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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Temporal factors on the periodic presentations has been described for many diseased states (ie, asthma, seizures, coronary attacks). We now report an analysis of factors that could affect the periodic character regarding emergency department (ED) presentation of drugs of abuse. All drugs presentations consistent with the Drug Abuse Warning Network (DAWN) reporting program from January 1988 through December 1997 were categorized. Data collection was based on daily chart review of ED medical records from Rush-Presbyterian-St. Luke's Hospital (Chicago, IL). Data were computer analyzed using SPSS and Pharmfit programs and analyzed for time, age, disposition, sex, and reasons for presentation and taking the drugs. During the above period, the Rush ED saw 369,770 patients of which 2,561 (0.7%) presented with a drug-related problem. The average age of men was 33. 7 + 0.29 and women 30.5 + 0.37 years. One hundred thirty-nine patients (5.4%) were under 17 years of age whereas only 72 patients (2.8%) were over 55 years of age. Cocaine was the most common drug presentation with a total of 859 visits. Seven hundred sixty-one (29. 7%) presented with an unexpected reaction, 754 (29.4%) experienced an over dosage, 135 (5.3%) had a drug withdrawal, 546 (21.3%) experienced chronic effects, 1,380 (53.9%) were drug dependent, 218 (8.5%) were suicide attempts, and the remaining 2.7% were unknown. There were 1,078 (42.2%) patients who were treated and released, 1, 394 (54.6%) who were admitted into the hospital, 74 (2.9%) left against medical advice whereas 9 patients (0.4%) died. Peak time for presentation was 5:03 PM (P =.00002). Suicide intent presentations were more likely to be women (P <.0001), older (P <.001), and present at a later time that of recreational drug use (acrophase 18:49 versus 16:39; P =.00011). Almost 90% of patients presenting to our urban ED over past 10 years with drug-related problems arrive because of drug abuse or dependency issues. ED staff should be most prepared to deal with these issues in the late afternoon.
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PMID:Trends in a decade of drug abuse presentation to an inner city ED. 1114 15

The issue of 'timing' of behavioural assessments in clinical trials can be approached in two different ways. Firstly the 'timing' during the process of drug development. As a rule, cognitive and behavioural side effects of antiepileptic drug treatment do not become an issue until the drug is marketed. At this stage a negative result has large marketing effects and this leads to a tendency to organise 'positive studies'('no-effect results'), that can be achieved by reducing power. A second approach is the 'timing' of cognitive assessment during a trial. The first and intuitive answer to the question 'when this should be done' is to perform assessments during an untreated baseline that is then compared with an endpoint during antiepileptic drug (AED) treatment. This is the 'gold standard design' for cognitive assessments in the majority of the cognitive trials. However, in patients with epilepsy, the behavioural drug effects are not independent from the effect of the epilepsy or the seizures. Recent studies have confirmed that the effect of uncontrolled seizures are often larger than the effects of drug treatment, leading to the so-called seizure confound, that is, adverse cognitive AED effects may be masked by beneficial effects of better seizure control. In such studies endpoint scores are thus improved, hiding possible negative drug effects. Other designs may have other limitations: e.g. in using adjunctive therapy the identification of the components of a treatment most responsible for any observed effects presents a difficult problem; in normal volunteers, exposure durations which are not representative of those in epilepsy patients on chronic treatment represent a major validity issue. We therefore consider the drug withdrawal study as the optimal design for assessing behavioural drug effects. In this design subjects are tested while still on medication and after withdrawal; larger gains in the epilepsy group relative to the controls are considered evidence for a reversible impairment, attributable to AED use.
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PMID:Cognitive and behavioural assessment in clinical trials: when should they be done? 1146 21

Recommendations have been made that all patients developing seizures should be referred to specialist services for full investigation and assessment and re-referred for issues such as inadequate seizure control, consideration of drug withdrawal and for pre-conceptual counselling. Bristol area general practitioners (GPs) were sent a questionnaire to determine their referral practices for adult patients with epilepsy. Details of their current management of these patients and their requirements from the specialist services were also obtained. Questionnaires were completed and returned by 67.8% of the GPs. Most referred their patients to the neurological or neuropsychiatric services. More than 70% wanted their new patients to be assessed within 4 weeks. Approximately, half at least sometimes treated their patients before this assessment of which a third never or only rarely sought advice as to the most suitable anticonvulsant. Most (71.5%) believed they had consultations with their patients with epilepsy at least yearly; however, only 34.3% had a recall system for non-attendees. Two-thirds either currently audited their practices or were willing to consider doing so, and 64.4% recognized a need for regular seminars on epilepsy. Few welcomed the introduction of joint clinics but two thirds believed co-operation cards could be useful. GPs in practices with an epilepsy nurse specialist were more supportive of the use of co-operation cards and were more likely to be involved in audit. Recommendations to improve the care provided by the Primary Health Care teams and aid communications with the specialist epilepsy services are made.
Seizure 2001 Jul
PMID:The assessment and management of adult patients with epilepsy--the role of general practitioners and the specialist services. 1148 45

While vigabatrin-associated visual field constrictions have been generally considered irreversible, some case reports have raised the hope of partial improvement after drug withdrawal in occasional patients. Here we describe seven children with epilepsy, whose visual field constrictions, as demonstrated by the kinetic perimetry (Goldmann), attenuated or recovered after discontinuation of vigabatrin therapy. While this improvement may be largely due to better performance in later test sessions, we want to raise the possibility that some visual field recovery may be possible at least in young patients.
Seizure 2001 Oct
PMID:Reversed visual field constrictions in children after vigabatrin withdrawal--true retinal recovery or improved test performance only? 1174 8

Carbamazepine, a widely used anticonvulsant, can induce hepatotoxicity, usually evolving with an acute hepatitis that ceases after drug withdrawal. Carbamazepine-induced vanishing bile duct syndrome (VBDS) is a rare complication and has seldom been reported in the medical literature. This report presents a case of a 26-year-old male who had onset of epilepsy at 12 months of age and was initially treated with phenobarbital. Carbamazepine (1200 mg/day) was added in June 1996 when he was 22 years old to control the frequency of seizures. Two years later, during a routine investigation, elevation of serum gamma-glutamyltransferase (GGT) levels was detected. For this reason, the patient was weaned off carbamazepine, followed 6 months later by complete withdrawal of the drug. The first liver biopsy disclosed total absence of interlobular bile ducts (IBD) in 30 portal tracts. Fourteen months later, a control biopsy showed the presence of IBD in eight of 14 portal tracts. There was also a decrease of GGT levels detected 27 months after withdrawal of carbamazepine. This case illustrates the ductopenic effect of carbamazepine when used for a prolonged time, as reported in three previous publications. However, this is the first case in which there was a remission of the VBDS and bile duct regeneration after withdrawal of the drug.
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PMID:Reversible vanishing bile duct syndrome induced by carbamazepine. 1235 23

Most children who are seizure free on antiepilepsy drugs for 2 or more years remain seizure free when taken off antiepilepsy drugs. We studied 27 children with well-controlled epilepsy in whom seizures unexpectedly recurred after antiepilepsy drug withdrawal. Seizures were focal in 20 of 27 cases (74%). In 11 of the 20 cases (55%), there was also a late onset of seizures (after 2 years) and an abnormal electroencephalogram (EEG) at antiepilepsy drug withdrawal. Of the remaining 9 patients with focal seizures, 3 (15%) had only a late seizure onset, 3 (15%) had only an abnormal EEG, and 3 (15%) had neither a late onset of seizures nor an abnormal EEG. In the 7 patients without focal seizures, 6 of 7 (86%) had a late seizure onset and/or an abnormal EEG. Our study suggests that partial seizures can be the most important predictor of unanticipated seizure recurrence when antiepilepsy drugs are withdrawn, particularly with late onset of seizures and an abnormal EEG at antiepilepsy drug withdrawal. A large, multicenter, prospective study looking at these and other potential risk factors for seizure recurrence is needed.
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PMID:Do partial seizures predict an increased risk of seizure recurrence after antiepilepsy drugs are withdrawn? 1503 95

Visual masking assesses visual perception and attention; it occurs when a visual stimulus (mask) interferes with the perception of a stimulus that the participant is trying to identify (target). A backward masking study (target presented before mask) was performed on 662 children without disabilities (338 females), aged between 6 and 17 years, in order to evaluate if performance varies with age. In the masking procedure 10 letters were presented through a tachistoscope as target stimuli. Fragments of letters oriented at random ('noise') represented the mask. A slight improvement of visual performance from the beginning of school age to 9-12 years of age was found. This paper gives normative data for the most important parameters which can be used as a standardized reference for the procedure employed. We also studied 113 children with epilepsy (56 females), aged between 5 and 19 years, who attended a mainstream school and had been seizure free for at least 2 years. Children were tested just before starting antiepileptic drug withdrawal and re-tested 1 year later; they were drug free for 3 months before the second test. These children showed, during and after treatment, only slightly worse results when compared with healthy children of the same age; after therapy withdrawal, their visual performance slightly improved but this was not statistically significant.
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PMID:Development of visual perception and attention, assessed by backward masking and application in children with epilepsy. 1288 36

In a prospective open label add-on study on 95 patients (age 1-63 years, mean 17.76 +/- 13.83 years) with seizures refractory to conventional antiepileptic drugs (AEDs) and other new AEDs, the addition of Topiramate (TPM) resulted in seizure worsening in 18 patients (19%) necessitating drug withdrawal over an average follow-up period of 4.94 +/- 1.69 months. Patients who had seizure worsening were older (P = 0.02), were more likely to have had a history of status epilepticus in the past (P = 0.03), were on three conventional AEDs (P = 0.027) or had tried one of the other new AEDs in the past with poor response (P = 0.04). Seven of 18 patients who had seizure worsening with TPM (7.4%) experienced initial seizure worsening, probably representing the subgroup with 'true' seizure worsening whilst 11 (11.6%) had initial improvement followed by 'apparent' seizure worsening. Initial seizure worsening was noted to be significantly more in females when compared with males who worsened after initial improvement (P = 0.05).
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PMID:Seizure worsening with topiramate amongst Indians with refractory epilepsy. 1294 Aug 32

Epilepsy is a common chronic neurological condition with a prevalence of 4-8 per 1000. The present classification of epilepsy is based on: 1) the etiology, which distinguishes symptomatic epilepsies from those that are idiopathic and cryptogenic, and 2) the localization of the disorder in the brain, separating the generalized seizures from epilepsies with partial or focal onset. The majority of patients with epilepsy will go into remission and two-thirds will remain so 2 years after drug withdrawal. The impact of epilepsy on individual patients varies. Employment, driving and learning may constitute major problems. There is a small but definite increase in mortality in patients suffering from epilepsy. Treatment of epilepsy usually involves long-term medical treatment, with the ultimate aim being no seizures and no drugs. Before starting treatment, the diagnosis of epilepsy should be assured. Initiation of antiepileptic drug therapy needs a full and adequate discussion with the patient and the choice of the minimum effective dose of an appropriate monotherapy. Nonpharmacological treatments may be necessary at a relatively early stage if pharmacologic treatment is ineffective. In choosing between different anti-epileptic drugs, consideration should be given to the efficacy of the drug for an individual patient and the tolerability of the drug. There is good evidence from many studies that the chief factor determining relative effectiveness is likely to be the spectrum and incidence of adverse effects of antiepileptic drugs. Some 20% of patients developing epilepsy have a chronic disorder uncontrolled by drugs. In patients receiving and complying with optimal doses of a single antiepileptic drug, the addition of further agents is likely to result in a significant improvement in seizure control in only about 10% of patients, but inevitably it increases the risks of dose-related, idiosyncratic and chronic toxicity due to both pharmacokinetic and pharmacodynamic drug interactions. For this group of patients an appropriate aim may not be complete remission of seizures but a compromise of reduced seizure frequency with less severe seizures, to be achieved with one or, at most, two drugs. The management of these patients with unremitting seizures constitutes a treatment challenge for epileptologists.
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PMID:Principles of treatment of epilepsy. 1297 7

This prospective observational study explored the efficacy and tolerability of levetiracetam (LEV) in a prospective series of 200 patients with refractory epilepsy attending a single epilepsy service. Patients were started on adjunctive LEV using one of two titration schedules (slow and fast) and patients were studied for at least 6 months after commencing LEV. Fifty-three patients had severe learning disabilities. 14.3% became seizure free, 57.7% showed >50% reduction, 15.4% showed seizure increase. Patients with learning disability showed less positive but still very worthwhile results. A highly significant improvement in clinical outcomes overall is shown (P<0.0001). 56.6% showed no adverse effects, 27.4% showed minor adverse effects, 16% were withdrawn. The most common adverse effect causing drug withdrawal was seizure exacerbation (12%) which was much commoner in primary generalised epilepsies (P=0.00035). LEV appears to be an effective and well-tolerated anti-epileptic drug in drug resistant partial epilepsies.
Seizure 2003 Dec
PMID:Levetiracetam in clinical use--a prospective observational study. 1463 May 5


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