Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 62-year-old woman developed neurologic deficits 7 months after pulmonary lobectomy for alveolar cell carcinoma of the lung. CT scan of the head demonstrated two metastases with marked peritumoral edema. Administration of Decadron, chemotherapy and 3,000 rad cranial radiation resulted in dramatic improvement of dysphasia and right hand paresis. Almost 2 months later, rhythmic, involuntary movements of the left hand developed. There was progression to multifocal seizures, grand mal seizures, postictal depression, status epilepticus, and coma, with death 9 days after onset of the movement disorder. Bronchoalveolar carcinoma was widely disseminated in lungs and bones, and as three metastases in brain. Bland "ischemic" necrosis in a pseudolaminar pattern was present in the neocortex. Innumerable Cowdry type A intranuclear inclusion bodies were seen in neurons, astrocytes, and oligodenodroglia. Immunofluorescence demonstrated Herpes simplex virus type 2 antigen and electron microscopy revealed virions with the morphology of the Herpes group. The case is significant for (1) the concurrence of intracranial metastases and Herpes simplex encephalitis, and (2) the causal agent, Herpes simplex virus type 2. The implication for the clinical neurocientist is the potential in a patient with systemic cancer, for the causation of neurologic complications by more than one factor or mechanism.
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PMID:Herpes simplex type 2 encephalitis concurrent with known cerebral metastases. 22 22

The properties of Althesin (anticonvulsant activity, depression of oxygen consumption, lowering of ICP, rapid excretion) led us to use this steroid combination to treat 11 patients in status epilepticus resistant to the standard drugs (benzodiazepines and barbiturates). The administration of Althesin by slow intravenous injection was ineffective in 2 of the 3 patients thus treated. The doses used (2--10 ml) were probably too small. One only administration of a 10% solution of Althesin in 10% fructose by intravenous drip (the rate was calculated so as to obtain the burst suppression stage at the EEG) stopped status epilepticus in 7 of the 9 patients thus treated. In this group the doses used varied from 25 to 50 ml. The 2 patients in whom it was necessary to repeat Althesin administration and combine it with other drugs had both been operated on for severe brain injuries involving marked cerebral edema. In spite of the very small number of cases, the definitive arrest of status epilepticus obtained in 8 out of 11 patients first treated with other drugs is encouraging: Althesin probably may be regarded as an adjunct in the treatment of status epilepticus.
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PMID:The use of althesin in drug-resistent status epilepticus. 47 37

During a nine-month period we have treated 46 patients with status epilepticus with intravenous application of diazepam or midazolam. The initial doze od diazepam was 10 mg (rate: 2-5 mg/min) and of midazolam 15 mg (rate: 5 mg/min). Diazepam was effective in 26 and ineffective in 15 patients. Midazolam stopped status in 4 out of 7 patients. Both drugs were more effective when they were administered at the beginning of status. After the initial termination of status and recovering of consciousness, seizures returned in 10 patients (22%). In the group treated with diazepam, 4 patients had sudden apnea and 6 respiratory depression (totally 10 out of 41). In the group treated with midazolam, 3 had apnea and 2 respiratory depression (totally 5 out of 7). All patients with apnea or respiratory depression received higher doses of both drugs at the higher rates than the others. We conclude that the efficacy of the therapy is moderate while the frequency of serious complications is high. In status epilepticus, where the life of patient is in danger, drugs with such activity are of limited value.
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PMID:[Efficacy of therapy, recurrence of seizures and respiratory complications in the treatment of status epilepticus by intravenous administration of diazepam or midazolam]. 130 8

Lidocaine (lignocaine) was given in 42 episodes of status epilepticus (SE) in 36 patients either because of limited pulmonary reserve (22 patients) or because of lack of response to diazepam (14 patients). Lidocaine (1.5-2 mg/kg) was given intravenously in two minutes. A further identical bolus was infused if no response had occurred or if seizures recurred. With the first bolus 11 episodes of SE did not stop, but 31 responded, always in less than one minute. In 19 episodes, however, this response lasted less than 30 minutes. Twelve episodes did not recur, but 30 needed a second bolus because of recurrence. Of these, 19 episodes responded at once but SE reappeared in seven. In these seven episodes the mean control time with the second dose was 102 minutes. Five of these subsequently responded to a continuous infusion of lidocaine. Eleven patients, who had not responded to the first bolus, had no response to the second. Lidocaine is a drug that may be epileptogenic at high doses. At the doses used here, however, lidocaine seems to be a rapid acting anticonvulsant, useful in the short term management of SE and may be indicated in patients in whom respiratory or consciousness depression is undesirable and in those with no response to diazepam. The absence of response to lidocaine indicates SE resistant to treatment and poor prognosis. These data show that prompt lidocaine administration may be worthwhile when management of respiratory depression is not possible.
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PMID:Role of lidocaine (lignocaine) in managing status epilepticus. 154 99

The potential hepatotoxicity resulting in fatal liver failure is of major concern in treating patients with valproate (VPA). Until now there is no relevant laboratory parameter allowing early detection of impending liver failure. The major routes of VPA biotransformation are glucuronidation and beta-oxidation. There are several other pathways of degradation with formation of mono- und di-unsaturated derivates. VPA dose, patients age, co-medication (anticonvulsants, aspirin), fasting and glucose supply influence the VPA metabolism. The clinical spectrum of VPA-associated hepatotoxicity reaches from slight increases of liver enzymes without clinical manifestations over reversible slight to severe liver dysfunction to fatal liver failure. With respect to pathogenesis attention has focused on depletion of beta-oxidation and change of biotransformation to other pathways with increased synthesis of toxic unsaturated VPA derivates. Several inborn errors of metabolism, acute infections and status epilepticus seem to predispose to liver failure. Another hypothesis lies in the possible VPA-induced depression of free radical scavenging enzyme activities. On this basis N-acetylcysteine has been used successfully in treating children with severe hepatotoxicity. In the presence of certain risk factors VPA should be avoided.
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PMID:[Valproate-associated hepatotoxicity--pathogenesis, clinical aspects, therapy and prevention]. 175 43

The excitatory amino acid glutamate plays an important role in the mammalian CNS. Studies conducted from 1940 to 1950 suggested that oral administration of glutamate could have a beneficial effect on normal and retardate intelligence. The neurotoxic nature of glutamate resulting in excitotoxic lesions (neuronal death) is thought possibly to underlie several neurological diseases including Huntington's disease, status epilepticus. Alzheimer's dementia and olivopontocerebellar atrophy. This neurodegenerative effect of glutamate also appears to regulate the formation, modulation and degeneration of brain cytoarchitecture during normal development and adult plasticity, by altering neuronal outgrowth and synaptogenesis. In addition to its function as a neurotransmitter in several regions of the CNS, glutamate seems to be specifically implicated in the memory process. Long-term potentiation (LTP) and long-term depression (LTD), two forms of synaptic plasticity associated with learning and memory, both involve glutamate receptors. Studies with antagonists of glutamate receptors reveal a highly selective dependency of LTP and LTD on the N-methyl-D-aspartate and quisqualate receptors respectively. The therapeutic value of glutamate receptor antagonists is being actively investigated. The most promising results have been obtained in epilepsy and to some extent in ischaemia and stroke. The major drawback remains the inability of antagonists to permeate the blood-brain barrier when administered systemically. Efforts should be directed towards finding antagonists that are lipid soluble and able to cross the blood-brain barrier and to find precursors that would yield the antagonist intracerebrally.
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PMID:Glutamate in the mammalian CNS. 198 Nov 50

Anticonvulsant management of status epilepticus (SE) may result in respiratory depression, often requiring endotracheal intubation (ETI). By examining rates of ETI in childhood SE after intravenous diazepam or lorazepam, when administered alone or in combination with phenytoin, the influence of anticonvulsants on the frequency of ETI during SE was determined. The medical records of 142 consecutive children younger than 16 years of age admitted from a university hospital ED with seizures during a 28-month period were retrospectively reviewed. SE was identified in 38 (27%) of cases. Records of children with SE were reviewed for demographic, seizure severity, and management variables. Twelve patients were excluded, ten of whom received concomitant phenobarbital. Patients receiving lorazepam had ETI rate of 27% (4/15), compared to 73% (8/11) in the diazepam group (P = 0.026, Fisher's exact). The groups were not significantly different in age, weight, sex, seizure type, seizure duration, and appropriate anticonvulsant dosage. A prospective, randomized trial comparing lorazepam and diazepam is warranted to confirm the apparent advantage of lorazepam in reducing respiratory depression.
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PMID:The influence of diazepam or lorazepam on the frequency of endotracheal intubation in childhood status epilepticus. 160 29

Rectal administration of diazepam is a good alternative to intravenous acute treatment in severe epileptic crises, but there is scarce information about its usefulness in status epilepticus. Treatment with rectal diazepam, 0.6 to 0.8 mg x kg of body weight as a single drug, in 10 children with 13 episodes of status epilepticus, defined as epileptic crises lasting 30 or more minutes (ten of these were generalized tonic and clonic, two were unilateral tonic and clonic, and one was of the partial complex type) is described. Nine status epilepticus episodes subsided at an average 4.4 minutes after the drug was given; in 3 cases there were no favourable effects, and one case recurred after initial response. There were no significant complications, with the exception of slight respiratory depression in a patient with encephalitis. In spite of the small size of the sample, these results suggest that rectal diazepam is an effective alternative to intravenous drug administration in the management of status epilepticus whenever venous access is difficult.
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PMID:[Treatment of status epilepticus with rectally administered diazepam]. 207 82

A patient who, two years after the surgical excision of a right frontal astrocytoma, presented with recurrent episodes of Partial Status Epilepticus of long duration is described. Ictal manifestations are initially inconspicuous from a clinical standpoint, but are accompanied by a marked interictal impairment of consciousness. The EEGs show a persistent depression of the background activity and very frequent subclinical right frontal discharges. Successively, seizures become more evident with polymorphic features (versive, oculoclonic, somatomotor, autonomic, automatic, laughing manifestations). The difficulties of an early definition of the clinical picture and the diagnostic importance of the EEG study are stressed, together with other peculiar features (polymorphism of seizures, difficulties of management, progressive mental impairment occurring after every episode of Status Epilepticus).
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PMID:Recurrent frontal status epilepticus with polymorphic clinical features. A case report. 240 25

Status epilepticus (SE) is defined as a continuous seizure that lasts more than 30 minutes or as serial seizures in which the patient does not regain a premorbid level of consciousness. This condition exists primarily in two forms: convulsive (focal or generalized) and nonconvulsive (absence or partial complex) SE. Protracted or serial convulsive seizures represent a medical emergency with a current mortality rate of 10%. As in any urgent or life-threatening situation, the initial treatment is directed at support and maintenance of vital functions. Specific anticonvulsant management is usually begun with intravenous lorazepam. This benzodiazepine is replacing diazepam in many medical centers because it has a longer duration of action and causes less respiratory depression. Concurrent intravenous loading with phenytoin is usually necessary for sustained control of seizures. Phenobarbital may be required as a third drug if seizures persist or recur. In cases of refractory status epilepticus, barbiturate coma, continuous anticonvulsant intravenous infusion, or general anesthesia may be necessary.
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PMID:Status epilepticus in children and adults. 305 85


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