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1.
Tidsskr Nor Laegeforen ; 139(18)2019 Dec 10.
Artigo em Norueguês | MEDLINE | ID: mdl-31823568

RESUMO

BACKGROUND: An active man in his fifties was treated for atrial fibrillation with ablation. One week later he noticed variable weakness in his lower extremities. In the days that followed, his symptoms improved but could vary from day to day. CASE PRESENTATION: On admission 3 months after the initial symptoms, he had spasticity and weakness in both lower extremities, with hyperreflexia and positive Babinski. Spinal fluid contained slightly elevated protein levels. Spinal MRI showed cord oedema and gadolinium enhancement over multiple spinal levels. Autoimmune myelitis was suspected, and he was treated with high dose steroids and rituximab. Due to lack of effect, repeated examinations were initiated. Information from his patient history regarding symptom exacerbation by walking or bending forward was emphasised. Repeated MRI showed unchanged spinal oedema and dilated peri- and intramedullary vessels. MRA and spinal digital DSA revealed a dural fistula at third lumbar level, with the left L3 radiculomedullary artery as the feed artery. The fistula was successfully ligated by the neurosurgeon. INTERPRETATION: Spinal vascular lesions are rare and the diagnosis may be challenging due to atypical presentation. The case shows that detailed information from the patient history and thorough clinical investigation is of paramount importance to disclose this probably underreported condition.


Assuntos
Dura-Máter , Fístula , Meios de Contraste , Dura-Máter/diagnóstico por imagem , Fístula/diagnóstico por imagem , Gadolínio , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Debilidade Muscular , Caminhada
2.
Epilepsia ; 58(10): e142-e146, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28833045

RESUMO

The purpose was to investigate pharmacokinetic variability of valproic acid (VPA) in women of childbearing age by therapeutic drug monitoring (TDM) data to elucidate the variable relationship between dose and serum concentrations with the ultimate aim of facilitating safer use of VPA. Anonymized retrospective data from the TDM database (2006-2015) at the National Center for Epilepsy in Norway were used. Trough total concentrations of VPA at assumed steady state in women aged 14-46 years were analyzed. Data from 643 nonpregnant women of childbearing age (mean age = 27 years) were included. Mean dose and serum concentration of VPA were 968 (standard deviation [SD] = 453) mg/day and 411 (SD = 138) µmol/L, respectively, and 59% used polytherapy. The pharmacokinetic variability in serum concentration/dose (C/D) ratios between women was extensive. For doses <700 mg/day (n = 202; 32%; 150-625 mg/day), mean serum concentration was 336 µmol/L and variability in C/D ratio was 10-fold. The variability decreased with increasing dose to eightfold (≥700 to <1,500 mg/day, n = 358) and fourfold (≥1,500 mg/day, n = 96). This study demonstrates the extensive pharmacokinetic variability of VPA among women of childbearing age, which is most pronounced at low doses. In future studies, serum concentrations of VPA, rather than dosage, should be used as a guide for exposure of VPA and possible risks of teratogenicity to evaluate safety aspects of VPA in women.


Assuntos
Anticonvulsivantes/farmacocinética , Epilepsia/metabolismo , Ácido Valproico/farmacocinética , Adolescente , Adulto , Anticonvulsivantes/uso terapêutico , Monitoramento de Medicamentos , Epilepsia/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Noruega , Estudos Retrospectivos , Ácido Valproico/uso terapêutico , Adulto Jovem
3.
Tidsskr Nor Laegeforen ; 136(22): 1895-1898, 2016 Dec.
Artigo em Norueguês | MEDLINE | ID: mdl-27929555

RESUMO

Idiopathic intracranial hypertension (IIH) is characterised by increased intracranial pressure with normal cerebrospinal fluid, and no evidence of space occupying process, meningeal pathology or venous thrombosis. The condition is associated with obesity, especially in women of childbearing age. IIH is a rare but serious cause of headache, and constitutes a differential diagnosis for sudden-onset headache, particularly if the patient has visual disturbances not related to migraine and reports pulsatile tinnitus, cranial nerve palsy or radiculopathy.


Assuntos
Pseudotumor Cerebral , Diagnóstico Diferencial , Cefaleia/etiologia , Humanos , Imageamento por Ressonância Magnética , Papiledema/diagnóstico , Pseudotumor Cerebral/classificação , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/terapia
4.
Tidsskr Nor Laegeforen ; 129(1): 26-8, 2009 Jan 01.
Artigo em Norueguês | MEDLINE | ID: mdl-19119293

RESUMO

BACKGROUND: 30 % of patients with epilepsy have recurrent drug-resistent seizures. Some children with catastrophic epilepsy have responded well to a ketogenic diet. Polyunsaturated fatty acids are at least partly responsible for the anticonvulsive effect of this diet and could perhaps be used to treat epilepsy. MATERIAL AND METHODS: The paper is based on literature (published before June 2008) retrieved through a non-systematic search of the Cochrane and PubMed databases. The following search words were used: epilepsy, polyunsaturated fatty acids, clinical trials, ketogen diet, and treatment. Articles focusing on clinical aspects were selected. RESULTS AND INTERPRETATION: Articles on clinical studies and laboratory research were retrieved from Pubmed, while studies on ketogen diet were retrieved from Cochrane. Animal studies show that increased intake of polyunsaturated fatty acids can reduce the likelihood of epileptic seizures through various biochemical mechanisms. However, there is not sufficient evidence to conclude that polyunsaturated fatty acids have antiepileptic effects in people with epilepsy. More research is needed before polyunsaturated fatty acids can be presented as a treatment option for epilepsy.


Assuntos
Anticonvulsivantes/administração & dosagem , Dieta Cetogênica , Epilepsia/dietoterapia , Ácidos Graxos Insaturados/administração & dosagem , Animais , Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Ácidos Graxos Insaturados/uso terapêutico , Humanos
5.
Epilepsy Res ; 141: 31-37, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29453075

RESUMO

BACKGROUND AND PURPOSE: Use of valproate (VPA) in women of childbearing age is restricted due to dose-dependent risk of teratogenicity. The purpose of this study was to characterise pharmacokinetic variability of VPA in pregnancy, and discuss use of therapeutic drug monitoring (TDM) as guidance to exposure in women. METHOD: Measurements of trough total and unbound VPA concentrations before, during and after pregnancy, at assumed steady-state were collected from the TDM-database (2006-2016) at the National Center for Epilepsy in Norway. Additional clinical data were obtained from the Oppland county Perinatal Database (1994-2011). RESULTS: Data from 51 pregnancies in 33 women aged 19-40 years were included. Each woman underwent 1-4 pregnancies, and 1-7 measurements per pregnancy were performed. The variability in total concentration/dose (C/D)-ratios between women was 13-fold, and intra-patient variability extensive. Total C/D-ratios were reduced by 46% from before pregnancy to third trimester (0.48-0.29 µmol/L/mg). Unbound concentrations of VPA were only requested in 10% of the pregnancies. Repeated measurements from two pregnancies in one women revealed increased unbound concentration of VPA during pregnancy. There were 19 with idiopathic generalized epilepsy and two focal based on clinical data from 21 women and 38 pregnancies; 1 major congenital malformation was noted. CONCLUSION: There is pronounced pharmacokinetic variability of VPA during pregnancy. Unbound concentrations are rarely requested. TDM should be used by measurements of both total and unbound concentrations since total concentrations may be misleading for efficacy and fetal exposure of VPA.


Assuntos
Anticonvulsivantes , Monitoramento de Medicamentos , Epilepsia/sangue , Epilepsia/tratamento farmacológico , Ácido Valproico , Adulto , Anticonvulsivantes/sangue , Anticonvulsivantes/farmacocinética , Anticonvulsivantes/uso terapêutico , Relação Dose-Resposta a Droga , Feminino , Humanos , Gravidez , Ácido Valproico/sangue , Ácido Valproico/farmacocinética , Ácido Valproico/uso terapêutico , Adulto Jovem
6.
Brain Behav ; 6(8): e00492, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27547497

RESUMO

OBJECTIVE: The aim of this study was to investigate birth rates and use of hormonal contraception in different age groups among women with epilepsy (WWE) in comparison to women without epilepsy. MATERIALS AND METHODS: Demographic data and medical information on more than 25,000 pregnant women (40,000 births), representing 95% of all pregnancies in Oppland County, Norway, were registered in the Oppland Perinatal Database in the period 1989-2011. Data were analyzed with respect to epilepsy diagnoses, and 176 women with a validated epilepsy diagnosis (303 pregnancies) were identified. Age-specific birth rates in these women were estimated and compared with age-specific birth rates in women without epilepsy in the same county. RESULTS: In WWE over 25 years of age, birth rates were significantly lower than in those of the same age group without epilepsy. In women below 20 years of age, birth rates were similar in those with and without epilepsy. The use of hormonal contraceptives prior to pregnancy was lower among WWE under 25 years than in the corresponding age group without epilepsy. CONCLUSIONS: Health professionals who counsel WWE who are of fertile age should be aware of the strongly reduced birth rates in WWE over 25 years of age, and the lower rates of use of contraceptives among young WWE.


Assuntos
Coeficiente de Natalidade , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais Orais Hormonais , Epilepsia/epidemiologia , Complicações na Gravidez/epidemiologia , Sistema de Registros/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Noruega/epidemiologia , Gravidez , Adulto Jovem
7.
Seizure ; 28: 76-80, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25797889

RESUMO

PURPOSE: Various factors may affect intrauterine foetal growth, amongst which conditions such as epilepsy and the use of anti-epileptic drugs (AED) may play a role. This study investigated intrauterine growth of foetuses in women with epilepsy, as compared with controls, and explored whether intrauterine growth was affected by prenatal exposure to AED. METHOD: Data were obtained from prospectively registered data regarding pregnancy and prenatal and perinatal factors in women in Oppland County in Norway. The final analysis included information from 166 mothers with epilepsy and 287 children. The control group consisted of 40,553 pregnancies in women without epilepsy registered in the same database. RESULTS: There was a significantly higher risk of the ponderal index being below the 10th percentile and infants being small for gestational age (SGA) in the epilepsy group; exposure to AED increased the risk. The frequency of SGA and low ponderal index was highest in Lamotrigine exposed infants. In the AED group, head circumference was significantly smaller among Carbamazepine exposed. CONCLUSION: Impaired intrauterine growth of foetuses in women with epilepsy was identified. The frequency of SGA and low ponderal index was highest in Lamotrigine exposed infants. The epilepsy group had a higher risk profile for having smaller babies, in being younger at age, lower in body weight and more frequent smokers. However despite these differences, the effects of epilepsy and AED exposure were significant. The ponderal index may be a useful supplement to more established measures assessing intrauterine growth in epilepsy.


Assuntos
Anticonvulsivantes/efeitos adversos , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/etiologia , Retardo do Crescimento Fetal/induzido quimicamente , Retardo do Crescimento Fetal/epidemiologia , Complicações na Gravidez/induzido quimicamente , Adulto , Peso ao Nascer , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Feminino , Humanos , Estudos Longitudinais , Troca Materno-Fetal , Noruega/epidemiologia , Gravidez , Estudos Prospectivos , Fatores de Risco
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