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Biomedical subjects

E S Tecoma

Publications and source records attributed to E S Tecoma.

11 recordsLinked to original sources
PubMed1999

Oxcarbazepine.

The success of carbamazepine (CBZ) as a broad-spectrum antiepileptic drug (AED) has led to its use as first-line therapy in children and adults for partial and generalized tonic-clonic seizures. The limitations of CBZ include toxicity in sensitive individuals, autoinduction, which requires dose adjustment when therapy is initiated, and chronic hepatic induction, producing drug interactions when CBZ is used with AEDs and other drugs that undergo hepatic metabolism. One of two main products of CBZ microsomal metabolism, CBZ-10,11-epoxide (formed by oxidation of the double bond between C-10 and C-11), appears to provide antiepileptic efficacy but contributes significantly to clinical toxicity. The most common adverse effects of CBZ are central nervous system (CNS) symptoms, followed by gastrointestinal, hepatic, endocrine disturbances, and teratogenic effects. Oxcarbazepine (OXC) was developed to provide a compound chemically similar enough to CBZ to mimic its efficacy and overall safety while improving its side-effect profile. Biotransformation of OXC does not involve formation of an epoxide metabolite. Compared with the parent compound, hepatic microsomal enzyme induction and autoinduction are greatly reduced. The clinical efficacy of OXC compares favorably with CBZ in clinical trials. Clinical development of OXC began in Europe. Results of Phase I trials started to appear in the early 1980s. Controlled clinical trials, reported in the mid- to late 1980s, led to approval of OXC in many European countries, and now in over 50 nations around the world. United States multicenter clinical trials have recently been completed, and at this writing the drug is awaiting approval by the FDA. This article reviews the pharmacology, animal data, outcomes of published controlled clinical trials, postmarketing data, adverse experiences, and current recommendations for clinical use of OXC.

Adult↗
PubMed1998

Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial.

OBJECTIVE: The purpose of this multicenter, add-on, double-blind, randomized, active-control study was to compare the efficacy and safety of presumably therapeutic (high) vagus nerve stimulation with less (low) stimulation. BACKGROUND: Chronic intermittent left vagus nerve stimulation has been shown in animal models and in preliminary clinical trials to suppress the occurrence of seizures. METHODS: Patients had at least six partial-onset seizures over 30 days involving complex partial or secondarily generalized seizures. Concurrent antiepileptic drugs were unaltered. After a 3-month baseline, patients were surgically implanted with stimulating leads coiled around the left vagus nerve and connected to an infraclavicular subcutaneous programmable pacemaker-like generator. After randomization, device initiation, and a 2-week ramp-up period, patients were assessed for seizure counts and safety over 3 months. The primary efficacy variable was the percentage change in total seizure frequency compared with baseline. RESULTS: Patients receiving high stimulation (94 patients, ages 13 to 54 years) had an average 28% reduction in total seizure frequency compared with a 15% reduction in the low stimulation group (102 patients, ages 15 to 60 year; p = 0.04). The high-stimulation group also had greater improvements on global evaluation scores, as rated by a blinded interviewer and the patient. High stimulation was associated with more voice alteration and dyspnea. No changes in physiologic indicators of gastric, cardiac, or pulmonary functions occurred. CONCLUSIONS: Vagus nerve stimulation is an effective and safe adjunctive treatment for patients with refractory partial-onset seizures. It represents the advent of a new, nonpharmacologic treatment for epilepsy.

Adolescent↗
PubMed1993

Frequency and characteristics of visual field deficits after surgery for mesial temporal sclerosis.

In a series of 33 patients undergoing tailored temporal lobe resection for mesial temporal sclerosis, the frequency of postoperative visual field deficit (VFD) was 52%. The size and configuration were similar after operation in the right and left hemispheres. We observed partial upper quadrantanopias in 16 of 28 patients who became seizure-free and in only one of five patients with residual seizures. VFDs may provide an independent measure of the functional extent of resection.

Adult↗
PubMed1989

Traumatic neuronal injury in vitro is attenuated by NMDA antagonists.

Pure traumatic neuronal injury was modeled in dispersed neocortical cell cultures derived from fetal mice. A plastic stylet was used to tear the neuronal and glial cell layer; medium oxygen content, pH, and glucose remained unchanged. Adjacent to this local disruption, many neurons developed acute swelling and went on to degenerate over the next day, but glia were relatively spared. If the same mechanical insult was delivered in the presence of the N-methyl-D-aspartate (NMDA) antagonists dextrorphan or D-2-amino-5-phosphonovalerate, resultant neuronal degeneration was markedly reduced. The protective effect of these NMDA antagonists was concentration-dependent between 1 and 100 microM, with EC50 near 10 microM for both compounds. Present findings suggest that endogenous excitatory amino acids may participate significantly in the propagation of central neuronal cell loss in response to a purely mechanical insult.

2-Amino-5-phosphonovalerate↗
PubMed1989

GABAergic neocortical neurons are resistant to NMDA receptor-mediated injury.

N-methyl-D-aspartate (NMDA) receptors are thought to mediate much of the central neuronal loss produced by certain neurologic insults, including hypoxia-ischemia, hypoglycemia, and trauma. Therefore, the specific vulnerability of GABAergic inhibitory neurons to NMDA receptor-mediated toxicity might be an important determinant of the potential for epileptogenesis following these insults. We have examined the fate of GABAergic cortical neurons in mouse cell cultured neuronal population) were identified either by immunoreactivity with antisera to GABA or by autoradiography following high-affinity uptake of 3H-GABA. Cultures exposed for 5 min to 20 to 750 microM NMDA showed NMDA concentration-dependent, widespread neuronal loss. However, GABAergic neurons were relatively spared, and thus represented an enhanced fraction of neuronal survivors. These observations suggest that GABAergic cortical neurons may possess some intrinsic resistance to NMDA receptor-mediated neurotoxicity, a property which might convey an anticonvulsant "inhibitory safety factor" to neocortex against certain forms of injury.

Animals↗
PubMed1986

Transient catecholamine modulation of neutrophil activation: kinetic and intracellular aspects of isoproterenol action.

Modulation of neutrophil activation by catecholamines may reflect regulatory mechanisms that couple beta-adrenergic and N-formyl peptide receptors to antagonistic biochemical pathways. We examined kinetic and mechanistic aspects of the inhibition by catecholamines of neutrophil activation by formyl peptides. Inhibition of oxidant production by isoproterenol (ISO) was detected as low as 3 nM, had an ID50 of 10(-7) M, and could be blocked and reversed by propranolol. Recovery of cell function occurred over a period of minutes when the concentration of ISO was less than 10(-6) M. These observations are discussed in terms of the interaction of ISO with the adrenergic receptors. The site of catecholamine action is addressed. ISO neither influences formyl peptide-receptor interaction nor does it inhibit oxidant production by phorbol ester. These results suggest an impairment of intracellular signalling processes that couple the formyl peptide-receptor binding to cell activation. We observed inhibition of intracellular Ca++ elevation by ISO only at low formyl peptide concentrations. This inhibition is consistent with a partial inhibition of phosphoinositide metabolism, which was observed. Several other cell responses, including actin polymerization and right angle light scatter, are minimally inhibited by 10(-6) M ISO indicating that the cell activation process is not entirely obliterated. The presence of catecholamine and formyl peptide results in a synergistic elevation of cAMP. The intracellular targets of ISO action may be regulated by cAMP dependent kinases and could follow a branchpoint in the activation sequence that leads distinctly to oxidase activation and cytoskeletal activation.

Actins↗
PubMed1985

Psychic distress and the immune response.

This minireview surveys recent progress in the field of immunoregulation by the central nervous system. Representative findings from human and animal studies show evidence for significant immunosuppression in states of psychic distress. Mechanisms of immunomodulation are discussed in light of data implicating neuroendocrine, genetic, neuroanatomical, and learning factors. Evidence for reciprocal modulation of immune and nervous systems is considered. A simple hierarchical model proposes traits that are acted on by environment and experience to produce chronic states of mental health vs. psychic distress; these states determine baseline immunocompetence and response to afferent signals during acute immune challenge. Multidisciplinary interest in psychoneuroimmunology has accelerated the rate of inquiry into the mechanistic details of immunoregulation and has generated new appreciation for the pervasive effects of mental status on physiologic homeostasis.

Adaptation, Psychological↗
PubMed1980

Membrane deenergization by colicin K affects fluorescence of exogenously added but not biosynthetically esterified parinaric acid probes in Escherichia coli.

Fluorescence of the conjugated polyene fatty acid, parinaric acid (PnA), was studied in membranes of Escherichia coli during deenergization by colicin K. The free fatty acid and biosynthetically esterified forms of cis-PnA (9,11,13,15-cis,trans,trans,cis-octadecatetraenoic acid), both of which are sensitive to E. coli lipid-phase transitions, were compared. When free cis-PnA was added exogenously to respiring bacteria, dissipation of the energized state of the membrane resulted in a dramatic increase in cis-PnA fluorescence; all-trans-PnA was much less sensitive. Neither spectral shifts nor a change in cis-PnA fluorescence polarization were observed. Analysis of the PnA content of extracellular fractions of deenergized and control cells revealed a difference in probe distribution: the membranes of energy-poisoned E. coli bound about 77% of exogenously added cis-PnA, whereas membranes of actively respiring controls bound only about 44%. No fluorescence enhancement was observed in cells centrifuged to remove unbound cis-PnA before colicin treatment. When cis-PnA was biosynthetically esterified to phospholipids of an unsaturated fatty acid auxotroph of E. coli, the fluorescence did not change during membrane deenergization. In double-probe experiments, membrane deenergization resulted in fluorescence enhancement of exogenously added N-phenyl-1-naphthylamine, without change in esterified PnA fluorescence. We conclude that deenergization of E. coli membranes leads to increased binding and fluorescence of exogenously added PnA and cannot be detected from within the inner and outer membranes by PnA esterified in vivo.

Cell Membrane↗
PubMed1977

Conjugated polyene fatty acids as fluorescent probes: biosynthetic incorporation of parinaric acid by Escherichia coli and studies of phase transitions.

The use of the fluorescent fatty acid, parinaric acid (9, 11, 13, 15-octadecatetraenoic acid) (PnA), was studied in cells of an unsaturated fatty acid auxotroph of Escherichia coli. Growth conditions were found that permitted biosynthetic incorporation of PnA (up to 3%) into membrane phospholipids during growth on oleic or elaidic acid. Fluorescence measurements of incorporated PnA revealed phase transitions in cells, membranes, and phospholipids at temperatures that reflected the fatty acid composition of the sample. Transitions had a well-defined onset from high temperature, while the lower and end point was less well defined. cis- and trans-PnA (cis, trnas, trans, cis, and all trans, respectively) gave comparable results. Similar phase transitions were detected with PnA, which was not biosynthetically incorporated. Fluorescence of tryptophan was measured in E. coli membranes as a function of concentration of PnA. Significant quenching of tryptophan fluorescence by PnA was observed.

Cell Membrane↗