Patient/caregiver was instructed upon therapeutic uses and mechanism of action of primidone as follows:
- Nerve impulses in the brain are transmitted from one cell to the other as mild electrical impulses.
- Many factors such as, neurotransmitters in the brain, sodium and glucose concentrations in the blood, bacterial infections, blood and oxygen supply to the brain, and mechanical injury to the brain play a significant role in influencing these nerve impulses in the brain.
- Some of these factors can act excitatory and some can act inhibitory to the nerve impulses in the brain. Excitatory factors can contribute to increased electrical discharge and nerve impulse transmission in the brain. Inhibitory factors can contribute to reduced electrical discharge and inhibition of nerve impulse transmission in the brain.
- Excitatory and inhibitory factors influencing the nerve impulse transmission in the brain are usually regulated in a fine balance. Disturbance to this fine balance due to any reason, favoring excitatory influence on the nerve impulse conduction in the brain, can result in excess electrical discharge in the brain, contributing to development of seizure activity.
- Primidone is an anticonvulsant medication, whose mechanism of action is poorly understood. Primidone is believed to increase the seizure threshold, which is a level of excitation of brain at which one will develop seizure.
- Primidone, by increasing the seizure threshold, will make it difficult for the excitation of brain to reach the threshold at which one will develop a seizure, thus helping to reduce and control the chance for seizures.
- Primidone is also metabolized or broken down in the body to two metabolites, which also have antiseizure properties, controlling the development of seizures.
- As primidone increases the seizure threshold and also forms metabolites that independently have anticonvulsant actions of their own, primidone is considered a stronger anticonvulsant and so, can be used in individuals with seizures that are difficult to control with other medications.
