[Is epilepsy in the elderly overlooked? An investigation in a home for the aged]. / Werden Epilepsien bei älteren Menschen übersehen?Eine Untersuchung in Altenheimen.

The symptoms of epileptic seizures in old patients differ from those in younger patients. Therefore, these seizures may be misinterpreted as symptoms of other "typical" diseases in old people. In an old people's home, we assessed whether a standardized questionnaire is able to reveal undiagnosed epilepsy in the elderly. Reported sudden falls, loss of consciousness, and cramps were the criteria for further diagnostic procedures. We found epilepsy in 11 of 389 study participants. In four of them (1% of the total sample), the epilepsy was newly diagnosed; five more cases remained unclear. Therefore, the total number of epileptic patients might have been even higher. Most of the reported sudden falls and unconsciousness (89%) were due to internal medical or other neurological or orthopaedic causes. Once these have been excluded, the diagnosis of epilepsy should be considered. The results of our pilot study suggest that epilepsy in old people's homes is often unrecognised. Early diagnosis and treatment of epilepsy in the elderly is important to improve prognosis and social consequences for affected persons.

Abrupt withdrawal of pindolol or metoprolol after chronic therapy.

1 In an open controlled study a group of 18 healthy volunteers received either pindolol 10 mg three times daily or metoprolol 100 mg three times daily for 4 weeks. Before treatment, and after abrupt withdrawal the resting heart rate, the blood pressure, the exercise heart rate and the isoprenaline CD25 (dose of isoprenaline to increase the heart rate of 25 beats/min) were determined. Heart rates were continuously monitored by an ECG-coupled computer. The CD25 values were calculated by an off line computer procedure from the on line recorded data. 2 After metoprolol we found 6 out of 12 patients with a CD25 below baseline, in one case with a corresponding increase in heart rate during exercise. After pindolol we observed a CD25 below baseline only in one case with no corresponding reaction in the exercise test. In both groups we observed a reactive increase in resting heart rate and systolic blood pressure around day 5 after withdrawal. 3 We conclude that abrupt withdrawal of metoprolol in contrast to pindolol is associated with a higher risk of developing beta-adrenergic receptor hypersensitivity.

Hemodynamic effects of single-dose administration of AR-L 115 BS in patients with coronary artery disease.

2-[(2-Methoxy-4-methylsulfinyl)phenyl]-1H-imidazo[4,5-b]pyridine (AR-L 115 BS) was investigated in 14 patients with coronary artery disease (CAD) and an elevated left ventricular enddiastolic pressure at rest (LVEDP). There was a significant decrease in the systolic (AOPS) and diastolic aortic pressures (AOPD) of 9% and 6%, respectively, (p less than 0.001, p less than 0.01). The LVEDP decreased by 29% (p less than 0.001), and the maximum rate of pressure rise (dp/dt max) increased by 19% (p less 0.001). The systolic (PAPS) and diastolic pulmonary artery pressures (PAPD) fell by 17% and 16%, respectively (p less than 0.05). The cardiac index (CI) increased by 12% (p less than 0.05), and the peripheral resistance (SVR) fell by 17% (p less than 0.001). Heart rate increased slightly by 5% (p less than 0.1) but this was of no clinical relevance. The right atrial pressure (RAP) and the tension time index (TTI) remained unchanged. AR-L 15 BS was observed to have vasodilating and positive inotropic effects without increasing oxygen consumption. It can therefore be recommended for use in patients with CAD and an elevated LVEDP. Side-effects have not been reported.