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Cynthia L. Harden

Publications and source records attributed to Cynthia L. Harden.

11 recordsLinked to original sources
PubMed2002

Epilepsy in Pregnant Women.

For women of childbearing potential with epilepsy, seizures should be controlled with the smallest dosage of anti-epileptic drug (AED). Treatment with monotherapy should be achieved, if possible. The possibility of AED withdrawal should be considered in appropriate clinical setting prior to conception, and the AED treatment should be optimized prior to conception. Many pregnancies are unplanned, underscoring the need for constant vigilance in streamlining the treatment regimen. Prenatal counseling becomes particularly important, in order that both the physician and patient have open communication and realistic expectations about the course and outcome of a potential pregnancy. All women of childbearing potential with epilepsy should be informed about the known rates of teratogenicity of AEDs, possibility of increased seizure frequency during pregnancy, and the risks of the pregnancy and labor. All of the conventional AEDs are associated with an increased risk of major and minor anomalies in the offspring and are categorized as US Food and Drug Administration class C or D. Polytherapy increases this risk. Valproic acid and carbamazepine are each associated with an increased risk of neural tube defects, and should be avoided by women with a family history of spina bifida. This combination should be avoided, if possible. When a woman with epilepsy presents with pregnancy, a monotherapy regimen should not be changed if the seizures are well controlled. Reducing the number of AEDs can be considered in case of polytherapy, if the seizures are well controlled. If seizures are poorly controlled, adequate seizure control is the primary goal. Serum AED levels should be documented prior to conception, and within each trimester. More frequent monitoring may be necessary in case of poorly controlled seizures. If seizures have occurred during pregnancy, therapeutic AED levels should be documented in the late third trimester, prior to delivery. Phenytoin levels should also include an unbound fraction ("free" level); other unbound AED levels are not generally available. The dose adjustment should be made taking the whole clinical picture into account. Vitamin K 10 mg per day orally should be administered in the last 4 weeks of pregnancy for women taking hepatic enzyme-inducing AEDS (phenytoin, phenobarbital, primidone, carbamazepine, topiramate, and oxcarbazepine). The newborn should receive vitamin K 1 mg intravenously or intramuscularly regardless of maternal AED exposure.

Journal Article↗
PubMed2002

Treatment of sexual disorders in people with epilepsy.

Sexual dysfunction is underreported in persons with epilepsy. The evaluation of sexual physiology in small samples of epilepsy patients shows abnormal sexual functioning, and points to low free testosterone levels as a contributing factor. Abnormal sexual physiology in epilepsy patients may be due to antiseizure medication-related altered testosterone metabolism and abnormal central gonadotropin secretion due to epileptic physiology in the brain. More information exists on the sexual side effects of "classic" antiseizure medications than the "new generation" of antiseizure medications; barbiturates appear to have the greatest risk. More active surveying for sexual dysfunction should be undertaken in epilepsy clinics; a simple, self-reported scale of sexual functioning is available. Testosterone replacement for men, dehydroepiandrosterone for women, and sildenafil for restoring sexual performance are appropriate.

Journal Article↗
PubMed2001

To the Editor.

Explore the source record for details and available documents.

Journal Article↗
PubMed2000

A Pilot Study of Mood in Epilepsy Patients Treated with Vagus Nerve Stimulation.

Context. Antiepileptic drugs (AEDs) are frequently used for their beneficial mood effects.Objective. We sought to determine if there was a quantifiable effect on mood of the vagus nerve stimulator (VNS) when used as an antiseizure treatment.Design. Mood was assessed before and 3 months after VNS implantation in adult epilepsy patients. A group of adult epilepsy patients on stable AED regimens were used as a comparison group. AED regimens were unchanged during the study. The change in mood scale scores across time was assessed by t test (intragroup) and two-factor repeated-measures ANOVA (intergroup).Setting. An epilepsy center in a university hospital was the setting.Subjects. Twenty consecutive adult epilepsy patients undergoing VNS implantation to improve seizure control and twenty adult seizure patients with no intervention were enrolled.Main outcome measures. The mood scales used were the Cornell Dysthymia Rating Scale (CDRS) and the Hamilton Depression (Ham-D), Hamilton Rating Scale for Anxiety (Ham-A), and Beck Depression Inventory (BDI) scales.Results. The VNS group showed a significant decrease in mood scale scores across time (t test CDRS P = 0.001, Ham-D P = 0.017, BDI P = 0.045), indicating a decrease in depressive symptoms. The Ham-A scores in the VNS group and the comparison group scores did not significantly change across time. There were no significant differences between groups across time, although the BDI approached significance at P = 0.07. The VNS group had a significant decrease in seizure frequency compared with the comparison group (P = 0.01). There was no difference in mood scales over time between the VNS treatment responders (defined by >50% decrease in seizure frequency) and nonresponders, suggesting dissociation between seizure frequency reduction and mood change.Conclusion. VNS treatment is associated with mood improvement as measured by multiple scales, but differences in mood scale scores over time between the VNS and a comparison group were not found.

Journal Article↗
PubMed2000

Epilepsy and Anxiety.

Although the affective and cognitive effects of seizures have long received attention, the anxiety spectrum of psychiatric complications of epilepsy has not been well-studied. Neither purely a mood, thought, or autonomic disorder, anxiety is a unique phenomenon in genesis and expression. Multidisciplinary efforts (neuroanatomy, neurochemistry, neuroendocrine, cognitive neuroscience, functional neuroimaging) are attempting to create a unified neuropsychiatric account of anxiety which, like epilepsy, can be regarded as a model phenomenon in the history of the relationship between neuroscience and mental illness. Comorbid anxiety and epilepsy offers a potentially rich nexus for theoretical and empiric investigation of the neurocircuitry and psychological mechanisms underlying each phenomenon.

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