Perampanel-Induced Psychosis in a Young Woman: A Case Report.

OBJECTIVES: A case of perampanel-induced psychosis in a young woman is reported, a side effect that has only rarely been reported in the literature. METHODS: We describe a case of a young woman with epilepsy and no psychiatric history with perampanel-associated altered behavior and psychotic symptoms, requiring hospitalization in an acute psychiatry ward. We also provide a literature review on the possible neurobiological pathways implicated. RESULTS: Perampanel is believed to block a small proportion of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor current, retarding epileptiform discharges while sparing most normal synaptic transmission. Most common adverse events are related to central nervous system (including dizziness, drowsiness, blurred vision and imbalance) and psychiatric symptoms have been reported. CONCLUSIONS: The biological vulnerability to psychiatric and behavioral adverse reactions of antiepileptic drugs is multifactorial and different mechanisms and clinical predisposing factors may interact. For this reason, patients starting these antiseizure drugs need long-term and comprehensive clinical monitoring.

Molecular recognition between adenine or 2,6-diaminopurine and copper(II) chelates with N,O2,S-tripodal tetradentate chelators having thioether or disulfide donor groups.

Five novel ternary copper(II) complexes with the N,O2,S-tripodal tetradentate chelators N,N-bis(carboxymethyl)-S-benzylcysteaminate(2-) ion (BCBC) or N,N,N',N'-tetrakis(carboxymethyl)cystaminate(4-) ion (TCC) and adenine (Hade), 2,6-diaminopurine (Hdap), 2,2'-bipyridine (bpy) or 1,10-phenanthroline (phen) as co-ligand were synthesized and characterized by X-ray diffraction and other physical methods: [Cu2(BCBC)2(µ2-N3,N7-H(N9)ade)(H2O)2]·H2O (1), [Cu2(BCBC)2(µ2-N7,N9-H(N3)dap)(H2O)2]·4H2O (2), [Cu2(µ2-TCC)(H(N9)ade)2(H2O)2]·10H2O (3), [Cu2(µ2-TCC)(bpy)2]·15H2O (4) and [Cu2(µ2-TCC)(phen)2]·14H2O (5). The crystal structure of H4TCC·3H2O was also determined. All ternary Cu(II) complexes have molecular structures. The N-(2-mercaptoethyl)-iminodiacetate moieties of BCBC or TCC ligands play a NO2+S-tripodal tetradentate role, with the S-(thioether or disulfide) atom as the apical/distal donor of the copper(II) center. In 1-3, the iminodiacetate moiety exhibits a mer-NO2 conformation (two nearly coplanar chelate rings) while in 4 and 5 (with bpy or phen as coligand) it displays a fac-NO+O (apical/distal) conformation. We conclude that the formation of the Cu-S(thioether or disulfide) bonds is strongly favored by the N-branched topology of the S-ligands in the reported compounds.

Small intestinal bacterial overgrowth in inactive Crohn's disease: influence of thiopurine and biological treatment.

AIM: To investigate the influence of thiopurines and biological drugs on the presence of small intestinal bacterial overgrowth (SIBO) in patients with inactive Crohn's disease (CD). METHODS: This was a prospective study in patients with CD in remission and without corticosteroid treatment, included consecutively from 2004 to 2010. SIBO was investigated using the hydrogen glucose breath test. RESULTS: One hundred and seven patients with CD in remission were included. Almost 58% of patients used maintenance immunosuppressant therapy and 19.6% used biological therapy. The prevalence of SIBO was 16.8%. No association was observed between SIBO and the use of thiopurine Immunosuppressant (12/62 patients), administration of biological drugs (2/21 patients), or with double treatment with an anti-tumor necrosis factor drugs plus thiopurine (1/13 patients). Half of the patients had symptoms that were suggestive of SIBO, though meteorism was the only symptom that was significantly associated with the presence of SIBO on univariate analysis (P < 0.05). Multivariate analysis revealed that the presence of meteorism and a fistulizing pattern were associated with the presence of SIBO (P < 0.05). CONCLUSION: Immunosuppressants and/or biological drugs do not induce SIBO in inactive CD. Fistulizing disease pattern and meteorism are associated with SIBO.

Short-fiber protein of ad40 confers enteric tropism and protection against acidic gastrointestinal conditions.

The lack of vectors for selective gene delivery to the intestine has hampered the development of gene therapy strategies for intestinal diseases. We hypothesized that chimeric adenoviruses of Ad5 (species C) displaying proteins of the naturally enteric Ad40 (species F) might hold the intestinal tropism of the species F and thus be useful for gene delivery to the intestine. As oral-fecal dissemination of enteric adenovirus must withstand the conditions encountered in the gastrointestinal tract, we studied the resistance of chimeric Ad5 carrying the short-fiber protein of Ad40 to acid milieu and proteases and found that the Ad40 short fiber confers resistance to inactivation in acidic conditions and that AdF/40S was further activated upon exposure to low pH. In contrast, the chimeric AdF/40S exhibited only a slightly higher protease resistance compared with Ad5 to proteases present in simulated gastric juice. Then, the biodistribution of different chimeric adenoviruses by oral, rectal, and intravenous routes was tested. Expression of reporter ß-galactosidase was measured in extracts of 15 different organs 3 days after administration. Our results indicate that among the chimeric viruses, only intrarectally given AdF/40S infected the colon (preferentially enteroendocrine cells and macrophages) and to a lesser extent, the small intestine, whereas Ad5 infectivity was very poor in all tissues. Additional in vitro experiments showed improved infectivity of AdF/40S also in different human epithelial cell lines. Therefore, our results point at the chimeric adenovirus AdF/40S as an interesting vector for selective gene delivery to treat intestinal diseases.