Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Remacemide hydrochloride is a low-affinity, non-competitive N-methyl-D-aspartic acid (NMDA) receptor channel blocker, under investigation in epilepsy. This double-blind, placebo-controlled, multicentre study assessed the safety and efficacy of remacemide hydrochloride or placebo, as adjunctive therapy, in 252 adult patients with refractory epilepsy who were already taking up to three antiepileptic drugs (including an enzyme-inducer). Patients were randomized to one of three doses of remacemide hydrochloride (300, 600 or 1200 mg /day) or placebo Q.I.D., for up to 15 weeks. An increasing percentage of responders (defined as a reduction in seizure frequency from baseline of > or =50%) was seen with increasing remacemide hydrochloride dose. At 1200 mg /day, 23% of patients were responders compared with 7% on placebo. This difference was significant (P = 0.016), as was the overall difference between treatments (P = 0.038). Adverse events: dizziness, abnormal gait, gastrointestinal disturbance, somnolence, diplopia and fatigue were mild or moderate in severity. Carbamazepine and phenytoin plasma concentrations were well controlled and maintained within target ranges, with no evidence of improved seizure control due to increases in the concentrations of these drugs. A dose-dependent, significant, increase in responders following adjunctive remacemide hydrochloride compared with placebo was observed. Remacemide hydrochloride was well tolerated.
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PMID:Remacemide hydrochloride as an add-on therapy in epilepsy: a randomized, placebo-controlled trial of three dose levels (300, 600 and 1200 mg/day) in a Q.I.D. regimen. 1194 98

A seventy-four years old woman is assessed for asthenia, fatigue, non ulcerous dyspepsia with macrocytic anemia. The patient's medical history taking in Binswanger disease--diagnosed 5 aa before-, epilepsy-2 aa before- and a previous episode of TVP of the left leg, suggested the hypothesis that a B12 deficiency, by a chronic gastritis, would involve an increase of homocysteine cause of the clinical manifestations of megaloblastic anemia, Binswanger disease, tardive epilepsy and previous TVP. The fisic and blood and instrumental exams confirmed the clinical diagnosis. The patient is having vitamin B12.
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PMID:[A 74-year-old woman with macrocytic anemia]. 1196 38

To investigate the extent and nature of the objective and subjective cognitive deficits and health-related quality of life (HRQOL) in adult outpatients with relatively well-controlled partial epilepsy without symptomatic aetiology, who were on carbamazepine (CBZ) monotherapy. Furthermore, we studied the influence of the epilepsy history and medication on various cognitive functions and the HRQOL. 56 outpatients (29 male, 27 female, mean age 41.3 years) with partial epilepsy were compared with 56 age-, gender-, and education-matched healthy controls. Patients were tested on attention, memory, speed of information processing, and executive functioning. Questionnaires aimed at measuring self-perceived cognitive functioning (CFQ) and HRQOL (SF-36) were administered. Mann Whitney-U tests were used to compare the two groups. Linear regression analysis was performed to identify the epilepsy and medication-related factors that are associated with cognitive functioning and HRQOL. Patients scored lower on measures of attention (P = 0.03), learning (P = 0.02) and speed of information processing (P = 0.00). Mental aspects of HRQOL such as fatigue were lower (P = 0.00), whereas physical functioning was unaffected. These patients also expressed reductions in mental functioning as indicated by a low self-perceived cognitive functioning (P = 0.01). Age at onset, duration of epilepsy, seizure type, seizure frequency, localisation, years on CBZ, and CBZ dosage were not related to cognitive functioning or HRQOL. Patients with partial epilepsy, even when able to maintain regular jobs, have impaired cognition and HRQOL that cannot be attributed to their epilepsy history or CBZ dosage or years of CBZ intake. Therefore, physicians should be more aware of their cognition and HRQOL, in addition to the antiepileptic drug regime.
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PMID:Cognition and health-related quality of life in a well-defined subgroup of patients with partial epilepsy. 1199 29

A 37-year-old man presented with new onset jamais vu episodes. Jamais vu is a mental state characterized by a sense of unfamiliarity in a familiar situation. The patient's episodes of jamais vu were unrelated to any known factor other than his use of baclofen. The episodes, which occurred as each baclofen dose wore off, resolved after the baclofen dose that triggered it was discontinued. The patient has had no recurrence of jamais vu states after discontinuation of his baclofen. This is the first known case report of jamais vu episodes caused by baclofen. Although jamais vu episodes can occur in healthy persons, they are known to occur more frequently in persons with epilepsy, fatigue, psychologic states, or intoxications. This case suggests that medications should be considered as a possible cause of jamais vu episodes.
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PMID:Jamais vu episodes in relationship to baclofen treatment: a case report. 1204 65

Hughlings Jackson at the turn of the century defined epilepsy as a disorder originating in a "morbid nutrition" of the neuron. With the advances in modern neurochemistry, it is becoming increasingly clear that a chronic seizure predisposition or a lowering of the brain's discharge threshold can be demarcated by a number of biochemical markers. They include a tendency for an increased release of glutamate with or without GABAergic impairment, (intra)neural tissue alterations in water redistribution/osmolarity or other distortions of the cytoarchitecture, and an elevation of ionic calcium inside the cell. These changes are dominantly shared parameters of the seizure prone brain. Magnetic resonance spectroscopy (MRS) shows that cerebral levels of glutamate + glutamine (Glx) are increased interictally in epileptogenic regions in human partial epilepsy; other findings using this technique suggest damage to (cellular/mitochondrial) membranes, denoted by N-acetyl-aspartic acid (NAA) changes and a decreased energy capability. The merging of previous in vitro and ex vivo findings in neurophysiology and neurochemistry with magnetic resonance spectroscopy technology provides a powerful new methodology to interpret and to obtain clinical insight into the metabolic alterations that underlie an epileptogenic process. In this review some of these basic neurochemical and electrophysiological mechanisms are discussed. In addition, certain adjuncts to established antiepileptic drug therapy are suggested in the hope that over the long term they may help in correcting the primary metabolic deficits.
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PMID:Metabolic parameters of epilepsy: adjuncts to established antiepileptic drug therapy. 1260 9

The purpose of this work was to assess the psychometric properties of the German Translation of the Quality of Life in Epilepsy Inventory, QOLIE-31. Internal consistency, construct and criterion validity, and responsiveness were tested in 509 patients with epilepsy who were administered the questionnaires at application or at admittance to the epilepsy center Bethel. Construct validity was tested in patients with different seizure frequencies and different degrees of tolerability of antiepileptic drug (AED) therapy (adverse effects). The scales Epilepsy-Related Fears und Restrictions in Daily Life due to Epilepsy were used as criterion measures. Test-retest reliability (long-term stability) and responsiveness of the questionnaire were analyzed in subgroups of patients who responded to the questionnaires a second time (n = 256). Cronbach's alpha of the QOLIE-31 was 0.94 and varied between 0.76 and 0.90 for the seven subscales. The correlations of the QOLIE with Epilepsy-Related Fears and Restrictions in Daily Life revealed high correlations between Epilepsy-Related Fears and the QOLIE subscale Seizure Worry (r = 0.81, P < 0.01) and the total score (r = 0.62, P < 0.01) and between Restrictions in Daily Life and the QOLIE subscale Social Functioning (r = 0.71) and the total score (r = 0.70, P < 0.01). Seizure frequency had a significant effect especially on the QOLIE subscales Social Functioning, Seizure Worry, and Overall QOL, whereas tolerability of AED therapy affected especially the subscales Medication Effects, Overall QOL, and Energy-Fatigue. The test-retest reliability (intraclass correlation coefficient) was 0.79 for the overall score and varied between 0.59 and 0.78 for the seven subscales. The German Translation of QOLIE-31 is a reliable and valid questionnaire with which to assess QOL in patients with epilepsy and is conceptually similar to the English version. It is a sensitive questionnaire with respect to seizure frequency and tolerability of antiepileptic drug treatment.
Epilepsy Behav 2001 Apr
PMID:Psychometric Properties of the German Translation of the QOLIE-31. 1260 92

This study examines changes in mood of 79 epilepsy patients who completed the Profile of Mood States during long-term video-electroencephalographic monitoring (LTM). Statistical linear models included the effects of age, gender, increased seizure frequency, sleep deprivation, and taper of antiepileptic drugs (AEDs) on mood. Sleep deprivation increased fatigue and decreased vigor from baseline to Day 3, but not from baseline to Day 8 or the final day of the protocol. Taper of AEDs did not adversely affect mood, with removal of phenytoin improving mood. Subjects who had seizures during LTM also improved in mood, becoming less depressed and less fatigued than those who did not have seizures. Overall, our data indicate that LTM does not adversely affect mood. However, in the first few days of LTM, sleep deprivation may produce fatigue and lack of vigor, and should be used only as needed to provoke seizures.
Epilepsy Behav 2001 Oct
PMID:Effects of Long-Term Video-electroencephalographic Monitoring on Mood in Epilepsy Patients. 1260 80

The effects of monotherapy with lamotrigine on health-related quality of life were compared with those of valproate monotherapy in a randomized, double-blind trial designed to evaluate treatment-emergent weight changes in patients with epilepsy. At the end of 8 months of treatment, significantly more patients using lamotrigine compared with valproate experienced quality-of-life improvements on the Health Perceptions (42% vs 15%), Energy/Fatigue (47% vs 28%), and Social Isolation (35% vs 16%) subscales of the Quality of Life in Epilepsy-89 (QOLIE-89) questionnaire (P<0.05). Compared with valproate-treated patients, lamotrigine-treated patients were four times more likely to experience improvement in Health Perceptions, 2.3 times more likely to experience improvement in Energy/Fatigue, and 2.8 times more likely to experience improvement in Social Isolation (P<0.05). These quality-of-life improvements are consistent with the improvements in mood measured with the Beck Depression Inventory, the Cornell Dysthymia Rating Scale, and the Profile of Mood States among patients receiving lamotrigine. These data show that lamotrigine monotherapy provides benefits over valproate monotherapy in improving several aspects of health-related quality of life in patients with epilepsy. The observation that quality-of-life improvements during lamotrigine monotherapy occurred concurrently with improvements in mood suggests that the quality-of-life and mood changes may be causally related.
Epilepsy Behav 2002 Aug
PMID:Lamotrigine monotherapy improves health-related quality of life in epilepsy: a double-blind comparison with valproate. 1260 36

Purpose. To determine if methylphenidate (MPH) therapy can improve cognition in adult epilepsy patients on multiple antiepileptic drugs (AEDs), we assessed the impact of MPH on seizure activity, quality of life, cognition, and fatigue in patients with a primary diagnosis of localization-related epilepsy.Methods. This was an open-label, nonrandomized 3-month study. MPH (Ritalin) was added to patients' current antiepileptic drug regimens. Outcome measures included seizure activity, select AED serum concentrations, quality of life (via Quality of Life in Epilepsy-89 questions (QOLIE-89)), cognition (via Microcog), and fatigue (via a visual analog scale) at baseline and at monthly intervals for the treatment phase.Results. Eleven patients were enrolled and eight completed this pilot study. Of the eight completing the study, five were seizure-free at baseline and throughout the study. One patient had an increase, one a decrease, and one no change in seizure activity. No serious adverse events were observed. On average, serum AED concentrations changed <10% from baseline to the end of the study. Mean overall QOLIE-89 scores and select domains improved significantly from baseline. All Microcog domains improved from baseline. Fatigue also improved significantly.Conclusions. Adult epilepsy patients received relief from sedation with MPH and showed an improved quality of life, without significant alteration of seizure control.
Epilepsy Behav 2002 Feb
PMID:An Evaluation of the Effects of Methylphenidate on Outcomes in Adult Epilepsy Patients. 1260 58

Obesity is a progressive disease of unwanted fat accumulation which has multiple, organ-specific pathological consequences. The manifestations of obesity occur within virtually every subspecialty of medicine or surgery and they interact importantly to accelerate the ageing process in many organs. Many of the hazards of obesity have multiple causes (e.g., diabetes, heart disease, stroke, colonic and breast cancer, urinary incontinence, tiredness, back pain, breathlessness). All of these conditions become more prevalent with age and are also more prevalent among overweight persons, particularly those with a central fat distribution marked by a high waist circumference. Hypertension may be caused or aggravated by weight gain. It is mediated by the physical demands of an expanded circulating volume and increased metabolic rate by metabolic mechanisms related to central fat distribution and the "metabolic syndrome", and to increased sodium consumption by overweight people (because they need more food to maintain a higher metabolic rate). Since body mass index (BMI) and waist circumference increase significantly with age there is an escalation of the burden of ill health from obesity with age. The best simple indicator of disease risk with obesity is the waist circumference since this identifies people who have a high body fat content and also those who have an increased intraabdominal accumulation of fat. The quantitative burden of ill health from overweight and obesity varies within different specialties, but up to 80% of type 2 diabetes or polycystic ovarian syndrome can be attributed to obesity. Obesity is the cause of sleep apnea syndrome in around 50% of cases and heart disease in perhaps 10-20% of cases. In Scotland 80% of people with existing cardiovascular disease are overweight compared with 57% of the general population. The financial burden to health services from overweight and obesity has been incompletely assessed, although it is estimated that around 4% of total health care budgets are attributable to people having BMI > 25 kg/m(2). This is similar to the entire cost of diabetes, epilepsy or major cancers. Obesity is therefore an extremely expensive disease based on these conservative estimates from limited evaluations. More general assessments show how obesity increases the amount of time taken off work, the number of drugs prescribed and the expenditure from social services support. Thus, obesity represents a huge burden not only on the individual patient physically, psychologically, socially and financially but also on families and careers and is a huge drain on health care resources. Overweight affects well over half of all adults worldwide, progressing to BMI > 30 kg/m(2) in around 20% outside subsistence rural communities. Its rapidly increasing prevalence now described as an epidemic demands major preventive measures, as well as better medical treatment for individuals affected.
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PMID:Obesity: burdens of illness and strategies for prevention or management. 1284 36


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