Epilepsy is a chronic
neurologic disorder which often induces numerous adverse long-term neurologic effects, such as behavioral and cognitive deficits, increased predisposition to additional
seizures, and cell injury or death.
Cognitive dysfunction, depression, anxiety and
sleep disorders are some of the highly prevalent and most disabling complications of
epilepsy. The mechanisms that lead to the generation of epileptic comorbidities are poorly understood. Treatment for epileptic complications still remains a challenge because of the poor adherence and drug interactions associated with multi
drug prescriptions and also for the fear of worsening
seizures by the individual medications for complications.
Melatonin, an endogenous
hormone secreted by pineal gland has a prominent role in
epilepsy.
Agomelatine is a novel
antidepressant which acts as
melatonin MT1 and
MT2 receptor agonist and
serotonin 5Ht2C receptor antagonist. The combined action at MT1/2 and 5HT2C receptors, reduction in the depolarization-evoked release of
glutamate, strong neuroprotective action and possible
antioxidant properties of
agomelatine could make it a potential agent in the treatment of
epilepsy. The effect of
agomelatine on hippocampal neuronal cell survival and neurogenesis,
neuroprotective effect in hippocampus and frontal cortex and the
antioxidant potential may contribute to the protective action of
agomelatine against
epilepsy induced memory decline.
Agomelatine is proven to be an
antidepressant and it has relieved anxiety symptoms and improved the quality of sleep in patients with
depressive disorder. The action of
agomelatine as a
melatonin agonist and the consequent circadian resynchronizing property as well as its action as
5-HT2C receptor antagonist, could possibly suggest an
antidepressant and
anxiolytic action of
agomelatine in
epilepsy induced depressive behavior and anxiety. Since one of the many causes of sleep disruption in
epilepsy is circadian rhythm disturbances and sleep promoting and circadian effects of
melatonin is attributed to the MT1 and MT2 subtypes of human
melatonin receptors,
agomelatine may also have a promising effect on
epilepsy induced sleep disruptions. Thus with all these potential pharmacological actions,
agomelatine could be recommended as a potential
drug to treat
epilepsy and its complications.