ABSTRACT
A group of 51 patients with chronic cryptogenic or symptomatic localized epilepsy refractory to therapy with barbiturates underwent progressive substitution with phenytoin or carbamazepine, in standardized and randomized fashion. After drug changes were completed two thirds of the patients remained seizure free during a period of 6 months. A clearer effect of phenytoin and carbamazepine was seen on secondary generalized than on partial seizures. The frequency of severe side effects decreased after the change to phenytoin and carbamazepine. The group on carbamazepine improved in immediate and late recall, and in immediate and late recognition of pictures. The group on phenytoin improved significantly in the Stroop test. Patients changed to phenytoin, but not those changed to carbamazepine, became significantly more aggressive, anxious and depressive than when on phenobarbital, as measured by subjective scales. The results indicate that patients should not be considered refractory to antiepileptic drug therapy while on barbiturates. Cognitive dysfunction and mood changes observed in epilepsy may be temporary and dependent on the presence of seizures and/or on use of barbiturates.
Subject(s)
Affect/drug effects , Carbamazepine/therapeutic use , Cognition/drug effects , Epilepsies, Partial/drug therapy , Epilepsy/drug therapy , Phenytoin/therapeutic use , Adolescent , Adult , Carbamazepine/adverse effects , Carbamazepine/pharmacokinetics , Child , Epilepsy/psychology , Female , Humans , Male , Middle Aged , Phenytoin/adverse effects , Phenytoin/pharmacokinetics , Prospective StudiesABSTRACT
A group of patients with portal-systemic encephalopathy were studied. The conscious disturbances, eletroencephalographic findings and the spinal fluid glutamine levels were analyzed. Based on the results the authors concluded that the eletrencephalogram can be utilized for determination of the degree of hepatic coma and also for its prognostic valuation. In addition they found that monitorization of spinal fluid glutamine levels is the most important test for characterization of the degree of hepatic encephalopathy.
Subject(s)
Electroencephalography , Glutamine/cerebrospinal fluid , Hepatic Encephalopathy/physiopathology , Adult , Aged , Ammonia/blood , Female , Hepatic Encephalopathy/cerebrospinal fluid , Humans , Male , Middle Aged , PrognosisABSTRACT
Approximately three-quarters of epileptic patients seen in consultation by specialists can easily be assigned to one of the diagnostic categories of the International League against Epilepsy. When patient age is taken into account, such a distribution shows that partial epilepsy is more common than generalized epilepsy (62% versus 38%) in patients of all ages, especially in those over 15 years of age (78% versus 22%). In contrast, generalized epilepsy is more frequent in subjects under 15 than partial epilepsy (55% versus 45%). In this younger age group the rarity of partial epilepsy is primarily due to the infrequency of temporal lobe epilepsy (21% of cases, as opposed to 56% in subjects over 15), whereas both primary and secondary generalized epilepsy contribute to the frequency of generalized epilepsy in this group.