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Biomedical subjects

D M Treiman

Publications and source records attributed to D M Treiman.

At least 73 records · Page 4Linked to original sources
PubMed1987

High-performance liquid chromatographic determination of nafimidone and its major metabolite nafimidone alcohol in human plasma and urine.

A rapid, sensitive and selective method for the determination in plasma and urine of nafimidone, a new antiepileptic drug, and its major metabolite, nafimidone alcohol, has been developed which uses a high-performance liquid chromatographic system and a fluorescence detector for nafimidone or ultraviolet detector for nafimidone alcohol. The detection limits for nafimidone and nafimidone alcohol are 5.0 and 12.5 ng/ml, respectively.

Anticonvulsants↗
PubMed1987

Efficacy and safety of antiepileptic drugs: a review of controlled trials.

Twenty randomized, double-blind, controlled clinical trials of antiepileptic drugs (AEDs) in mostly adult patients with mostly partial onset and/or generalized tonic-clonic seizures have been reported, with a total of 1,336 patients. None of these studies has demonstrated significant differences in antiepileptic efficacy between available antiepileptic drugs, but the results show that there are considerable individual differences between patients' responses to the same drug. While side effects are common with all of the antiepileptic drugs currently available, these are usually mild and reversible. Although some toxic effects may occur more frequently with certain drugs, there is sufficient overlap between the effects of various antiepileptic drugs that most side effects cannot be attributed with certainty to any one drug. Since side effects are generally dose-related, they can frequently be avoided or minimized by careful dosage titration and individualization of therapy.

Anticonvulsants↗
PubMed1987

Vigabatrin for refractory complex partial seizures: multicenter single-blind study with long-term follow-up.

The irreversible GABA transaminase inhibitor vigabatrin (VGB) was given in a single-blind fashion to 89 patients with complex partial seizures (CPS) refractory to conventional drugs. The median number of CPS per month decreased from 11.0 to 5.0 after addition of VGB, and 51% of patients had a 50% or greater decrease in CPS frequency (p less than 0.001). Side effects (principally drowsiness, ataxia, and headache) occurred mainly during the initiation of therapy and decreased during therapy. After 12 weeks on VGB, side effects significantly interfered with functioning in only 13% of patients, and the efficacy:toxicity ratio warranted continued administration in 74% of patients. Coadministration of VGB resulted in a mean decrease of 20% in phenytoin serum concentration (p less than 0.001). Sixty-six patients with a favorable response to VGB during the single-blind study have been followed for a median of 16.7 months on VGB. No serious systemic or neurologic toxicity has been detected, and most patients have retained their initial favorable CPS control.

Aminocaproates↗
PubMed1987

Pharmacokinetics of nafimidone in patients with chronic intractable epilepsy.

Nafimidone is a new antiepileptic drug which may be effective in partial onset seizures. We studied the pharmacokinetics of nafimidone and its metabolite, nafimidone alcohol, in 12 patients already taking phenytoin and/or carbamazepine. The half-life of nafimidone was 1.34 +/- 0.48 hours after a 100mg single dose and 1.69 +/- 0.91 hours after a 300mg single dose. However, the half-life of nafimidone alcohol increased from 2.84 +/- 0.72 hours after a 100mg single dose to 4.22 +/- 1.09 hours after a 300mg single dose (p less than 0.02). The clearance of nafimidone was 43.56 +/- 22.11 L/h/kg after a 100mg single dose and 35.51 +/- 28.93 L/h/kg after the 300mg single dose. The respective apparent volumes of distribution of nafimidone after single 100 and 300mg doses were 80.78 +/- 46.11 L/kg and 71.01 +/- 36.86 L/kg. After short term (9 to 10 weeks) and long term (127 to 152 weeks) maintenance therapy on nafimidone 600mg per day the half-life of nafimidone alcohol was 2.23 +/- 0.36 hours and 2.16 +/- 0.60 hours, respectively. No nafimidone could be detected in urine but from 4 to 7% of the daily nafimidone dose was recovered as nafimidone alcohol. Thus, it appears that over 90% of the administered dose of nafimidone is metabolised by pathways other than glucuronidation of nafimidone alcohol and urinary excretion.

Adult↗
PubMed1986

Epilepsy and violence: medical and legal issues.

A possible relationship between epilepsy and violence has been debated for over a century. The debate has taken on new importance because of the increasing use of the "epilepsy defense" in criminal cases. In this review the following issues are addressed: (1) Is epilepsy more common among violent criminals and patients? (2) Is violence more common among epileptics? (3) Can directed violence or aggression occur as part of an epileptic seizure? (4) What medical and legal criteria should be used to determine whether a specific violent crime was the result of an epileptic seizure? Answers to these questions may be summarized as follows. (1) There is a two- to fourfold greater prevalence of epilepsy in prisoners than in control populations, but the prevalence is similar to the prevalence in other lower socioeconomic populations from which most prisoners come. There is no greater prevalence of epilepsy in persons convicted of violent crimes than in other prisoners matched as controls. (2) There is no evidence that violence is more common among epileptics than among non-epileptics, and no evidence that violence is more common in patients with temporal lobe epilepsy than in those with other types of epilepsy. (3) Ictal violence is rare, and when it does occur usually takes the form of "resistive violence" as the result of physical restraint at the end of a seizure, while the patient is still confused. Violence early in a seizure is extremely rare, stereotyped, and never supported by consecutive series of purposeful movements. (4) Five criteria should be used to determine if a specific violent act was the result of an epileptic seizure: a. the diagnosis of epilepsy should be established by a neurologist with special competence in epilepsy; b. the presence of epileptic automatisms should be documented by the case history and closed-circuit TV-EEG; c. aggression during epileptic automatisms should be documented on closed-circuit TV-EEG; d. the aggressive act should be characteristic of the patient's habitual seizures; and e. a clinical judgment should be made by the neurologist as to the possibility that the violent act was part of a seizure.

Adolescent↗
PubMed1985

Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures.

We conducted a 10-center, double-blind trial to compare the efficacy and toxicity of four antiepileptic drugs in the treatment of partial and secondarily generalized tonic-clonic seizures in 622 adults. Patients were randomly assigned to treatment with carbamazepine, phenobarbital, phenytoin, or primidone and were followed for two years or until the drug failed to control seizures or caused unacceptable side effects. Overall treatment success was highest with carbamazepine or phenytoin, intermediate with phenobarbital, and lowest with primidone (P less than 0.002). Differences in failure rates of the drugs were explained primarily by the fact that primidone caused more intolerable acute toxic effects, such as nausea, vomiting, dizziness, and sedation. Decreased libido and impotence were more common in patients given primidone. Phenytoin caused more dysmorphic effects and hypersensitivity. Control of tonic-clonic seizures did not differ significantly with the various drugs. Carbamazepine provided complete control of partial seizures more often than primidone or phenobarbital (P less than 0.03). Overall, carbamazepine and phenytoin are recommended drugs of first choice for single-drug therapy of adults with partial or generalized tonic-clonic seizures or with both.

Adolescent↗
PubMed1982

Complex partial seizures on closed-circuit television and EEG: a study of 691 attacks in 79 patients.

Automatisms of 691 complex partial seizures in 79 patients were studied on closed-circuit television (CCTV) and by electroencephalography. Simple stereotyped perseverative automatisms such as chewing, swallowing, and fumbling with clothes or sheets followed an initial motionless stare and lapse of consciousness in type I attacks. Ambulatory automatisms, bilateral arm and leg perseverative movements, and tonic adversive head or eye movements (or both) characterized type II attacks, in which a motionless stare was not observed. Type III started with a drop attack followed by confusion, amnesia, and gradual recomposure. Some type II and III attacks are suspected to begin in areas outside the temporal lobe, while type I attacks are thought to originate from the temporal lobe. Further studies using CCTV and depth electrode recordings are necessary to verify these suspicions.

Adult↗