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Biomedical subjects

F M Besag

Publications and source records attributed to F M Besag.

28 records · Page 2Linked to original sources
PubMed1996

Modern management of epilepsy: Adolescents.

Epilepsy most commonly starts in the first two decades of life. Adolescence is a time of great change both in the epilepsy itself and in a number of other areas. Growth into adulthood, issues of preparation for university or employment, driving, drinking, preparation for marriage/conception and a general increase of responsibility add to the complexity of this time of life. Epilepsy affects all these areas to a significant degree. The incidence of several epilepsy syndromes peaks in adolescence. These include juvenile myoclonic epilepsy, juvenile absence epilepsy, epilepsy with grand mal on awakening, benign partial seizures of adolescence and reading epilepsy. Photosensitivity also appears to peak around puberty and needs to be managed well to avoid both unreasonable risks and unnecessary restrictions. Early diagnosis and correct management of the epilepsy and the specific epilepsy syndrome are the main factors in minimizing the difficulties. Epilepsy may change in the early adolescent years, with seizures starting and stopping or altering in form, all of which add to the uncertainty. Denial of the epilepsy may lead to risk-taking which may include be provided on the high risk of the unsupervised bath, the effect of irregular sleep, alcohol, driving, sport, employment, genetic implications, advantages/adverse effects of specific antiepileptic drugs and the role of surgery. The doctor should listen, counsel and inform. Adolescents generally do not appreciate being given advice. They should be empowered by the doctor to make informed decisions and encouraged to take control in a situation which they may view as implying devastating loss of control, unless it is managed wisely.

Adolescent↗
PubMed1995

Lamotrigine for the treatment of epilepsy in childhood.

OBJECTIVE: In this multicenter study, the efficacy and tolerability of lamotrigine were assessed in 285 children less than 13 years of age, recruited from 37 centers in 11 countries. METHODS: Pooled data from five open add-on studies have been analyzed. All the children had treatment-resistant epilepsy and most had two or more seizure types. Seizure frequency and global evaluation were assessed at the end of four successive 12-week periods of therapy. RESULTS: Seizure frequency was reduced by 50% or more in one third of the patients. Lamotrigine was effective in all seizure types examined, particularly for typical and atypical absence seizures. Atonic seizures also responded well. Improvement was well maintained during the treatment period. The maintenance dose had to be adjusted according to concomitant medication; dose ranges were 1 to 5 mg/kg per day for children taking valproate and 5 to 15 mg/kg per day for those not taking valproate. The commonest reported adverse experiences were somnolence, rash, vomiting, and seizure exacerbations. Adverse experiences led to withdrawal of treatment from 36 patients (12.6%). CONCLUSIONS: These results indicate that lamotrigine is well tolerated and is effective for a broad range of seizure types, especially absence seizures and atonic seizures.

Adolescent↗
PubMed1995

The therapeutic dilemma: treating subtle seizures or indulging in electroencephalogram cosmetics?

The treatment of epileptiform abnormalities in the absence of obvious seizures has, in the past, been dismissed as "EEG cosmetics." The work on transitory cognitive impairment has highlighted the importance of asking the question: "What is a seizure?" The extent to which epileptiform discharges cause temporary or permanent impairment, profoundly influences decisions on whether to treat with antiepileptic medication or surgery.

Anticonvulsants↗
PubMed1994

Lamotrigine--managing the challenging patient.

Childhood epilepsy presents many different challenges requiring a careful assessment and an individual management plan appropriate to the needs of each child. The first rule in managing the difficult-to-treat patient is to re-examine the diagnosis. The characterization of the seizures may also guide the clinician into prescribing the appropriate therapy. If the child has failed to respond to first-line antiepileptic drugs, the situation should be reviewed carefully. There may be a role for one of the new antiepileptic drugs. It is important to treat with adequate doses and for adequate duration before deciding whether a drug is effective or not. Failure to do this may deny the child the benefit of a particular medication. Drugs which affect behaviour or cause lethargy can have a secondary effect on cognition. Failure to treat frequent subtle seizures may also have serious cognitive consequences. Lamotrigine is of value in treating a variety of different seizure types, including subtle seizures, and has a low incidence of adverse effects.

Adolescent↗
PubMed1993

Adapting the Rivermead Behavioural Memory Test for use with children aged 5 to 10 years.

We describe modifications made to the Rivermead Behavioural Memory Test (RBMT) to make it appropriate for use with children. Results of a sample of 335 children aged 5 to 10 years, attending mainstream schools, are reported. Each child was given two of the four versions of the modified test for children together with a number of tests of memory and achievement from the Wechsler Intelligence Test for Children (Revised WISC-R), and the British Ability Scales (BAS). The children's version of the behavioural memory test (RBMTC) has good interrater and parallel from reliability. The validity of the RBMTC was established in two ways. First, with other tests of memory from the WISC and BAS. Second, a small (n = 36) group of children with severe epilepsy and memory difficulties, attending a residential school, were tested. The houseparents of these children were asked to complete rating scales on everyday memory performance. There was significant agreement between houseparents' observations and scores on the RBMTC (Spearman rank correlation = .71, p < .001), indicating that the test is indeed assessing everyday memory.

Child↗
PubMed1989

The validation of a new ambulatory spike and wave monitor.

The reliability of a new pocket-size ambulatory monitor designed to automatically detect, indicate, measure and store spike and wave episodes in the EEG was determined. Eleven teenage children with epilepsy were studied. All had spike and wave episodes that were around 3/sec in frequency. A double-blind trial was carried out in which 2 experienced encephalographers scored independently the simultaneous records of the monitor and EEG. Correlation coefficients were calculated and, taking into account any inconsistencies between the 2 scorers' sets of data, a validation based on unity was determined for the monitor's record for each child. Of the 11 children studied only one had a validity measure that was less than 0.9, suggesting that when correctly adjusted for each child the monitor gave a reliable automatic indication of the duration and number of spike and wave events.

Adolescent↗
PubMedDate not supplied

Nifedipine for epilepsy? A double-blind, placebo-controlled trial.

The movement of calcium into neurons may be the common denominator for the triggering and propagation of seizure activity. We report results of the first double-blind, placebo-controlled, crossover trial with the dihidropyridine calcium antagonist nifedipine (NFD) as adjuvant therapy in refractory epilepsy. Twenty-two students (12 male, 10 female, age 17-22 years) attending Lingfield Hospital School received NFD retard and matched placebo for 8 weeks in 2 doses (20 and 40 mg b.i.d. each for 4 weeks) with a washout period of 8 weeks between treatment phases. In the 20 students who completed the trial, fewer partial seizures (p less than 0.05) were documented during the first 2 weeks of NFD administration. Similarly, fewer seizure days (p less than 0.05) were reported in the first month of active treatment. This response was not sustained into the second month of the trial. Blind scoring of EEGs suggested a small improvement with NFD (p less than 0.05). More patients reported headache when receiving NFD (p less than 0.02) than placebo, but heart rate and erect and supine blood pressure remained unaffected. Mean maximum NFD concentrations were 13.1 +/- 10.4 ng/ml. A weak correlation was noted between total (p less than 0.05) and partial (p = 0.025) seizure numbers and NFD concentrations following 8 weeks of treatment. This study does not support important anticonvulsant efficacy for NFD as adjuvant therapy for refractory epilepsy at doses appropriate for the treatment of angina or hypertension. Further trials are recommended using higher doses of NFD in less severely affected patients.

Adolescent↗