Vigabatrin: clinical evidence supporting rational polytherapy in management of uncontrolled seizures.

Monotherapy is the policy for management of patients with epilepsy. With increasing knowledge of the biology of epilepsy and of the modes of action of antiepileptic drugs (AEDs), this concept must be reevaluated. When monotherapy fails to control seizures, subsequent treatment should be based on "rational pharmacology," taking into consideration the mode of action of the drugs, to provide improved efficacy with maintained tolerance and ease of administration. Introduction of vigabatrin (VGB) as a new AED calls for just such a reevaluation. VGB is an enzyme-activated irreversible inhibitor of gamma-aminobutyric acid (GABA)-transaminase that increases brain and cerebrospinal (CSF) GABA concentrations in animals and humans. It has limited efficacy in the classic animal seizure screening tests, but in many clinical studies has halved the incidence of seizures in approximately 50% of patients, especially those with partial epilepsies. We evaluated the efficacy of VGB in "socially integrated and active outpatients" as a likely subset to demonstrate any advantage of rational polytherapy. The criteria for this evaluation included the effects on seizure frequency, patient tolerability, and cognitive performance in a battery of psychometric tests. Fourteen of the 19 patients (73%) completing the study had > 50% reduction in seizure frequency, and 10 of 19 (52%) had > 70% reduction in seizure frequency. Tolerability appeared good; somnolence was the most frequent adverse event. Three patients complained of a worsening of their seizures, 1 with an increase in frequency and 2 with development of myoclonic jerks not previously reported.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ulterior observations on the use of C3 in acute myocardial infarction: 105 patients were treated within the 1st 6 hours after the symptoms started]. / Observaciones ulteriores sobre el uso del C3 en el infarto miocárdico agudo: 105 pacientes tratados a las seis horas del comienzo de los sintomas

Two homogeneous groups of patients with acute myocardial infarction were observed within the first six hours from the coronary attack. On admittance and for ten days, 105 patients were treated with C3: the mortality rate resulted in 13.3%. The control group of 108 patients showed a mortality of 18.5%. Strict criteria of randomization were followed in allocating patients to the two groups. Although the difference is not statistically significant it is however interesting since it confirms a previous research. Statistically significant differences between the two groups were observed in all surviving patients in the injury signs regression time and in the cardiac volume in favour of the group treated with C3.