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

Although the standard tricyclic antidepressants (TCAs) are generally effective in the treatment of depression, they can cause several troublesome adverse effects. Chief among these are their anticholinergic actions, which range from annoying dryness of the mouth and constipation to potentially dangerous urinary retention and confusion or delirium in the ill and elderly. Cardiovascular effects of TCAs include orthostatic hypotension, tachycardia and cardiac conduction slowing. Many TCAs are sedating and promote weight gain. Also problematic is the potential lethality of TCAs in overdose. The continual introduction of a host of new antidepressants over the past 15 years has provided an opportunity to improve the benefit-risk ratio for many patients by reducing medication-related toxicity. Selective serotonin reuptake inhibitors (SSRIs) and amfebutamone (bupropion), among others, are examples of effective antidepressants free of tricyclic-like anticholinergic, cardiovascular, sedating and appetite/weight-increasing effects. However, the new-generation drugs also present adverse effects of their own, including gastrointestinal distress, agitation and drug-drug interactions in the case of the SSRIs, and the risk of seizures or psychosis in amfebutamone recipients. Monoamine oxidase (MAO) inhibitors have also been refined; reversible inhibitors of MAO-type A afford protection against the usually feared hypertensive reaction to indirect sympathomimetic substances. The availability of new-generation antidepressants thus increases the likelihood of clinical response with a reduction in unwanted toxicity.
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PMID:Comparative tolerability profiles of the newer versus older antidepressants. 813 85

We surveyed procedural techniques in 804 routine clinical sessions of electroconvulsive therapy (ECT) over 4 2/3 years. No significant problems occurred. Side effects as agitation, physical complications such as urinary stasis, and protocol deviations such as failure to use the bite block were occasionally documented. Mechanical difficulties such as trouble gaining intravenous access and medicinal problems such as inappropriate dosing were rare. Our assessment resulted in a more precise method of diminishing the risks of ECT. For example, the chin is held manually, closing the mouth during delivery of the stimulus, to obviate oral trauma. Similarly, electrode contact is always verified visually and with the ECT machine "self-test" just before each treatment. Both cuff and electroencephalographic means are used to determine seizure timing. ECT is safe; a carefully applied protocol should make it safer.
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PMID:Procedural complications of electroconvulsive therapy: assessment and recommendations. 802 20

More than 360 children with intractable epilepsy have been treated with vigabatrin in single-blind or open, add-on studies. Approximately 50% or more of patients with West syndrome and partial seizures have shown a 50% or greater reduction in seizure frequency with the use of vigabatrin. A less consistent response has been found between studies evaluating vigabatrin in children with Lennox-Gastaut syndrome, although, overall, approximately 50% of these patients have also shown a greater than 50% decrease in seizures. The use of vigabatrin in idiopathic localization-related epilepsy, idiopathic generalized epilepsy, and the Landau Kleffner syndrome have not been reported, but its evaluation in these conditions may be warranted based on the relatively excellent safety profile of vigabatrin. Vigabatrin has been shown to aggravate "nonprogressive myoclonic epilepsies." Vigabatrin has been well tolerated in children, with mild drowsiness and agitation being the most commonly reported side effects.
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PMID:The role of vigabatrin in the management of infantile epileptic syndromes. 823 83

Two separate methods of preventing post-ECT emergence agitation are increasing the succinylcholine dose to about 1.1 mg/kg and adding a methohexital bolus of about 0.67 mg/kg immediately at seizure end. These methods can work separately and additively without any expectation of diminishing treatment efficacy. A relevant case is described.
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PMID:ECT emergence agitation and methohexital-succinylcholine interaction. Case report. 830 49

Cocaine abuse surged in the 1980s, forcing reevaluation of its previously benign image. Snorted, smoked, and injected, the drug is more widely abused than ever and, the consequences are devastating. Medical complications are frequent and range from mild (eg, cough, itching, headache) to life-threatening (eg. stroke, seizure, cardiovascular failure). Behavioral disturbances constitute the most dramatic and widespread effects of intoxication and withdrawal. Psychopathologic responses may include perceptual disturbances (eg. hallucinations) agitation, aggression, delirium, confusion, and profound delusional ideation. The goals of treatment are abstinence, rehabilitation, and relapse prevention. Hospital care may be necessary in certain circumstances. Regardless of where treatment takes place, a comprehensive program of supportive care, behavioral therapy, urine monitoring, and often psychopharmacologic intervention is required.
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PMID:The treatment of cocaine abuse. 831 99

Clozapine was used to treat nine brain-injured patients with psychotic symptoms or outbursts of rage and aggression refractory to other medications. Verbal and physical aggression decreased markedly in two patients, and one additional patient had a dramatic decrease in bizarre behaviors. Mild improvement occurred in three patients with a decrease in agitation and frequency of auditory hallucinations. Response was indeterminate in three patients because of inadequate length of treatment. The incidence of side effects appeared to be higher than expected, with seizures occurring in two of nine patients. These case reports illustrate that clozapine may be useful in the treatment of psychosis and aggressive behavior after brain injury, despite the occurrence of adverse effects.
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PMID:Clozapine response and adverse effects in nine brain-injured patients. 835 36

During normal circumstances, individuals have a delicate balance of water requirement and water intake. If the balance of water is altered, electrolyte imbalance can occur. If fluid intake continues uncurbed, an extreme condition may result known as self-induced water intoxication and psychoses. If untreated, complications may develop, including dilated and hypotonic bowel and bladder, hydronephrosis, renal failure, congestive heart failure, mild confusion, acute delirium, seizures, coma, and death. The ongoing problem of water intoxication presents a modern day nursing challenge to psychiatric nurses. The present study monitors nine chronically ill patients in a special program for water intoxication involving control and monitoring and a psychoeducational group approach in a closed unit of a state hospital. At the end of 3 months serum electrolytes, serum osmolality, and urine specific gravity were within normal limits since the start of the program. Anxiety, as evidenced by restlessness, pacing, increased talking, demanding behavior, hyperactivity, yelling, and irritability, had lessened. This improvement was accompanied by a stabilization of psychotic behavior. The use of restraints dropped from 1303 hr in the 3 months before the program to 20 hr and 55 min for the nine patients in the first 3 months of the program. Progress in relation to the study hypothesis will be evaluated every 3 months.
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PMID:A program for water-intoxicated patients at a state hospital. 836 31

Antipsychotic agents, most often used for treatment of schizophrenia, are sometimes prescribed for the agitated patient with an organic brain disorder. We report the case of a brain-injured patient who was prescribed chlorpromazine for agitation and who developed a delusional state while taking this antipsychotic agent. The emergence of this delusional state coincided with the exacerbation of certain cognitive deficits. Possible mechanisms for this phenomenon are discussed. Caution is advised when prescribing neuroleptics for patients with traumatic brain injury, especially those agents with significant cognitive side-effects or with a significant potential to precipitate seizures.
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PMID:Chlorpromazine-induced psychosis after brain injury. 842 19

Measurement methods from behavioral psychology were used to assess antiepileptic drug behavioral side effects in 5 individuals with mental retardation. When the suspected antiepileptic drug was altered, an 81% reduction of maladaptive behaviors occurred. Quality of life outcomes included successful community placement and termination of an aversive intervention procedure. Three cases demonstrated antiepileptic drug exacerbation of disruptive vocalizations, agitation, self-injurious behavior, and property destruction; 2 demonstrated improved aggression, but illustrated a common clinical problem. When seizure control must be maintained and a suspected antiepileptic drug cannot be reduced before a second antiepileptic drug with potential psychotropic properties is initiated, it was not possible to absolutely conclude that the first antiepileptic drug was responsible for the behavior problem. Overall, these measurement methods were instrumental in the systematic clinical evaluation of antiepileptic drug behavioral side effects in individuals unable to verbally communicate the presence of these side effects.
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PMID:Antiepileptic drug behavioral side effects in individuals with mental retardation and the use of behavioral measurement techniques. 856 87

During an epidemic of dengue type 2 virus in the rural community of Charters Towers, North Queensland, Australia, in 1993, 210 cases presented to the local hospital with signs and symptoms of classic dengue fever. Two cases were noteworthy because of neurologic complications, which included drowsiness, short term memory loss, agitation, and seizure. The cases are presented in detail because they are the first cases of dengue-associated encephalopathy to be documented in Australia. An increasing number of cases of encephalopathy associated with classic dengue fever is being reported world wide, but the etiology of this clinical syndrome remains unknown.
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PMID:Dengue fever with encephalopathy in Australia. 860 Jul 60


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