RESUMO
Expertise in a variety of fields is required for the diagnostic process of epilepsies in children and adolescents as well as for their treatment with anticonvulsants. Patients benefit in the process from the cooperation of different health care professionals. It is of critical importance for risks to be minimised and for the efficacy shown in controlled clinical trials to be maintained in routine conditions. In the first instance, drug prescription procedures, including the choice of anticonvulsants and combinations of drugs and dosing, have to be considered. The administration of drugs has, of course, also to be taken into account. Only if patients are given their anticonvulsants appropriately, the intended success of the therapy can be accomplished. Strategies aimed at improving drug administration have to be directed not only at nurses but also at parents, children and adolescents themselves, as well as caregivers in schools and children's day-care facilities. By providing theoretical teaching, practical training, and routinely including pharmacists in the therapeutic team, drug-related problems that may result in limited effectiveness and increased risks are prevented. As a result, drug (therapy) safety is not only qualitatively improved, but the degree of participation and quality of life of patients and families is improved as well.
Assuntos
Anticonvulsivantes/uso terapêutico , Comunicação Interdisciplinar , Hanseníase/tratamento farmacológico , Pediatria , Farmacêuticos , Adolescente , Criança , Humanos , Hanseníase/psicologia , Pais , Qualidade de VidaAssuntos
Anticonvulsivantes/efeitos adversos , Edema/induzido quimicamente , Mãos/fisiopatologia , Hiperpigmentação/induzido quimicamente , Fenitoína/efeitos adversos , Anticonvulsivantes/uso terapêutico , Edema/fisiopatologia , Feminino , Seguimentos , Humanos , Hiperpigmentação/fisiopatologia , Infusões Intravenosas , Transplante de Rim/métodos , Pessoa de Meia-Idade , Fenitoína/administração & dosagem , Medição de Risco , Convulsões/diagnóstico , Convulsões/tratamento farmacológico , SíndromeRESUMO
BACKGROUND: Opportunistic fungi are dispersed as airborne, ground and decaying matter. The second most frequent extra-pulmonary disease by Aspergillus is in the central nervous system. CASE PRESENTATION: The case subject was 55 years old, male, mulatto, and an assistant surveyor residing in Teresina, Piauí. He presented with headache, seizures, confusion, fever and left hemiparesis upon hospitalization in 2006 at Hospital São Marcos. Five years previously, he was diagnosed with diabetes mellitus, and 17 months previously he had acne margined by hyperpigmented areas and was diagnosed with leprosy. Laboratory tests indicated leukocytosis and magnetic resonance imaging showed an infarction in the right cerebral hemisphere. Cerebrospinal fluid examination showed 120 cells/mm(3) and was alcohol-resistant bacilli negative. Trans-sphenoidal surgery with biopsy showed inflammation was caused by infection with Aspergillus fumigatus. We initiated use of parenteral amphotericin B, but his condition worsened. He underwent another surgery to implant a reservoir of Ommaya-Hickmann, a subcutaneous catheter. We started liposomal amphotericin B 5 mg/kg in the reservoir on alternate days. He was discharged with a prescription of tegretol and fluconazole. CONCLUSION: This report has scientific interest because of the occurrence of angioinvasive cerebral aspergillosis in a diabetic patient, which is rarely reported. In conclusion, we suggest a definitive diagnosis of cerebral aspergillosis should not postpone quick effective treatment.
Assuntos
Aspergillus fumigatus/patogenicidade , Cérebro/microbiologia , Diabetes Mellitus , Hanseníase Virchowiana/complicações , Neuroaspergilose/microbiologia , Anfotericina B/administração & dosagem , Anticonvulsivantes/uso terapêutico , Antifúngicos/administração & dosagem , Aspergillus fumigatus/isolamento & purificação , Biópsia , Carbamazepina/uso terapêutico , Diabetes Mellitus/diagnóstico , Fluconazol/administração & dosagem , Humanos , Hanseníase Virchowiana/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroaspergilose/complicações , Neuroaspergilose/diagnóstico , Neuroaspergilose/tratamento farmacológico , Valor Preditivo dos Testes , Convulsões/tratamento farmacológico , Convulsões/etiologia , Resultado do TratamentoRESUMO
BACKGROUND: The trophic or chronic plantar ulcer of leprosy is one of the principle causes of disability and deformity in the disease and has been given due importance in the evolution of its classification. In view of the diversity of its clinical implications, the World Health Organization was obliged to bring this entity under its remit in order to develop uniform guidelines to be applied around the globe. Despite relentless endeavor, its management continues to represent a dilemma. OBJECTIVES: The role of topical phenytoin sodium in wound healing led this group to evaluate its efficacy in the healing of trophic or chronic plantar ulcers. The success of the therapy was assessed according to the extent of regression in the size of the ulcer(s) following the formation of granulation tissue. METHODS: Forty patients released from leprosy control were recruited. A retrospective diagnosis was made in each case, and patients were grouped accordingly. Demographic data were recorded after the provision of informed consent. Bacterial cultures before and after treatment, and radiography were performed in each case. A phenytoin sodium fine powder zinc oxide paste dressing was applied every day for four weeks. Granulation was graded according to its appearance in order to evaluate the success of the topical therapy. RESULTS: Of the 40 patients, 26 (65.0%) borderline lepromatous leprosy patients had trophic ulcers, with the ball of the great toe being the most common site. Twelve (30.0%) patients had bone involvement. A total of 22 (55.0%) patients achieved complete resolution of the ulcer, and evidence of granulation formation was seen in 33 (82.5%) patients. The clearance of bacterial load after treatment was a significant finding. Zinc oxide paste per se was not effective, but its role as a vehicle was an asset. CONCLUSIONS: Phenytoin sodium zinc oxide paste was found to be an efficacious, cost-effective, and well-tolerated alternative therapy. Patient compliance was good. Bone involvement contributed to poor wound healing, but the clearance of bacterial load was significant.
Assuntos
Anticonvulsivantes/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Úlcera do Pé/tratamento farmacológico , Hanseníase Dimorfa/complicações , Fenitoína/uso terapêutico , Óxido de Zinco/uso terapêutico , Administração Cutânea , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/administração & dosagem , Carga Bacteriana/efeitos dos fármacos , Criança , Doença Crônica , Fármacos Dermatológicos/administração & dosagem , Combinação de Medicamentos , Feminino , Úlcera do Pé/microbiologia , Tecido de Granulação , Humanos , Masculino , Pessoa de Meia-Idade , Fenitoína/administração & dosagem , Cicatrização , Adulto Jovem , Óxido de Zinco/administração & dosagemRESUMO
Dapsone has shown anti-convulsive properties in animal models of epilepsy. In the present study, we tested the safety and tolerability of dapsone as adjunctive therapy in adult patients with drug-resistant partial-onset seizures. Twenty-two adult patients with drug-resistant partial-onset seizures were included. After a 3-month baseline period, patients received dapsone 100 mg per day, for a 3-month evaluation period. Plasma concentrations of anti-epileptic drugs (AEDs) did not significantly change during the study. No alteration of mean clinical laboratory values was observed. The reported adverse events were: mild methemoglobinemia (50%), headache (31.8%), paleness (27.3%) and somnolence (4.5%).Sixteen of 22 patients reduced their seizure frequency in more than 50% as a result of dapsone treatment. Three subjects remained seizure-free during the entire dapsone treatment period. This open-label study of adjunctive dapsone therapy at 100 mg/day suggests that dapsone is safe, and well-tolerated in adults with drug-resistant partial-onset seizures.
Assuntos
Anticonvulsivantes/uso terapêutico , Dapsona/uso terapêutico , Epilepsias Parciais/tratamento farmacológico , Hansenostáticos/uso terapêutico , Adolescente , Adulto , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/sangue , Dapsona/sangue , Interações Medicamentosas , Eletrocardiografia , Epilepsias Parciais/induzido quimicamente , Feminino , Seguimentos , Humanos , Hansenostáticos/sangue , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
INTRODUCTION: Digital neuropathy is a pure sensory neuropathy of a digital nerve. It may be caused by acute or chronic local trauma or pressure, or accompany systemic illnesses such as rheumatoid disease, leprosy, Raynaud disease, dysproteinemia, or diabetes mellitus. We describe an extraordinary case of digital neuropathy of the median and ulnar nerves caused by Dupuytren contracture. CASE REPORT: A 56-year-old right-handed man was presented with numbness and tingling of the little finger of the right and ring finger of the left hand. The clinical and EMG findings in this patient were consistent with a lesion of the median and ulnar palmar digital nerves of the right and left ring and little fingers. CONCLUSION: Dupuytren tissue usually affects the palmar fascia, superficial to the digital nerves, and it may rarely affect the spiral cord in the digits. A spiral cord may cause sensory loss due to impingement of digital nerves or Dupuytren tissue may have been compressing the palmar digital nerves against the relatively inelastic deep transverse metacarpal ligament. As a result, digital neuropathy can develop in those with Dupuytren's contracture, and nerve conduction studies should also be performed to determine the condition. New studies are needed to provide better diagnostic criteria for the condition.
Assuntos
Contratura de Dupuytren/fisiopatologia , Dedos/fisiopatologia , Neuropatia Mediana/fisiopatologia , Neuropatias Ulnares/fisiopatologia , Anticonvulsivantes/farmacologia , Anticonvulsivantes/uso terapêutico , Carbamazepina/farmacologia , Carbamazepina/uso terapêutico , Contratura de Dupuytren/etiologia , Contratura de Dupuytren/patologia , Eletrodiagnóstico , Fáscia/patologia , Fáscia/fisiopatologia , Dedos/inervação , Glucocorticoides/farmacologia , Glucocorticoides/uso terapêutico , Mãos/inervação , Mãos/patologia , Mãos/fisiopatologia , Humanos , Masculino , Nervo Mediano/patologia , Nervo Mediano/fisiopatologia , Nervo Mediano/cirurgia , Neuropatia Mediana/etiologia , Neuropatia Mediana/patologia , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Cooperação do Paciente , Resultado do Tratamento , Triancinolona/farmacologia , Triancinolona/uso terapêutico , Nervo Ulnar/patologia , Nervo Ulnar/fisiopatologia , Nervo Ulnar/cirurgia , Neuropatias Ulnares/etiologia , Neuropatias Ulnares/patologiaRESUMO
Neuropathic pain has been known to be refractory to traditional analgesics, such as opioids and non-steroidal anti-inflammatoy drugs. Some mechanisms of the development of neuropathic pain have been proposed; 1) sprouting of A beta fibers to the superficial layer of the dorsal horn, 2) ectopic discharge in the dorsal root ganglion and/or in neuroma at the nerve stump, 3) spinal sensitization. Ectopic discharge has been reported to be inhibited by Na+ channel blocker, such as lidocaine, and anticonvulsant. Lidocaine and anticonvulsant are used in the management of neuropathic pain. Activation of NMDA receptor is usually involved in the development of spinal sensitization and NMDA receptor antagonist, such as ketamine, is used in the management of neuropathic pain. Recently, alpha2delta subunit blocker, new class of anticonvulsant, is introduced to the management of neuropathic pain. alpha2delta subunit is the subunit of Ca2+ channel and modulate the influx of Ca2+. This Ca2+ influx induces release of neurotransmitter in the neuron. alpha 2 delta subunit blockers, such as gabapentin and pregabalin, may reduce the release of neurotransmitter and elicit analgesic effect in the treatment of neuropathic pain.
Assuntos
Neuralgia/tratamento farmacológico , Neuralgia/etiologia , Aminas/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Doença Crônica , Ácidos Cicloexanocarboxílicos/uso terapêutico , Gabapentina , Humanos , Ketamina/uso terapêutico , Hanseníase/complicações , Lidocaína/uso terapêutico , Células do Corno Posterior/fisiopatologia , Pregabalina , Receptores de N-Metil-D-Aspartato/antagonistas & inibidores , Bloqueadores dos Canais de Sódio/uso terapêutico , Ácido gama-Aminobutírico/análogos & derivados , Ácido gama-Aminobutírico/uso terapêuticoRESUMO
BACKGROUND: Oral phenytoin was first introduced as an antiseizure medication in 1937. Over 60 years investigators have shown an interest in how topical phenytoin may be used to promote wound healing in a variety of chronic wounds. OBJECTIVES: Systematically to identify, summarize and critically appraise the clinical evidence available on the effects of topical phenytoin on wound healing. METHODS: Systematic searches were carried out in PubMed (1963-2005), Medline (1966-2005) and Cinahl (1982-2005) for the years listed and in the Cochrane Library and the University of York NHS Centre for Reviews and Dissemination. The search terms used the following key words alone and in combination: phenytoin, wounds and injuries, wound healing, and wound care. Secondary hand searching was also carried out using relevant journal articles and reference lists, historical books, conference proceedings and theses in the area of wound healing. Papers were included if they described randomized controlled trials (RCTs) on humans and if the primary aim was wound closure, with a secondary aim of measuring wound healing over time. The methodological quality of the papers in this systematic review was assessed using the van Tulder method and in addition best-evidence synthesis was carried out. The magnitude of the effect of phenytoin therapy in the studies included in the systematic review was investigated in four of the 14 trials. RESULTS: Fourteen RCTs were included in the systematic review. Two papers were of high and 12 papers of low to moderate methodological quality. Most papers failed to describe randomization, treatment allocation and blinding techniques adequately. There was moderate evidence presented to support the use of phenytoin for the treatment of leg ulcers, leprosy wounds, chronic wounds and diabetic foot ulcers. There was a positive percentage treatment effect in favour of the phenytoin-treated group in one study investigating diabetic foot wounds and one study on chronic wounds. There was limited evidence for the use of phenytoin on burns and war wounds. CONCLUSIONS: Overall it would appear that studies investigating the effect of topical phenytoin on wound healing are of moderate methodological quality, and these suggest that there may be a positive effect on wound healing in a variety of wounds.
Assuntos
Anticonvulsivantes/uso terapêutico , Fenitoína/uso terapêutico , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/tratamento farmacológico , Administração Tópica , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Estudo clínico, prospectivo, aleatório, duplamente encoberto em 80 hansênicos com dor neuropática, de ambos sexos, idade entre 18 e 65 anos, divididos em 4 grupos: gabapentina 400mg/dia, carbamazepina 200/mg dia, gabapentina 400mg/dia e amitriptilina 25 mg/dia, carbamazepina 200 mg/dia e amitriptilina 25 mg/dia, avaliados por 4 meses quanto intensidade e duração da dor. A intensidade da dor foi semelhante em todos os grupos no momento da inclusão e encerramento do estudo, a diminuição da dor foi semelhante em todos os grupos, não havendo superioridade de nenhuma das terapêuticas. Duração da dor, em dias, foi maior no grupo gabapentina, foi menor e igual nos grupos carbamazepina e gabapentina/amitriptilina e intermediária no grupo carbamazepina/amitriptilina / This study is a clinical trial prospective controlled four-way crossover double-blind randomized. Eighty Hansen's patients, male and female, aged 18 to 65, with neuropathic pain took part. The patients were divided into 4 groups as follows: gabapentin 400 mg dose daily, carbamazepine 200 mg dose daily, gabapentin 400 mg dose in association with an amitriptyline 25 mg daily, carbamazepine 200 mg dose in association with an amitriptyline 25 mg daily, assessed for four months taking into account pain intensity.The results demonstrated that intensity of pain was similar in patients belonging to all groups,at the moment of inclusion and at the end of the study. The reduction in the intensity of pain was also similar in all groups, without any report of superior effectiveness in any of the four groups studied...
Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Humanos , Anticonvulsivantes/uso terapêutico , Hanseníase/etiologia , Neuralgia/terapia , Amitriptilina , AntidepressivosRESUMO
Dapsone (4,4'-diaminodiphenyl sulfone; DDS), an established anti-leprosy drug, showed anticonvulsive effects in the amygdaloid kindling model of epilepsy. Single doses of the drug in rats (6.25-12.5 mg/kg, i.p.) suppressed the kindled seizures in a dose-dependent manner without overt behavioral toxicity. With repeated oral administration in cats, relatively higher initial doses (13-23 mg/kg) were required to obtain seizure suppression, and neurotoxic signs occurred within a few days with serum drug levels of approximately 20 micrograms/ml. Although dapsone showed anticonvulsive effects in both animal species, the effective serum levels overlapped the toxic levels reported in the clinical treatment of leprosy. In the majority of the cats, however, seizure suppression was maintained even after the discontinuation of dapsone with lower serum levels than those observed at the beginning of the seizure suppression. Therefore, dapsone would be useful as an antiepileptic drug only when long-term anticonvulsive efficacy is demonstrated using smaller doses comparable to those used in the treatment of leprosy.