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

This article describes an imipenem/cilastatin (I/C) target drug program. The program, developed following completion of a drug usage evaluation study, was designed to improve I/C dosing, reduce central nervous system (CNS) adverse effects, and reduce antibiotic costs. Following completion of an inservice education program for the medical and pharmacy professional staffs, ongoing monitoring of I/C usage was accomplished through the pharmacy-based drug-dosing service. Pharmacists evaluated I/C dosage based upon culture/sensitivity results and indicators of renal function. If deemed inappropriate, the pharmacist contacted the prescribing physician with a dosage recommendation. Two hundred ten courses of I/C therapy were prescribed in the nine-month period following implementation of the target drug program; 26 cases (12 percent) required dosage adjustment. The incidence of CNS adverse effects including seizures decreased from 15 to 1 percent (p = 0.0015). A $6033 drug cost avoidance also resulted from pharmacist intervention.
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PMID:Evaluation of an imipenem/cilastatin target drug program. 192

Lipoxygenase pathway products of arachidonic acid (AA) metabolism (known as leukotrienes, LTs) are produced in the brain during pathologic conditions such as ischemia, hemorrhage, trauma, and seizure in which the release of AA is sustained by the activation of local phospholipases. The most common type of LT in the central nervous system is an LTC4 which is a highly potent vasoconstrictor leading to increase in vascular permeability. In this study, we compared the serum (S) and cerebrospinal fluid (CSF) prostaglandin E2 (PGE2) and LTC4 levels in 13 consecutively admitted patients with acute cerebral ischemia aged 55-80 years with 10 age-matched controls. Patients with previous glucocorticosteroid and antiinflammatory drug usage were not included in the study. S and CSF samples were drawn during the first 72 h of the attack, and samples were evaluated by bioassay. There was no significant difference in S PGE2 and LTC4 values, whereas a significant difference was observed between CSF PGE2 and LTC4 values as compared with the control group. The high levels of CSF PGE2 and LTC4-like activity in acute cerebral ischemia may indicate that these mediators have a role to play in cerebral edema. The CSF PGE2/LTC4 ratio was also found to be reduced in the ischemic group implying higher LTC4 synthesis than PGE2 synthesis. In the light of these findings, we suggest that use of a selective antagonist of LTs may be helpful in reducing the ischemic penumbra during acute cerebral ischemia by controlling the vasogenic edema.
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PMID:Leukotriene C4 and prostaglandin E2 activities in the serum and cerebrospinal fluid during acute cerebral ischemia. 194 52

Sudden unexpected death in epilepsy (SUDE) remains an under-investigated area. Little progress has been made in prospective evaluation of its incidence and causes. We report an audit of Cardiff Epilepsy Unit data that identified 14 cases of SUDE within a time period of 7000 patient-treatment years. These data suggest that SUDE occurs in 1 in 500 of our patients per year. Males were affected twice as often as females. The mean age of affected patients was 35 years, and most were in the 20-40 year age bracket. Eleven had epilepsy for more than 6 years, 12 were taking one or two antiepileptic drugs, and nine had been experiencing four or fewer seizures per month. Ten patients had idiopathic generalized seizures, and only one patient did not experience tonic-clonic seizures. Antiepileptic drug usage favoured carbamazepine. Most patients were not living alone but 11 of 14 (79%) were either unmarried, separated or widowed. In comparison with other patients attending the Epilepsy Unit (more than 1820 patients), SUDE patients were significantly (chi 2 < 0.05) more likely to be male, to have idiopathic generalized tonic-clonic seizures, or to be taking carbamazepine (monotherapy or in combination with another drug). There were no statistically significant differences in age, duration of epilepsy, number of drugs, or seizure frequency between the SUDE patients and our other patients. Correct case identification, and controlled, prospective, ante-mortem studies are needed so that the true incidence, associated risk factors and causes of sudden unexpected death in epilepsy can be accurately ascertained.
Seizure 1993 Dec
PMID:Sudden unexpected death in epilepsy: a local audit. 816 97

Sudden unexpected death in epilepsy (SUDEP) has been recognised for centuries. The precise frequency of occurrence is not well defined. Education of medical professionals is needed, so that death certificates and coronial inquests may appropriately, correctly and consistently record SUDEP as the case of death. Correct identification will then allow further investigation of this misunderstood, and often ignored, epilepsy complication. SUDEP incidence may be increasing, either as a result of increased recognition, or possibly due to a real increase in incidence. All currently available antiepileptic drugs (AEDs) have been associated with SUDEP, and current opinion assumes that the relative proportion of patients suffering SUDEP is representative of average AED usage type for a particular time and locality, however, recently analysed data suggest a strong bias towards carbamazepine. A review of Cardiff Epilepsy Unit data shows that carbamazepine was disproportionately represented in patients suffering SUDEP. In this series, 11 of the 14 SUDEP patients were taking carbamazepine at the time of death. This was calculated as 79% of all patients, compared to average carbamazepine usage by all other Cardiff Epilepsy Unit patients of 38%. The data also indicate that one patient was not taking any drug therapy, and died during his first seizure, reducing the number of evaluable 'drug usage' patients to 13, and increasing the proportion taking carbamazepine at the time of death to 85%, (P < 0.01). Possible mechanisms include carbamazepine induced lengthening of the ECG Q-T interval combined with a mild pro-arrhythmic effect of epileptic seizure discharges, and consequent transient cardiac instability leading to arrhythmic death. Or alternatively, excessive post-seizure brainstem inhibition might result in blunting or transient abolition of central hypoxic and hypercarbic respiratory drive, with consequent post-ictal respiratory arrest, subsequent exacerbation of hypoxia, further cardiac destabilisation and death due to hypoxia/failed re-establishment of respiration and terminal cardiac arrhythmia. Current knowledge about SUDEP remains poor. Education is needed so that case ascertainment can be correctly documented. Delineation of the precise mechanisms involved should lead to definitive prevention strategies. Evaluation of carbamazepine as a significant causative factor in SUDEP is also needed.
Seizure 1998 Aug
PMID:Sudden unexpected death in epilepsy: is carbamazepine implicated? 973 3

Valproate is an anticonvulsive drug whose mechanism of action is based on GABAergic systems. One of the infrequent adverse effects of valproate is choreiform movements. In our study, we report a patient having head trauma history with partial and secondary generalized seizures taking 1500 mg/day valproate. During the second month of the therapy, generalized chorea was observed. Since other aetiologic causes of chorea were excluded, acutely occurring chorea in the patient was thought to be related with valproate usage because of persistence of choreiform movements for days without any fluctuation. Valproate was stopped slowly and lamotrigine was added at a dose of 400 mg/day. Within a two-month period after cessation of the valproate, choreiform movements had disappeared. We thought that the history of head trauma and another antiepileptic drug usage were the risk factors for the occurrence of valproate-induced choreiform movements.
Seizure 2002 Apr
PMID:Reversible valproate-induced choreiform movements. 1201 66

The authors report a double-blind, placebo-controlled, crossover study of talampanel in 49 patients with refractory partial seizures. Three doses of talampanel were investigated based on differences in patients' concomitant antiepileptic drug usage. Talampanel showed efficacy in reducing seizure frequency (p = 0.001) with a median seizure reduction of 21%. Eighty percent of patients had fewer seizures on talampanel than on placebo. Dizziness (52%) and ataxia (26%) were the only significant adverse events.
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PMID:A crossover, add-on trial of talampanel in patients with refractory partial seizures. 1205

Epilepsy is a common childhood neurological morbidity needs careful evaluation, relevant investigations and precise therapy with appropriate antiepileptic drugs for optimal duration. Majority of childhood epilepsy remits with antiepileptic drugs and should be managed in the community. Practising pediatricians must counsel the family for possible etiology of epilepsy, compliance during treatment and possible outcome. It is important to distinguish pseudo seizures and nonepileptic events from true epilepsy, as this would reduce the burden of unwanted medication. It is also equally important to enable ourselves to recognize early predictors of intractability and refer them to appropriate referral units. Epilepsy is a social and an economic burden for the family. Preventive strategies by improved perinatal care, prevention and managemnt of neuro infections and infestations which will mitigate epilepsy burden in the community are essential. In this context it is important to familarize appropriate and relevant use of investigations. Inappropriate antiepileptic drug usage is common in the community and drug therapy should be rationalized. Epilepsy management requires a close interaction between the patient, family and the treating physician and a concerted effort is essential.
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PMID:Management of childhood epilepsy. 1266 10

Numerous drugs have the potential to adversely influence a patient's sense of taste, either by decreasing function or producing perceptual distortions or phantom tastes. In some cases, such adverse effects are long lasting and cannot be quickly reversed by drug cessation. In a number of cases, taste-related adverse effects significantly alter the patient's quality of life, dietary choices, emotional state and compliance with medication regimens. In this review, we describe common drug-related taste disturbances and review the major classes of medications associated with them, including antihypertensives, antimicrobials and antidepressants. We point out that there is a dearth of scientific information related to this problem, limiting our understanding of the true nature, incidence and prevalence of drug-related chemosensory disturbances. The limited data available suggest that large differences exist among individuals in terms of their susceptibility to taste-related adverse effects, and that sex, age, body mass and genetic variations in taste sensitivity are likely involved. Aside from altering drug usage, management strategies for patients with taste-related adverse effects are sorely needed. Unfortunately, stopping a medication is not always an easy option, particularly when one is dealing with life-threatening conditions such as seizures, cancer, infection, diabetes mellitus and uncontrolled hypertension. Hopefully, the information contained in this review will sensitize physicians, researchers and drug manufacturers to this problem and will result in much more research on this pressing topic.
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PMID:Drug-induced taste disorders. 1830 45

Depression is common in patients with epilepsy and the strongest predictor of poor quality of life. Few studies have assessed the association of uncontrolled seizures with depression. We used the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), a validated six-item self-report questionnaire, to assess the relationship between depression, seizure control, and antiepileptic drug (AED) and antidepressant drug usage. Two hundred ninety-eight patients were studied. Twenty percent of patients with any epileptic seizures over a 6-month period had NDDI-E scores >15, consistent with major depression. Higher NDDI-E scores were associated with higher seizure frequency (P<0.0002). The prevalence ratio of NDDI-E scores >15 in patients with no seizures versus any seizure in the past 6 months was 0.48 (95% CI = 0.26-0.88). Higher NDDI-E scores were associated with the number of AEDs taken (P = 0.0023). Major depression is associated with uncontrolled seizures, with a prevalence double that of patients whose seizures are controlled.
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PMID:Depression in epilepsy is associated with lack of seizure control. 2088 6

The objective of the study described here was to compare gender-specific differences of the personal impact of juvenile myoclonic epilepsy (JME) and temporal lobe epilepsy (TLE). We interviewed consecutive men and women with JME or TLE attending a tertiary epilepsy center to characterize their clinical and psychological profiles and details of employment and marriage. We recruited 150 persons with JME (74 males) and 150 with TLE (80 males). There were no gender-specific differences between men and women with respect to age at onset or semiology or frequency of seizures. Antiepileptic drug usage was comparable for both sexes except that fewer women with JME were prescribed valproate. Comorbidities, lower employment, and higher anxiety state were more frequent for women with epilepsy than for men with epilepsy. Females had more difficulty finding life partners compared with males. Women with epilepsy were at increased risk of divorce. Women with epilepsy have more problems with, marriage, mood, and employment as compared with men, even when the clinical profiles of their epilepsy syndromes are comparable.
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PMID:Gender-specific psychosocial outcome for women with epilepsy. 2109 81


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