there are almost two billion people worldwide who consume alcohol on a regular basis. It’s a common abuse and almost 80 million are diagnozed with “alcohol abuse disorders” (WHO 2002, 2004). Excessive alcohol consumption is related to more than 60 different medical conditions, as suicide, homicide and different forms of accidents. Some conditions are acute, while other conditions such as liver cirrhosis, chronic pancreatitis, haemorrhagic stroke and various forms of cancer, are chronic consequences. Non-carious destructions of teeth like dental erosion are also associated with frequent alcohol consumption, because of precipitation of salivary proline-rich proteins caused by polyphenols present in most alcoholic drinks. The high concentration of organic and inorganic acids and the habit of keeping the alcoholic drink in the mouth can cause chronic inflammations of the soft tissues in the mouth and can increase the negative side effects from metals of crowns, bridges, orthodontic devises and various restorations. A literature review has been made due to the authors clinical observations and experiences.</abstract>

Conservative Dentistry, FDM, MU – Sofia, Faculty of Dental Medicine Medical University 1 Sv. G. Sofi yski St. BG – 1431 Sofia

Conservative Dentistry, FDM, MU – Sofia

Effect of Alcohol to Oral Health

<abstract><title style='display:none'>Abstract</title>Dehydration and electrolyte imbalance as a result of prolonged strenuous exercise leads to poor thermoregulation and impaired muscle performance. Thus, appropriate rehydration during and after exercise with a solution that has a balanced combination of nutrients including electrolytes, carbohydrates and proteins is crucial in preventing the side effects of dehydration. Yogurt drink as a traditional drink with an appropriate nutritious content could be used as an alternative to expensive commercially available drinks for rehydrating athletes after long exercises in warm and humid environments and in developing countries. In this cross-over trial we examined the rehydration potential of yogurt drink in comparison to water and a commercial drink after a strenuous exercise (cycling) session in a hot and humid environment. Blood measurements included blood osmolality, serum glucose, hematocrit and serum electrolytes. Urine measurements included urine volume, osmolality and electrolyte concentrations. The results showed that early after rehydration Yogurt drink compared to water significantly increased urine sodium (mmol/L) (138.8 ± 93.4 vs. 90.0 ± 50.7, P &lt; 0.01), urine potassium (mmol/L) (105.6 ± 55.1 vs. 35.8 ± 22.0, P &lt; 0.05) and urine chloride (mmol/L) (113.2 ± 28.4 vs. 35.8 ± 25.1 P &lt; 0.01). This degree of improvement was the same as with the commercial drink for urine sodium, potassium, and chloride. Yogurt drink prevented dehydration-induced changes in the blood as it stabilized the hematocrit and serum sodium, potassium and osmolality within the normal range after exercise. Finally, our results indicated that yogurt drink, as a natural and affordable rehydration option, can be considered to restore fluid and electrolyte losses after strenuous exercises in hot and humid environments.</abstract>

Yogurt Drink Effectively Rehydrates Athletes After a Strenuous Exercise Session

<abstract><title style='display:none'>Abstract</title>Cocaine is a natural alkaloid extracted from the leaves of the South American plant Erythroxylum coca or synthesized chemically. After cannabis, it is the second most frequently abused recreational substance worldwide. Cocaine can affect every tissue and organ within the human body, including the kidneys, causing tissue ischemia due to vasoconstriction, endothelial dysfunction and damage, procoagulant activity and oxidative stress with subsequent ischemic infarctions and fibrosis. The renal changes in cocaine abuse and addiction are due to rhabdomyolysis, ischemic, hypertensive, and inflammatory changes with the development of cell proliferation and fibrosis. The authors present three patients with cocaine-associated renal damage and discuss the underlying mechanisms of cocaine-induces tissue changes.</abstract>

Renal Changes in Cocaine Abuse and Addiction

<abstract>
<title style='display:none'>Abstract</title>
<sec>
<title style='display:none'>Aims</title>
The aims of the present study are to investigate the relationship between the anthropometric indicators and peculiarities of the nutritional intake in people with overweight and obesity and the risk factors for the development of dental caries in adults.
</sec>
<sec>
<title style='display:none'>Materials and Methods</title>
The study involved 264 individuals aged between 18 and 60 years. The following risk factors for the development of dental caries were traced: diet (carbohydrate intake), oral hygiene habits and social status in overweight and obese people. The dental caries incidence was determined through the DMFT index, by assessing the total number of teeth which are decayed (D), missing (M) due to caries, or filled (treated, F).
</sec>
<sec>
<title style='display:none'>Results</title>
The age-related distribution was as follows: from 18 to 25 years – 14.4%; from 25 to 35 years – 16.7%; from 35 to 50 years – 42.4%; and over 50 years – 26.5%. The established average BMI was 25.60 ± 4.359, with the lowest and highest measured values – 18.5 and 37.55, respectively. The value of DMFT was 12.55 ± 5.545. A direct correlation between the elevated incidence of dental caries in patients with overweight and obesity was revealed. No significant relationship was found between the decreased nutritional intake of vitamin D and the incidence of dental caries in individuals with Class I and Class II obesity.
</sec>
<sec>
<title style='display:none'>Conclusion</title>
Dental caries and obesity have a similar etiology – improper dietary habits, excessive consumption of foods containing low molecular weight carbohydrates and carbonated beverages. The reported higher levels of dental caries in these groups could be explained by an improper diet and more frequent snacking.
</sec>
</abstract>

Dietary Intake of Vitamin D and Dental Caries Incidence in People with Overweight and Obesity

<abstract><title style='display:none'>Summary</title>Crohn’s disease is an inflammatory bowel disease which causes inflammation of the digestive tract. Crohn’s disease most frequently affects the ileum and the colon. In the active stage of the disease signs and symptoms may include diarrhea, abdominal pain and cramping, blood in the stools, reduced appetite and weight loss. In patients with severe Crohn’s disease the following signs and symptoms may be observed: fever, fatigue, arthritis, eye inflammation, oral ulcers, skin disorders, inflammation of the liver or bile ducts or delayed growth. Heredity and dysfunctions of the immune system are considered to cause the development of Crohn’s disease. About 10% of people with inflammatory bowel disease have also ocular problems. The most common ocular manifestations of Crohn’s disease are uveitis, iritis, episcleritis, keratopathy, keratoconjunctivitis and retinal vasculitis. Untreated uveitis may cause glaucoma and vision loss. Uveitis and iritis are four times more common in women than in men. In patients in the active stage of the disease, episcleritis also flares. Symptoms of episcleritis include inflammation, bright red spots on the sclera and localized pain. Keratoconjunctivitis in Crohn’s disease is caused by decreased tear production or increased tear film evaporation. Dry eyes can cause itching, burning or infection. Keratopathy usually causes no pain or vision loss, therefore in most cases no treatment is needed. In retinal vasculitis tortuosity of retinal veins, retinal edema at the posterior pole and intraretinal blood near blood vessels are observed. Intravenous fluorescein angiography shows intraretinal neovascularisation and haemorrhage in the posterior pole.</abstract>

Crohn’s  Disease Ocular Manifestations

<abstract><title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background: </title>
Prosthetic rehabilitation of missing teeth with dental implant-supported restorations has recently become a predictable treatment option in contemporary dentistry with a highly successful rate. Due to different factors, vertical and horizontal bone loss could present, and the available alveolar bone may not be sufficient for optimum implant position. Ridge augmentation procedures could be applied to increase the volume of the deficient sites for accurate prosthetic implant placement, which assures functional and esthetic stability of tissues around the implants, essential for long-term success.
</sec>
<sec><title style='display:none'>Our </title>
study aims to evaluate the efficiency of the bilayer technique of guided bone regeneration for alveolar ridge augmentation procedure in cases of bone deficiency for optimum implant placement and long-term success.
</sec>
<sec><title style='display:none'>Materials and methods: </title>
We present several cases of alveolar bone deficiency treated with the bilayer technique – the combination of allo- and xenograft, covered by collagen membrane, with long-term follow-up. The defects were filled with allograft, and a layer of xenograft and barrier membrane was placed above it. This technique combines the benefits of all xenografts and barrier membranes.
</sec>
<sec><title style='display:none'>Results: </title>
The bilayer technique with allo- and xenograft and collagen membranes is predictable, with a high success rate and lower morbidity. We have a 100% survival rate of the implants placed in a grafted area with long-term follow-up with excellent aesthetic and functional results.
</sec>
<sec><title style='display:none'>Conclusions: </title>
The bilayer technique uses the benefits of two bone graft materials, is associated with less morbidity for the patients, and has excellent long-term results if performed accurately according to indications and technique.
</sec>
</abstract>

Bilayer Technique for Alveolar Ridge Augmentation in Pre-Prosthetic Implant Surgery: Indications and Problems

<abstract><title style='display:none'>Abstract</title>
In May 1988 the World Health Assembly set to World Health Organization (WHO) the goal to achieve a global eradication of poliomyelitis by the year 2000. Surveillance of the acute flaccid paralysis (AFP) remains the ‘gold standard’ for the detection of polio. The criterion of sensitivity of the surveillance system is the incidence from non-polio related AFP, in children under 15 years of age. The aim is to detect more than 1 case of AFP, per 100,000 children. In 2019, WHO announced the eradication of wild poliovirus 3, and poliovirus 2 was eradicated in 2015. Wild poliovirus 1 continues to circulate. The main goals of the WHO Polio Eradication Strategy for the period 2022-2026 are: permanently interrupt all poliovirus transmission in endemic countries (Afghanistan and Pakistan), stop cVDPV (circulating vaccine-derived poliovirus) transmission and prevent outbreaks in non-endemic countries.
</abstract>

Epidemiological Surveillance of Acute Flaccid Paralysis for Eradication of Poliomyelitis (A Brief Review)

<abstract><title style='display:none'>Abstract</title>
The cytochrome P450 superfamily consists of hemeproteins involved in the detoxication of different xenobiotics, including drugs. The CYP2 gene family is responsible for the metabolism of 80% of the drugs in clinical use. There are considerable interindividual and interethnic variabilities in the rate of drug metabolism as a result of genetic polymorphisms. The goal of our study was to determine the frequency of 10 genetic polymorphisms in CYP2 family genes to give light on the pharmacogenetic defects of the main CYPs, involved in drug metabolism, in Bulgarian individuals. We detected high allele frequency for CYP2D6*10 (0.27), CYP2D6*4 (0.22), and CYP2B6*9 (0.24), followed by CYP2C19*2 (0.14), CYP2C9*3 (0.11) and CYP2C9*2 (0.09). The genotype frequencies were also determined for all investigated variants. In total 47.2% of the analyzed individuals carried CYP2D6 genetic polymorphisms – 5.6% carried a single variant and 41.6% were found to have two or more such variants. Homozygotes for CYP2D6 variants were established among 14% of Bulgarian individuals. Determination of the prevailing pharmacogenetic polymorphisms of the CYPs, most responsible for drug metabolism, will lead to a lower risk of drug toxicity, increased drug efficacy, and drug dose optimization.
</abstract>

Molecular Medicine Center, Medical University – Sofia

Genetic Polymorphisms in CYP2 Gene Family in Bulgarian Individuals and their Clinical Implications

<abstract><title style='display:none'>Abstract</title>
The spread of SARS-CoV-2 represented a global health crisis. On May 5, 2023, the chief of the World Health Organization (WHO) officially announced the end of COVID-19 as a global health emergency. Serological assays can identify previously infected SARS-CoV-2 individuals, even if they did not go for testing while acutely ill. The current study sought to detect antibodies directed against the nucleocapsid of SARS-CoV-2 (IgG against the SARS-CoV-2 N protein) in both vaccinated and unvaccinated COVID-19 individuals. Of the 100 participants, 53 and 47 were vaccinated and unvaccinated, respectively. The vaccination status of the cohort based on gender data indicates that 41 (41%) of all participants were vaccinated males, whereas 12 (12%) were vaccinated females. We found that 42 (42%) were unvaccinated males and 5 (5%) were unvaccinated females. Of 53 vaccinated subjects, 42 and 11 participants were positive and negative for IgG against the SARS-CoV-2 N protein, respectively. Of 47 unvaccinated participants, 28 and 19 were positive and negative for IgG against the SARS-CoV-2 N protein, respectively. The average of S/P “Sample/Positive control” percentages, which correlate to levels of IgG against SARS-CoV-2 N protein, were significantly higher among the vaccinated patients (73.8%) as compared to non-vaccinated patients (57.1%), with p = 0.02. There was a downward trend in levels of IgG against the SARS-CoV-2 N protein with increasing age, except for the 60–69 age group.
</abstract>

Seroprevalence of IgG Antibodies Against SARS-CoV-2 N Protein Among Vaccinated and Unvaccinated Subjects in Lahore, Pakistan

<abstract><title style='display:none'>Abstract</title>
<sec><title style='display:none'>Aim: </title>
Our aim was to assess the prevalence of the metabolic syndrome (MetS) and its components in patients with controlled Graves’ disease (GD).
</sec>
<sec><title style='display:none'>Methods: </title>
This was a cross-sectional study involving 95 consecutive patients with GD referred to our tertiary care inpatient clinical center meeting the following inclusion criteria: controlled hyperthyroidism, treatment with antithyroid drugs, untreated Graves’ orbitopathy (GO), if present. Patients’ anthropometric parameters were evaluated and laboratory tests were performed with measurement of fasting blood glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, thyroid hormone and antibody levels. The presence of the MetS and its components as defined by the International Diabetes Federation from 2009 were evaluated.
</sec>
<sec><title style='display:none'>Results: </title>
In our patient cohort 82.1% were females, 17.9% were males, mean age 50.2 ± 13 years, with median duration of GD 16.5 months. The MetS was observed in 32.6% of our patients, obesity – in 34.7%, hyperglycemia in 38.9%, arterial hypertension – in 36.8%, low HDL-cholesterol – in 23.2% and hypertriglyceridemia – in 13.7%. There was not statistical difference neither between the prevalence of the MetS, nor between the prevalence of its individual components in female and male GD patients. The MetS was significantly more frequent in older patients, as well as abdominal obesity, hyperglycemia and arterial hypertension. There was not statistical difference in the frequency of the MetS and its components between GD patients with and without GO, except for waist circumference, which was significantly higher in patients with GO.
</sec>
<sec><title style='display:none'>Conclusions: </title>
The presence of the MetS and its components among GD patients are to great extent similar to those reported in the general population, which underlines the need for their screening and proper treatment in this subpopulation.
</sec>
</abstract>

Prevalence of Metabolic Syndrome and its Components in Patients with Controlled Graves’ Disease

<abstract><title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background: </title>
As the use of cone-beam computed tomography (CBCT) is increasing and the quality of images is enhanced, the likelihood of incidental findings detection in CBCT radiographs is raised. Variable frequency of incidental findings on oral and maxillofacial CBCT scans has been reported.
</sec>
<sec><title style='display:none'>Aims: </title>
To perform a systematic review and meta-analysis to resolve the conflicting results about the overall prevalence of incidental findings in oral and maxillofacial CBCT scans.
</sec>
<sec><title style='display:none'>Methods: </title>
We searched the literature in PubMed, Embase, and Scopus databases from inception to 31 October 2022 to identify studies that reported the frequency of incidental findings in the subjects undergoing CBCT imaging. We pooled the extracted data and reported the estimates as a percent with a 95% confidence interval (CI).
</sec>
<sec><title style='display:none'>Results: </title>
A total of 21 eligible studies were included, comprising 9,788 patients (54.2% women) and 10,625 CBCT scans. Analysis showed that the incidental findings were present in 69.1% (95% CI: 55.6-80.0) of the CBCT scans. There were 1.48 incidental findings per CBCT scan. Pooled prevalence of incidental findings in men was 50.2% (95% CI: 23.1-77.3), which was higher than in women (41.8% [95% CI: 16.5-72.2]).
</sec>
<sec><title style='display:none'>Conclusion: </title>
A considerable prevalence of incidental findings was observed in oral and maxillofacial CBCT scans.
</sec>
</abstract>

Prevalence of Incidental Findings in Oral and Maxillofacial Cone-Beam Computed Tomography: A Systematic Review and Meta-Analysis

<abstract><title style='display:none'>Abstract</title>This study attempted to determine the level of psychological well-being among postgraduate students. The study also aimed to assess the relationship between psychological well-being and demographic factors, such as age and field of study. Psychological well-being questionnaires were administered to a sample of 192 Master of Education students. The findings demonstrated that Master of Education students possessed a slightly high level of psychological well-being. Differences were found in students’ psychological well-being across age groups, F (4, 167) = 3.178, p = 0.01, and field of study, F (8, 163) = 2.668, p = 0.01, respectively. According to the results, students in the age group of 41 years and above possessed the highest level of psychological well-being (M = 5, SD = 0.71).</abstract>

Psychological Well-being among Postgraduate Students

<abstract><title style='display:none'>Summary</title>Biological rhythm of sleeping is a natural disparity in an organism corresponding to and in reply to cyclic environmental changes, such as daylight hours and hours of darkness or elevated and low down flow. There is some evidence, based upon epidemiological studies as well as studies upon smaller groups of subjects, that individuals who work during the night and sleep during the daytime show cognitive impairment at work, have poorer and fragmented daytime sleep, and have increased risks of developing a wide range of social, psychological, physiological and medical impairments and disorders. Circadian rhythms are one of the most important effective factors on the physiological and physical performances of humans and disturbing this normal rhythm leads to different groups of diseases. The majority of investigations in biological rhythm demeanor vary noticeably in regards to the exact type of disease, population and protocols of sampling over the other outcomes or issues. We conducted a systematic review of [Science Direct, Pubmed, Scopus] to identify influence of different kinds of diseases among shift workers in response to abnormal rhythm of sleeping. The results of this review indicate that abnormal patterns of sleeping can lead to immunological issues, hypertension, metabolic syndrome, insomnia, cardiovascular disease, obesity and depression. It is vital for subsequent investigations to find a way to reduce negative effects (such as decreased amount of works’ time and altered diet) without side effects to help them.</abstract>

Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, University Putra Malaysia

Faculty of Physical Education and Sport Science, Shahid Bahonar University of Kerman, Kerman, Iran

Faculty of Educational Studies, Department of Sport Sciences, University Putra Malaysia, Malaysia

The Adverse Health Effects of Shift Work in Relation to Risk of Illness/Disease: A Review

<abstract><title style='display:none'>Summary</title>There are a variety of body aches that fall under the umbrella term of Musculoskeletal Discomforts (MSDs). These can be distinguished based on the level of pain suffered by the patient, ranging from mild and sporadic to serious, constant and fatal. It has been suggested that a link exists between MSDs and risk factors involving one’s occupational conditions and physicality. Examining the prevalence rate of musculoskeletal discomforts based on the severity among office workers was the main objective of this study. In order to achieve this objective, we had, in February 2015, selected from a population of 20 000 Malaysian office workers, 753 subjects within the age range of 20-50 years who have had a minimum of a year’s working experience. For this study, a form of structured questionnaire, known as the Cornell questionnaire, has been evaluated and put to use. Under the watch of the researchers, the subjects were instructed to complete the questionnaire in the morning before they begin their respective jobs. Based on their responses, the Cornell questionnaire has revealed that at least one case of severe pain in the neck, shoulder or lower back, respectively, is suffered by 69.7% of the subjects. In the case of neck-related aches, 15% low pain, whereas 51% involved mild pain and 33.9% were cases of severe pain. That being said, 19.3% low pain in the lower back, while 50.7% suffered from mild pain and 30% had severe pain in the same region. Percentages of 34.9% for high severity, 45.4% for mild severity and 19.7% for low severity were simultaneously reported in the shoulder section. In a nutshell, the study has revealed that, in comparison with body aches in the arms, knees, upper back, forearms, wrists, hands, hips and thighs, the subjects are more vulnerable to body aches in the neck, shoulders and lower back. </abstract>

Department of Occupational Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Malaysia

Department of Orthopedics, Faculty of Medicine and Health Sciences, University Putra Malaysia, Malaysia

University for the Enhancement of Academic Performance, University of Malaya, Malaysia

Department of Pathology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Malaysia

Prevalence Rate of Musculoskeletal Discomforts Based on Severity Level Among Office Workers

<abstract><title style='display:none'>Summary</title>Wound reparative process after surgery, burns, injuries, and inflammatory processes results in a spectrum of scar formation ranging from nearly scarless healing to excessive fibrosis or atrophy. Scarring is considered a major medical problem that leads to aesthetic and functional sequelae. Scar tissue is clinically distinguished from normal skin by an aberrant color, rough surface texture, increased thickness (hypertrophy), occurrence of contraction, and firmness. In the last decade, the concept of wound healing kinetics has been developed to describe the delicate balance of cell activity involved in scar formation and remodeling. Hypertrophic scars and keloids are formed as a result of the process of abnormal wound healing. Despite all that has been written on improving the appearance of these types of scars, there are no definitive management protocols. The aim of the present article is to make a brief review of the basic wound healing, while focusing on medicine’s latest understanding of the development and treatment of keloids and hypertrophic scars.</abstract>

Unit of Plastic Surgery and Burns, Military Medical Academy, Sofia

Department of Dermatovenereology and Allergology, Military Medical Academy, Sofia

Hypertrophic Scars and Keloids – Contemporary Concepts and Treatment Options

<abstract><title style='display:none'>Abstract</title>Cotinus coggygria Scop. leaf aqueous ethanolic extract was examined for its in vitro antiproliferative and antioxidant activity. Antiproliferative effect was assessed on four human gynecological cancer cell lines: breast (MCF7, T47D), cervical (HeLa) and ovarian (A2780) and compared to the cell growth inhibitory effect on non-cancerous breast epithelial cell line MCF10A using MTT cell proliferation assay. Radical scavenging assay with DPPH was applied to evaluate antioxidant potential of the extract. The obtained results showed that the herb inhibited cell growth of all of the tested cancer cell lines and the highest was the cytostatic effect on A2780 cells with a half maximal inhibitory concentration (IC50) value of 30.8 μg/ml. For the other cell lines the IC50 values were in the range of 55-122.7 μg/ml. Additionally, the extract exerted considerably weaker reduction in cell proliferation of the non-cancerous cell line MCF10A compared to cancer cells, which indicates for antiproliferative selectivity. C. coggygria extract showed high free radical scavenging activity with an IC50 value of 11.2 μg/ml. The obtained data provide evidence for pharmacological potential of the tested extract and future more detailed studies concerning the molecular mechanisms of the anticancer effect of the herb are needed.</abstract>

Antiproliferative Properties Against Human Breast, Cervical and Ovarian Cancer Cell Lines, and Antioxidant Capacity of Leaf Aqueous Ethanolic Extract from <italic>Cotinus coggygria</italic> Scop.

<abstract><title style='display:none'>Abstract</title>Available antiepileptic drugs interact with a variety of different molecular targets. The mechanism of action of most anticonvulsants is most often complex with a number of affected regions. The combination of mechanisms of action of drugs in particular proportions can possibly determine the showcase of its antiepileptic activity. The common factor between the different supposed mechanisms for a number of drugs includes the possibility for modulating the excitatory and inhibitory neurotransmission through effects upon the voltage-gated ion channels, synaptic plasticity, heterogeneous receptors, and metabolism of neurotransmitters. There are controversial data on the extent to which a specific action can be the reason for the wholesome anticonvulsive characteristics of various medications, as well as the relation with the presence of undesired drug effects. The complexity of the action of some antiepileptic drugs creates conditions for optimal choice during therapy. In many cases, the insufficient familiarity with individual genetic differences and the disease related receptor damages can hinder defining a particular drug action. Characterizing the mechanisms of action of the present antiepileptic medications would increase the understanding for the pathophysiological mechanisms of epileptic seizures, as well as the development of new therapeutic strategies. The development of novel antiepileptic drugs and the ongoing research regarding the mechanism of action of established antiepileptic drugs, are continuously increasing the level of complexity in the spectrum of molecular targets relevant for epilepsy therapy. The current state of knowledge as well as the limitations in our understanding should guide future research aiming for a more detailed elucidation of the impact of genetics and pathophysiological mechanisms on interindividual differences in expression and function of antiepileptic drug targets.</abstract>

Basic Mechanisms of Action of the Antiepileptic Drugs

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Acta Medica Bulgarica

pISSN: 0324-1750, eISSN: 2719-5384  Aim &amp; Scope  The Journal Acta Medica Bulgarica (AMB), published continuously since 1973, is...

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pISSN: 0324-1750, eISSN: 2719-5384  Aim &amp; Scope  The Journal Acta Medica Bulgarica...