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1.
Neurology ; 96(1): e102-e110, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33055270

RESUMO

OBJECTIVE: To test the accuracy of an equation in adult patients with status epilepticus that calculates the free concentration of serum valproic acid (fVPA) from the total concentration of serum valproic acid (tVPA) and serum albumin. METHODS: All adult patients with status epilepticus who were treated at a Swiss academic medical center between 2005 and 2018 with concurrent measurements of tVPA, fVPA, and serum albumin were included. fVPA was categorized as subtherapeutic, therapeutic (5-10 mg/L), or supratherapeutic. Agreement was defined as the proportion of measured and calculated fVPA falling within the same category. RESULTS: Of 676 patients with status epilepticus, 104 had 506 measurements, with a median of 3 (interquartile range [IQR] 1.5-6.5) per patient. The median tVPA was 43.5 mg/L (27.4-63.6), with measured fVPA 9.1 mg/L (4.5-14.7) and calculated fVPA 10.1 mg/L (7.0-13.0), respectively. The median deviation of calculated from measured fVPA was -0.8 mg/L (-3.2 to 2.5) with 336 measurements >1 mg/L. While the association between measured and calculated fVPA was linear (regression coefficient 1.1, 95% confidence interval 0.9-1.2, p < 0.0001), the agreement on effective drug levels did not match in 39.8% of measurements regardless of serum albumin levels, with calculated fVPA overestimating measured fVPA in 30.4%. tVPA and serum albumin independently influenced the accuracy of the calculated fVPA in the multivariable model. CONCLUSIONS: Calculated fVPA is inaccurate when using the proposed equation in adult patients with status epilepticus, calling for drug monitoring based on measured fVPA in this context.


Assuntos
Anticonvulsivantes/sangue , Análise Química do Sangue/métodos , Análise Química do Sangue/normas , Estado Epiléptico/tratamento farmacológico , Ácido Valproico/sangue , Idoso , Anticonvulsivantes/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Albumina Sérica/análise , Ácido Valproico/uso terapêutico
2.
Med Clin North Am ; 105(1): 39-53, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246522

RESUMO

Headaches are common in primary care. The diagnosis is made by a careful history and physical examination. Imaging is generally not warranted. Several general principles underlie the acute treatment of headache: early initiation of therapy and adequate dosing at first dose. Careful attention to avoiding too frequent administration of acute therapy is important to avoid medication overuse headaches. Opioids should always be avoided. Preventive treatment is indicated for frequent headaches. Successful treatment entails low-dose medication with careful titration and monitoring of headache frequency. Behavioral strategies are important and should be part of any comprehensive headache management plan.


Assuntos
Cefaleia/diagnóstico , Cefaleia/terapia , Adulto , Analgésicos/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Terapia Comportamental , Cefaleia/classificação , Cefaleia/fisiopatologia , Humanos , Anamnese , Exame Físico , Atenção Primária à Saúde
3.
Emerg Med Clin North Am ; 39(1): 133-154, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218654

RESUMO

Management of acute neurologic disorders in the emergency department is multimodal and may require the use of medications to decrease morbidity and mortality secondary to neurologic injury. Clinicians should form an individualized treatment approach with regard to various patient specific factors. This review article focuses on the pharmacotherapy for common neurologic emergencies that present to the emergency department, including traumatic brain injury, central nervous system infections, status epilepticus, hypertensive emergencies, spinal cord injury, and neurogenic shock.


Assuntos
Serviço Hospitalar de Emergência , Doenças do Sistema Nervoso/tratamento farmacológico , Anticonvulsivantes/uso terapêutico , Lesões Encefálicas Traumáticas/tratamento farmacológico , Infecções do Sistema Nervoso Central/tratamento farmacológico , Emergências , Humanos , Pressão Intracraniana/efeitos dos fármacos , Neurofarmacologia , Estado Epiléptico/tratamento farmacológico
5.
Acta Neurol Scand ; 143(2): 206-209, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32990951

RESUMO

BACKGROUND: Lockdown due to the SARS-CoV-2 pandemic became a challenge to maintain care for patients with epilepsy; we aimed to find out how the pandemic affected them. METHODS: We sent an online 22-item questionnaire to patients from our outpatient clinic, a reference centre in Spain for drug-resistant epilepsy, inquiring about the effects of lockdown, from March to May 2020. RESULTS: We sent the survey to 627 patients; 312 (58% women) sent a complete response and were included. Of all respondents, 57% took >2 antiseizure medications. One-third of respondents (29%) declared an associated cognitive or motor disability. A minority had confirmed infection with SARS-CoV-2 (1.92%). Seizure frequency remained like usual in 56% of patients, while 31.2% reported an increase. Less than 10% needed emergent assistance. Almost half reported anxiety or depression, and 25% increased behavioural disorders. Mood (F: 5.40; p: 0.002) and sleep disorders (F = 2.67; p: 0.05) were associated with increase in seizure frequency. Patients were able to contact their physicians when needed and were open to a future telematic approach to follow-up visits. CONCLUSIONS: Seizure frequency and severity remained unchanged in most patients during the lockdown. Mood and sleep disorders were common and associated with seizure worsening. Patients were open to telematic care in the future.


Assuntos
Epilepsia/terapia , Pandemias , Quarentena/estatística & dados numéricos , Adulto , Anticonvulsivantes/uso terapêutico , Ansiedade/complicações , /epidemiologia , Transtornos Cognitivos/complicações , Controle de Doenças Transmissíveis , Depressão/complicações , Pessoas com Deficiência , Epilepsia/complicações , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Transtornos Motores/complicações , Pacientes Ambulatoriais , Convulsões/epidemiologia , Transtornos do Sono-Vigília/classificação , Transtornos do Sono-Vigília/epidemiologia , Espanha/epidemiologia , Inquéritos e Questionários , Telemedicina
6.
Epilepsia ; 62(1): 41-50, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33258109

RESUMO

OBJECTIVE: Our epilepsy population recently experienced the acute effects of the COVID-19 pandemic in New York City. Herein, we aimed to determine patient-perceived seizure control during the surge, specific variables associated with worsened seizures, the prevalence of specific barriers to care, and patient-perceived efficacy of epilepsy care delivered via telephone and live video visits during the pandemic. METHODS: We performed a cross-sectional questionnaire study of adult epilepsy patients who had a scheduled appointment at a single urban Comprehensive Epilepsy Center (Montefiore Medical Center) between March 1, 2020 and May 31, 2020 during the peak of the COVID-19 pandemic in the Bronx. Subjects able to answer the questionnaire themselves in English or Spanish were eligible to complete a one-time survey via telephone or secure online platform (REDCap). RESULTS: Of 1212 subjects screened, 675 were eligible, and 177 adequately completed the questionnaire. During the COVID-19 pandemic, 75.1% of patients reported no change in seizure control, whereas 17.5% reported that their seizure control had worsened, and 7.3% reported improvement. Subjects who reported worsened seizure control had more frequent seizures at baseline, were more likely to identify stress and headaches/migraines as their typical seizure precipitants, and were significantly more likely to report increased stress related to the pandemic. Subjects with confirmed or suspected COVID-19 did not report worsened seizure control. Nearly 17% of subjects reported poorer epilepsy care, and 9.6% had difficulty obtaining their antiseizure medications; these subjects were significantly more likely to report worse seizure control. SIGNIFICANCE: Of the nearly 20% of subjects who reported worsened seizure control during the COVID-19 pandemic, stress and barriers to care appear to have posed the greatest challenge. This unprecedented pandemic exacerbated existing and created new barriers to epilepsy care, which must be addressed.


Assuntos
Atitude Frente a Saúde , /psicologia , Epilepsia/psicologia , Epilepsia/terapia , Acesso aos Serviços de Saúde , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , População Urbana , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/uso terapêutico , Estudos Transversais , Epilepsia/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Satisfação do Paciente , Consulta Remota , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
7.
Aquat Toxicol ; 230: 105673, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33221665

RESUMO

The negative effects induced in marine organisms by Climate Change related abiotic factors consequences, namely ocean warming, are well-known. However, few works studied the combined impacts of ocean warming and contaminants, as pharmaceutical drugs. Carbamazepine (CBZ) and cetirizine (CTZ) occur in the marine environment, showing negative effects in marine organisms. This study aimed to evaluate the impacts of ocean warming on the effects of CBZ and CTZ, when acting individually and combined (drug vs drug), in the edible clam Ruditapes philippinarum. For that, drugs concentration, bioconcentration factors and biochemical parameters, related with clam's metabolic capacity and oxidative stress, were evaluated after 28 days exposure to environmentally relevant scenarios of these stressors. The results showed limited impacts of the drugs (single and combined) at control and warming condition. Indeed, it appeared that warming improved the oxidative status of contaminated clams (higher reduced to oxidized glutathione ratio, lower lipid peroxidation and protein carbonylation levels), especially when both drugs were combined. This may result from clam's defence mechanisms activation and reduced metabolic capacity that, respectively, increased elimination and limited production of reactive oxygen species. At low stress levels, defence mechanisms were not activated which resulted into oxidative stress. The present findings highlighted that under higher stress levels clams may be able to activate defence strategies that were sufficient to avoid cellular damages and loss of redox homeostasis. Nevertheless, low concentrations were tested in the present study and the observed responses may greatly change under increased pollution levels or temperatures. Further research on this topic is needed since marine heat waves are increasing in frequency and intensity and pollution levels of some pharmaceuticals are also increasing in coastal systems.


Assuntos
Anticonvulsivantes/toxicidade , Bivalves/efeitos dos fármacos , Antagonistas dos Receptores Histamínicos/toxicidade , Estresse Oxidativo/efeitos dos fármacos , Água do Mar/química , Poluentes Químicos da Água/toxicidade , Animais , Biomarcadores/metabolismo , Bivalves/metabolismo , Mudança Climática , Interações Medicamentosas , Modelos Teóricos , Oceanos e Mares , Temperatura
8.
Int J Dermatol ; 60(1): 53-59, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33252832

RESUMO

BACKGROUND: To retrospectively review the outcomes of two rare cutaneous diseases, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), and to question the practice of averaging the mortality rate on the assumption that they are one disease. METHODS: A retrospective chart review of all patients diagnosed with SJS and TEN by a dermatologist between January 1, 2000, and January 1, 2020, at our institution was performed. Seventy-one patients were identified (21 pediatric and 50 adults). Pathology slides from 32 adult patients (64%) were evaluated by a blinded board-certified dermatopathologist. RESULTS: Of the adult patients, 31 had SJS, two had SJS-TEN overlap, and 17 had TEN. All 21 patients in the pediatric group were diagnosed with SJS mainly caused by Mycoplasma. Mortality rates were 6.5% for SJS among adults and 35.3% for TEN. Chemotherapy-induced TEN is a trigger with 50% mortality. CONCLUSIONS: SJS was more common in adults and pediatric cases than TEN (3:1) and had a much better prognosis and outcome. Combining and averaging the mortality rates of TEN and SJS are not advised as SJS is mainly a mucocutaneous disorder with good prognosis versus TEN, a systemic toxicity of multiple organs with deep skin detachment.


Assuntos
Síndrome de Stevens-Johnson/etiologia , Síndrome de Stevens-Johnson/mortalidade , Adolescente , Adulto , Fatores Etários , Antibacterianos/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Anticonvulsivantes/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infecções por Mycoplasma/complicações , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Esteroides/uso terapêutico , Síndrome de Stevens-Johnson/patologia , Síndrome de Stevens-Johnson/terapia , Adulto Jovem
12.
Medicine (Baltimore) ; 99(50): e23577, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327318

RESUMO

OBJECTIVE: Atorvastatin and aspirin have been used in treating different forms of epilepsy. However, their effect on post-stroke epilepsy (PSE) still needs to be validated by large-scale clinical studies. In addition, their impact on the use of the antiepileptic drug levetiracetam for post-stroke epilepsy remains to be explored. Thus, the aim of this study was to further evaluate the effect of atorvastatin and aspirin on PSE and their effect on the usage of the antiepileptic drug levetiracetam in PSE patients. METHODS: Patients, aged 65 to 85 years, with newly diagnosed post-ischemic stroke epilepsy from August 30, 2014 to August 30, 2018 were included in the study, with the exclusion of those with coexisting conditions. RESULTS: Initially, 1321 patients were included, and 780 remained in the study at the 1-year follow-up. During the study, atorvastatin treatment with or without aspirin reduced the number of clinical epileptic episodes in PSE patients. It also reduced the dosage of levetiracetam and achieved better control of epilepsy compared to levetiracetam mono-treatment. Aspirin co-treatment with levetiracetam did not result in a significant improvement. However, the combination of aspirin with atorvastatin significantly reduced the number of seizures compared to atorvastatin treatment alone. CONCLUSION: Atorvastatin and aspirin co-treatment with levetiracetam can reduce epilepsy in PSE patients and reduce the dosage of levetiracetam required for effective control of PSE.


Assuntos
Anticonvulsivantes/uso terapêutico , Aspirina/uso terapêutico , Atorvastatina/uso terapêutico , Epilepsia/tratamento farmacológico , Levetiracetam/uso terapêutico , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/administração & dosagem , Aspirina/administração & dosagem , Atorvastatina/administração & dosagem , Infarto Cerebral/complicações , Infarto Cerebral/patologia , Quimioterapia Combinada , Epilepsia/etiologia , Feminino , Humanos , Levetiracetam/administração & dosagem , Masculino , Índice de Gravidade de Doença , Acidente Vascular Cerebral/patologia
13.
BMJ Case Rep ; 13(12)2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33323420

RESUMO

Hyperekplexia is an exaggerated startle to external stimuli associated with a generalised increase in tone seen in neonates with both sporadic and genetic predisposition. This is an uncommon neurological entity that is misdiagnosed as seizure. A 28-days-old infant was admitted to us with characteristic intermittent generalised tonic spasm being treated as a seizure disorder. The infant had characteristic stiffening episode, exaggerated startle and non-habituation on tapping the nose. Hyperekplexia was suspected and confirmed by genetic testing (mutation in the ß subunit of glycine was found). Initial improvement was seen with the use of clonazepam, which was not sustained. At the age of 4.5 years, the child is still having neurobehavioural issues like hyperactivity and sensory hyper-responsiveness. Usually, hyperekplexia is benign in nature. We report a case of hyperekplexia with non-sense mutation in the ß subunit of GlyR gene having abnormal neurodevelopmental findings at 4.5 years.


Assuntos
Hiperecplexia/diagnóstico , Hiperecplexia/genética , Mutação de Sentido Incorreto/genética , Receptores da Glicina/genética , Anticonvulsivantes/uso terapêutico , Pré-Escolar , Clonazepam/uso terapêutico , Diagnóstico Diferencial , Erros de Diagnóstico , Humanos , Hiperecplexia/fisiopatologia , Hipercinese/genética , Hipercinese/fisiopatologia , Recém-Nascido , Masculino , Reflexo Anormal/genética , Reflexo de Sobressalto/genética
14.
Sci Rep ; 10(1): 20982, 2020 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-33268798

RESUMO

The Amazon rodent Proechimys guyannensis is widely studied for hosting various pathogens, though rarely getting sick. Previous studies on male Proechimys have revealed an endogenous resistance to epilepsy. Here, we assess in female Proechimys, whether sex hormones and biochemical aspects can interfere with the induction of status epilepticus (SE). The lithium-pilocarpine ramp-up protocol was used to induce SE, and blood sera were collected at 30 and 90 min after SE, alongside brains, for biochemical, western blot and immunohistochemical analyses. Results from non-ovariectomised (NOVX) Proechimys were compared to ovariectomised (OVX) animals. Data from female Wistars were used as a positive control of SE inductions. SE latency was similar in NOVX, OVX, and female Wistars groups. However, the pilocarpine dose required to induce SE in Proechimys was higher (25- to 50-folds more). Despite a higher dose, Proechimys did not show strong SE like Wistars; they only reached stage 2 of the Racine scale. These data suggest that female Proechimys are resistant to SE induction. Glucose and progesterone levels increased at 30 min and returned to normal at 90 min after SE. A relevant fact because in humans and rodents, SE leads to hypoglycaemia after 30 min of SE and does not return to normal levels in a short time, a typical adverse effect of SE. In OVX animals, a decrease in GABAergic receptors within 90 min of SE may suggest that ovariectomy produces changes in the hippocampus, including a certain vulnerability to seizures. We speculate that progesterone and glucose increases form part of the compensatory mechanisms that provide resistance in Proechimys against SE induction.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia Resistente a Medicamentos/fisiopatologia , Pilocarpina/uso terapêutico , Roedores/fisiologia , Estado Epiléptico/tratamento farmacológico , Animais , Glicemia/análise , Modelos Animais de Doenças , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Epilepsia Resistente a Medicamentos/metabolismo , Feminino , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Hipocampo/fisiopatologia , Ovariectomia , Progesterona/sangue , Receptores Estrogênicos/metabolismo , Receptores de Progesterona/metabolismo , Roedores/metabolismo , Estado Epiléptico/metabolismo , Estado Epiléptico/fisiopatologia
15.
N Engl J Med ; 383(26): 2547-2556, 2020 12 24.
Artigo em Inglês | MEDLINE | ID: mdl-33369356

RESUMO

BACKGROUND: Among women with epilepsy, studies regarding changes in seizure frequency during pregnancy have been limited by the lack of an appropriate nonpregnant comparator group to provide data on the natural course of seizure frequency in both groups. METHODS: In this prospective, observational, multicenter cohort study, we compared the frequency of seizures during pregnancy through the peripartum period (the first 6 weeks after birth) (epoch 1) with the frequency during the postpartum period (the following 7.5 months after pregnancy) (epoch 2). Nonpregnant women with epilepsy were enrolled as controls and had similar follow-up during an 18-month period. The primary outcome was the percentage of women who had a higher frequency of seizures that impaired awareness during epoch 1 than during epoch 2. We also compared changes in the doses of antiepileptic drugs that were administered in the two groups during the first 9 months of epoch 1. RESULTS: We enrolled 351 pregnant women and 109 controls with epilepsy. Among the 299 pregnant women and 93 controls who had a history of seizures that impaired awareness and who had available data for the two epochs, seizure frequency was higher during epoch 1 than during epoch 2 in 70 pregnant women (23%) and in 23 controls (25%) (odds ratio, 0.93; 95% confidence interval [CI], 0.54 to 1.60). During pregnancy, the dose of an antiepileptic drug was changed at least once in 74% of pregnant women and in 31% of controls (odds ratio, 6.36; 95% CI, 3.82 to 10.59). CONCLUSIONS: Among women with epilepsy, the percentage who had a higher incidence of seizures during pregnancy than during the postpartum period was similar to that in women who were not pregnant during the corresponding epochs. Changes in doses of antiepileptic drugs occurred more frequently in pregnant women than in nonpregnant women during similar time periods. (Funded by the National Institutes of Health; MONEAD ClinicalTrials.gov number, NCT01730170.).


Assuntos
Anticonvulsivantes/administração & dosagem , Epilepsia/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Convulsões/prevenção & controle , Adulto , Feminino , Humanos , Incidência , Período Pós-Parto , Gravidez , Estudos Prospectivos , Convulsões/epidemiologia
16.
Medicine (Baltimore) ; 99(52): e23771, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350762

RESUMO

BACKGROUND: Lesional and symptomatic causes of epilepsy are the most common neurological disorders of the brain. Topiramate effectively controls newly diagnosed epilepsy and refractory focal seizures, but high-dose topiramate does not improve seizure control. This study aimed to evaluate the clinical efficacy and safety of dose-escalated topiramate as first-line monotherapy and add-on therapy in patients with neurosurgery-related epilepsy. MATERIAL AND METHODS: A total of 55 neurosurgical patients with epilepsy were divided into monotherapy and add-on therapy groups and both groups received topiramate via the dose-escalation method. The primary efficacy outcomes were seizure-free rate and seizure response rate. Adverse events and seizure frequency were recorded. RESULTS: The seizure response rate in the first month of monotherapy was significantly better than that of add-on therapy (89% vs 65%, P < .05), but no significant differences were found in seizure response rates between the 2 groups after 2 months of treatment. Both monotherapy and add-on therapy were effective in controlling seizures, with mean seizure frequency of 0.725 vs 0.536 and seizure-free rate of 88% vs 78.6%. Both treatments showed good improvement of seizure frequency in patients without tumor. The efficacy of monotherapy was better than that of add-on therapy (80% vs 29.2%) in patients with body mass index (BMI) ≤24. However, add-on therapy was better than monotherapy (76.7% vs 21.4%) in patients with BMI > 24. Dizziness (25.5%) and headache (16.4%) were the most common adverse events. No severe adverse event such as cognitive impairment was observed. CONCLUSIONS: Dose-escalated topiramate monotherapy and add-on therapy demonstrate good efficacy and safety, with fewer adverse events in seizure control in neurosurgical patients.


Assuntos
Relação Dose-Resposta a Droga , Quimioterapia Combinada/métodos , Epilepsia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias , Topiramato , Adulto , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/efeitos adversos , Monitoramento de Medicamentos/métodos , Epilepsia/diagnóstico , Epilepsia/tratamento farmacológico , Epilepsia/etiologia , Feminino , Humanos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Topiramato/administração & dosagem , Topiramato/efeitos adversos , Resultado do Tratamento
17.
Medicine (Baltimore) ; 99(52): e23929, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350798

RESUMO

BACKGROUND: Several studies demonstrated a connection between human leukocyte antigen (HLA)-B∗1502 and lamotrigine (LTG)-induced cutaneous adverse drug reactions (cADRs). The correlation between the HLA-A∗24:02 and LTG-cADRs remains controversial. To examine the associations between HLA-A∗24:02 and LTG-cADRs, we conducted a systematic review and meta-analysis. METHODS: We performed a comprehensive search of the literature in several electronic database systems including Cochrane Library, EMBASE and PubMed from inception to January 2020. Review Manager was used to compare the frequencies of HLA-A∗24:02 carriers between the subgroups. RESULTS: A total of 5 studies were eligible, including 197 LTD-cADRs, 396 LTD-tolerant controls, and 2068 population controls. Compared with the LTG-tolerant controls, there was a statistically significant association between the HLA-A∗24:02 allele and LTG-induced cADRs (odds ratios: 1.94, 95% confidence intervals 1.06-3.54; P = .03). Compared with the general population, the relationship between the HLA-A∗24:02 genotype and LTG-induced cADRs was statistically significant (summary odds ratios: 2.12, 95% confidence intervals 1.04-4.30; P = .04). CONCLUSIONS: HLA-A∗24:02 may be a risk factor for LTG-cADRs.


Assuntos
Erupção por Droga/genética , Antígeno HLA-A24/genética , Lamotrigina/efeitos adversos , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/farmacologia , Humanos , Lamotrigina/farmacologia , Variantes Farmacogenômicos , Fatores de Risco
18.
Zhonghua Yi Xue Za Zhi ; 100(47): 3764-3767, 2020 Dec 22.
Artigo em Chinês | MEDLINE | ID: mdl-33379840

RESUMO

Objective: To provide a portable electroencephalograph that can facilitate long-term monitoring of epilepsy patients outside the hospital, and establish a medical platform for epilepsy data monitoring and treatment. Methods: From June 2018 to October 2019, twenty-nine patients from Huashan Hospital (superior hospital) and Jing'an District Central Hospital (subordinate hospital) of Fudan University were enrolled in the study. Among them, twenty-eight cases were diagnosed with epilepsy and 1 case was epileptic seizure. Electroencephalogram (EEG) was collected by portable electroencephalograph once a week and followed up for three months. The seizure frequency, seizure form, medication type, EEG lead number and positive rate were recorded. Patients' medical records and EEG data were uploaded to the cloud database to build a medical alliance platform. Doctors of different levels of hospitals couldobtain diagnosis and achieve resource sharing based on the platform. The data was statistically analyzed using SPSS 18.0. Results: The EEG data collected by the portable electroencephalograph hadfewer artifacts, complete sleep cycle, and could record the interictaldischarges. Twenty-nine patientsunderwent a total of 148 EEG monitoring during the three-month follow-up. Eighty-five cases of epileptic discharges were detected, and the EEG positive rate was 57.4%. The positive rate of EEG in patients with generalized seizures (84.9%) was higher than that in patients with focal seizures (42.1%) (P<0.01); the positive rate of EEG in patients with 2-3 antiepileptic drugs and patients with frequent seizures within three months were also higher (P<0.05). Doctors in the superior hospital in the platform make diagnosis and treatment suggestions according to the above data. Elevenseizure-free patients and four patients with fewer seizures and discharges were diverted to the community hospital for follow-up. Fourteen patients with poor seizure control and/or continuous epileptic discharges were diverted to the superior hospitalto adjust the medication. Doctors of subordinate hospital acquired the diagnosis and treatment suggestions through the platform, and then strengthened the daily care and follow-up. Conclusion: Combined with a portable electroencephalograph, the current study establishs a medical platform for patients with epilepsy to achieve long-term monitoring and rational use of medical resources.


Assuntos
Epilepsia , Anticonvulsivantes/uso terapêutico , Eletroencefalografia , Epilepsia/diagnóstico , Humanos , Monitorização Fisiológica , Convulsões/diagnóstico
19.
Artigo em Russo | MEDLINE | ID: mdl-33340298

RESUMO

OBJECTIVE: To study the efficacy of reamberin in treatment of epilepsy in children and to evaluate its effect on the cognitive functions. MATERIAL AND METHODS: The study included 51 patients with epilepsy aged 7 to 15 years. The children were divided into four groups depending on the prescribed treatment. The first study group (n=16) received intravenous reamberin once daily for 5 days in addition to carbamazepine. The second group (n=15) received intravenous reamberin once daily for 5 days in addition to valproic acid. Two comparison groups (10 patients each) received only carbamazepine or only valproic acid, respectively. Cognitive functions were assessed at admission and on the 6th day of treatment using Schulte tables (10 words). RESULTS AND CONCLUSION: Reamberin significantly increases the work efficiency by 19-21%, and workability degree by 8-12% compared with the patients of the control groups. An analysis of the effect of succinate-containing drug on auditory memory has shown that the volumes of short-term memory and long-term memory are by 1.8 times and 1.3 times, respectively, higher than those in the control groups. Thus, the addition of reamberin into the treatment of children with epilepsy should be considered clinically reasonable, and promising.


Assuntos
Epilepsia , Succinatos , Adolescente , Anticonvulsivantes/uso terapêutico , Criança , Cognição , Epilepsia/tratamento farmacológico , Humanos , Meglumina/análogos & derivados , Meglumina/uso terapêutico , Succinatos/uso terapêutico
20.
Seizure ; 83: 251-263, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33334546

RESUMO

Epilepsy is one of the most common neurological disorders, affecting approximately 50 million people worldwide. Despite a dramatic increase in treatment options over the past 30 years, it still ranks fourth in the world's disease burden. There are now close to 30 antiepileptic drugs (AEDs), with more than two thirds introduced to the market after carbamazepine (CBZ) and one third after its derivative, oxcarbazepine (OXC). Following the introduction of these newer AEDs, the role of CBZ and OXC in the therapeutic armamentarium for seizure control and effective epilepsy management needs to be reviewed. The main guidelines list both CBZ and OXC as first-line options or second-line alternatives for the treatment of focal-onset epilepsy and primary generalized tonic-clonic seizures. While evidence suggests that overall AEDs have similar efficacy, some newer AEDs may be better tolerated than CBZ. In line with this, there have been changes in treatment patterns, with many variations across different countries. However, CBZ remains among the two or three most prescribed drugs for focal epilepsy in many countries, and is widely used across Europe, Africa, South America, and Asia, where it represents a good compromise between cost, availability, and effectiveness. OXC is among the first-choice options for the initial treatment of focal-onset seizures in several countries, including the US and China, where the oral suspension is commonly prescribed. This review provides guidance on the optimal use of these two drugs in clinical practice, including in children, the elderly, and in pregnancy.


Assuntos
Anticonvulsivantes/uso terapêutico , Carbamazepina/uso terapêutico , Epilepsia/tratamento farmacológico , Oxcarbazepina/uso terapêutico , Epilepsia Generalizada/tratamento farmacológico , Humanos , Topiramato/uso terapêutico
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