Fig. 2

Clinical use of COX-2 inhibitors in epilepsy treatment. a Anticonvulsant, COX-2 inhibitors reduce the production of PGE₂ causing decreased activation of EP receptors which, in turn, lowers calcium ion influx and release of glutamate, thus blocking the seizures. They also reduce neuroinflammation by decreasing the production of cytokines in the brain cells. b Adjunctive to AED therapy, COX-2 inhibitors reduce activation of EP1 receptor by decreasing the production of PGE₂ which, in turn, follows an unknown cascade of biological events leading to downregulation of the efflux transporter, P-glycoprotein, at the blood-brain barrier. This ultimately results in reduced efflux of the administered AED/s, further enhancing their brain uptake and hence efficacy