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Biomedical subjects

D Chadwick

Publications and source records attributed to D Chadwick.

At least 37 records · Page 2Linked to original sources
PubMed1994

Epilepsy, pseudoseizures and perceived family characteristics: a controlled study.

Previous research in the area of pseudoseizures has focused upon their phenomenology and the characteristics of the individual with pseudoseizures. This study set out to examine the role of pseudoseizure behaviour in fulfilling a function within the family context. Pseudoseizure patients, patients with epilepsy and healthy controls completed questionnaires measuring the following variables--anxiety and depression, locus of control, self-esteem, family characteristics and perceived seizure severity. People with pseudoseizures perceived their families as displaying less commitment and support to each other (family Cohesion scale) and less emphasis on ethical issues and values (family Moral-religious scale) than both the epilepsy and the control groups. People with pseudoseizures reported levels of family interest in political, social and recreational activities (family Intellectual-cultural scale) similar to people with epilepsy, both these group scores being lower than the control group. The two patient groups also reported higher depression scores than controls, yet only the epilepsy group had lower self-esteem than the controls. These initial findings support a role of family involvement in therapy for people with pseudoseizures and may lead to a better understanding of the aetiology of pseudoseizures, as well as clarifying characteristics which may well aid the differentiation of pseudoseizures from epilepsy.

Adolescent↗
PubMed1994

Lymphocyte microsomal epoxide hydrolase in patients on carbamazepine therapy.

1. In order to determine whether carbamazepine is an inducer of lymphocyte microsomal epoxide hydrolase, the activity of the enzyme has been measured in the lymphocytes of 40 patients on continuous drug therapy using [3H]-cis stilbene oxide as a substrate. 2. Induction of the cytochrome P450 isoform, CYP3A, has been assessed in the same patients by measurement of the 24 h urinary excretion of 6 beta-hydroxycortisol by radioimmunoassay. The urinary concentrations of carbamazepine and its two metabolites, the 10,11-epoxide and trans-dihydrodiol, have also been measured by h.p.l.c. 3. The 24 h urinary 6 beta-hydroxycortisol excretion in the patients increased with the dose of carbamazepine (r = 0.57, P < 0.001) indicating induction of CYP3A. 4. The total amount of trans-dihydrodiol excreted in the urine increased with the dose of carbamazepine, and it was the most abundant urinary metabolite in all patients and at all dose-levels. There was no relationship between the dose of carbamazepine and the diol to epoxide ratio (r = 0.01, NS). 5. Lymphocyte microsomal epoxide hydrolase activity was marginally, but significantly (P = 0.02) higher in the patients (28.4 pmol diol min-1 mg-1 protein) than in drug-free controls (23.4 pmol diol min-1 mg-1 protein (95% CI for difference -9 to -0.8)). 6. The results indicate that at concentrations of carbamazepine which produce marked induction of hepatic CYP3A, an enzyme involved in the metabolism and bioactivation of carbamazepine, there is only a slight increase in lymphocyte microsomal epoxide hydrolase.

Adolescent↗
PubMed1994

Standard approach to antiepileptic drug treatment in the United Kingdom.

In the United Kingdom, the question of whether to commence antiepileptic drug (AED) treatment remains controversial. Surveys indicate that 15% of patients are treated after a first seizure. Pediatricians often wait for a third or fourth seizure before treating, whereas clinicians who deal with adult patients are more likely to intervene early, largely because of concerns about driving and employment. Monotherapy is becoming the rule for the majority of patients. The four primary AEDs in the United Kingdom are carbamazepine and phenytoin (approximately 30% each), valproate (VPA; approximately 25%), and phenobarbital (approximately 18%). For partial epilepsies, studies show few major differences in efficacy among these four AEDs. A firstline AED should be one, such as VPA, with a broad spectrum of activity that is easily managed by clinicians who may not have special expertise in the recognition of differing seizure types and epilepsy syndromes. Where differences in efficacy are marginal, comparative drug toxicity may be a major factor in AED selection. Most new AEDs have low toxicity profiles. With respect to discontinuation, pediatricians usually recommend a trial discontinuation period in most children who achieve a 1- or 2-year remission of epilepsy. For adults, however, overall relapse rates after discontinuation are approximately 40-50%; therefore, patients usually opt for long-term AED therapy.

Adolescent↗
PubMed1994

Valproate in the treatment of partial epilepsies.

Review of randomized controlled trials (RCTs) shows that valproate (VPA) is effective against partial seizures with or without becoming secondarily generalized. A number of RCTs show little difference in the efficacy of VPA and carbamazepine in this patient group, particularly where patients are randomized at the time of diagnosis. The length of time that it has taken to arrive at these conclusions emphasizes the importance of large active-controlled RCTs at an early stage in drug development in informing clinical practice.

Adolescent↗
PubMed1994

Epilepsy.

Explore the source record for details and available documents.

Adolescent↗
PubMed1994

Measuring antiepileptic therapies: the patient vs the physician viewpoint.

In clinical practice, clinicians use patients' views of treatment when making decisions about management. In clinical trials, however, the patient's perspective is largely ignored, and there has been a preference for "objective" measurements. It is important that clinical trials reflect clinical practice and are clinically relevant; thus, there is a need to include broader-based patient-assessed outcomes in clinical trials. Quality-of-life assessment has been widely applied and accepted in other chronic illnesses; however, standard health and quality-of-life measures might be insensitive to the unusual disabilities produced by epilepsy. A quality-of-life model has been used in order to develop novel measures of seizure severity, impact of epilepsy, and life fulfillment. These scales might add to the sensitivity of clinical trials of new antiepileptic drugs. This approach has been used in a study of lamotrigine and indicates that the drug has some positive effects on seizure severity, in addition to improving quality of life.

Adolescent↗
PubMed1993

Measuring the impact of epilepsy: the development of a novel scale.

The impact of a chronic illness is experienced not only through its physical symptoms, but also as a result of its effect on psychosocial functioning. In the case of an illness such as epilepsy, where the physical manifestations are transient, the psychosocial consequences may, with time, come to be of greater concern. We have been involved in developing a quality of life model for epilepsy. As part of the refinement of the initial model, we have devised a novel scale to measure the impact of the condition on a number of different aspects of daily life. The scale was administered to 75 patients attending an epilepsy out-patient clinic. Initial analysis of its psychometric properties is encouraging, although the inclusion of an item relating to employment reduced the scale's reliability. As a result, the wording of the existing item has been amended and an additional item has been incorporated. We hope the scale will be useful in investigations of treatment for epilepsy and of its psychosocial aspects.

Adolescent↗
PubMed1993

The impact of counselling with a practical statistical model on patients' decision-making about treatment for epilepsy: findings from a pilot study.

To ascertain the impact of a computer-based predictive model on patients' decisions about continuing treatment of their epilepsy, 72 subjects were asked to complete questionnaires prior to and following counselling with the model. The subjects were attending the neurology out-patient clinic in a large UK hospital, and were identified from medical records as eligible for withdrawal of AEDs. The effect of counselling with the model was to make the majority of patients opt to continue AED therapy. Positive or negative framing of risk information appeared to influence the decisions of patients who were initially uncertain about continuing treatment, as did patients' perceptions of the clinician's views. The prognostic model appeared to allow relatively complex statistical information to be conveyed to patients in an accessible form. We suggest its use will aid clinicians in counselling patients and will help patients reach better-informed decisions about treatment.

Counseling↗
PubMed1993

An epilepsy needs document.

Services for epilepsy in the UK are poor in quality, fragmentary and poorly organized. We attempt to define and quantify the scope, content and standards of medical, paramedical and nursing services required, from primary health care to specialist centres. This document has been approved by the Joint Epilepsy Council of Great Britain and Ireland, representing all major patient organizations and care providers.

Cross-Sectional Studies↗
PubMed1993

Human islet isolation--a prospective randomized comparison of pancreatic vascular perfusion with hyperosmolar citrate or University of Wisconsin solution.

University of Wisconsin solution has become the most commonly used vascular perfusate during multiorgan donation world-wide. In the UK however, hyperosmolar citrate remains in common use. The purpose of this prospective randomized study was to compare the effect of systemic perfusion with UW or HOC on subsequent islet yield and purification for pancreata with short cold ischemic times. Seven pancreata were randomized to each group, with the donor age, pancreas weight, and period of cold ischemia being similar in both. Perfusion with UW was shown to inhibit collagenase digestion, and a higher concentration of this enzyme was needed to achieve comparable numbers of islets with good separation of exocrine and islet tissue after a similar period of digestion. There were no differences in the number, size, purity, or viability of islets between the two groups. In conclusion, UW solution offers no benefits over HOC for pancreata with short cold ischemic times, and because of its expense and need to use greater amounts of collagenase enzyme, we continue to use HOC.

Adenosine↗
PubMed1993

Lipoprotein levels following treatment with cyproterone acetate or LHRH analogues.

Fasting serum lipoproteins were measured in patients with carcinoma of the prostate. Twelve patients were on no hormonal treatment (Group 1). Fifteen were on cyproterone acetate (Group 3), 17 were on the long-acting LHRH analogue Zoladex (Group 4) and 11 on a combination of cyproterone acetate and Zoladex (group 5). In addition, 27 patients with benign urological disease were taken as controls (Group 2). In both groups in which cyproterone acetate was part of the treatment the total high density lipoprotein cholesterol levels were significantly lower than in the other groups. Patients on cyproterone acetate alone had significantly higher levels of very low density lipoprotein (VLDL) triglyceride levels than those not on cyproterone acetate. These results confirm changes in serum lipoprotein levels in patients taking cyproterone acetate and these changes may have potential adverse effects if the treatment is prolonged.

Cholesterol↗
PubMed1993

Seizure severity and the quality of life.

The efficacy of an antiepileptic drug (AED) is determined at present by the drug-elicited reduction in seizure frequency. Reduction of seizure frequency as the sole measure of efficacy does not account for treatment-induced reductions in seizure severity and positive psychological effects experienced by the patient. A clinical trial was undertaken in which seizure frequency was the primary and seizure severity and psychological well-being were the secondary measures of efficacy. Psychological assessment and seizure frequency were monitored in patients whose epilepsy was treated with lamotrigine (LTG) or placebo. The results indicate that LTG is an effective AED, causing reductions in seizure frequency and severity and improvements in mood and mastery. In addition, the study demonstrated that the use of seizure severity scales, especially the ictal subscale, may enhance the sensitivity of assessment of trials of AED treatments.

Anticonvulsants↗
PubMed1993

Potential of measurements of unsaturated vitamin B12-binding capacity in serial colonoscopic biopsy specimens for global and regional assessments of disease severity in inflammatory bowel disease.

We investigated whether measurements of unsaturated vitamin B12-binding capacity (UBBC), in homogenates of serial colonoscopic biopsy specimens, could be used as objective measures of disease severity in ulcerative colitis (UC) and Crohn's disease (CD). On a regional basis UBBC activity correlated with and showed good agreement with endoscopic and histologic activity scores (r = 0.8 and 0.6, respectively, for UC, and r = 0.7 and 0.7, respectively, for CD). For global assessment aggregate UBBC, endoscopic and histologic scores were compared with standard clinical activity scores. In UC, correlations with the van Hees index were r = 0.7, 0.8, and 0.7, respectively, and UBBC assays accurately reflected both regional and global disease activity. In CD, correlations with the CDAI were -0.1, 0.7, and 0.6, respectively. Thus, aggregate UBBC scores failed to reflect disease activity in CD, in which focal deep ulcers may produce high symptom scores but in which adjacent specimens may show no acute inflammation.

Biomarkers↗