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Biomedical subjects

H Meinardi

Publications and source records attributed to H Meinardi.

100 records · Page 6Linked to original sources
PubMedDate not supplied

Oxcarbazepine (GP 47.680): a possible alternative to carbamazepine?

A double-blind randomized crossover design trial of carbamazepine (CBZ) and oxcarbazepine (OCBZ) was performed with 48 in-patients with epilepsy. All were stabilized on polytherapy including CBZ and had at least two seizures per week. CBZ was replaced by the trial medication. Each trial period started with a titration, followed by a 12-week steady state. Concomitant medications were kept constant during the trial. The criteria for assessment were seizure fit frequency and severity; tolerability; hematology and blood chemistry; plasma levels of antiepileptic drugs; EEG; cardiovascular parameters; and treatment preference. The following differences regarding OCBZ were detected: 9% reduction of the total number of seizures, with a significant reduction of tonic-clonic (20%) and tonic (31%) seizures; increased alertness and concentration ability in five patients; an allergic skin reaction with CBZ that completely disappeared in two patients while receiving OCBZ; an increase of valproate and phenytoin plasma levels in a number of patients, probably caused by reduced enzyme induction; a slight but significant reduction of serum Na, not causing clinical symptoms; less seizures than in the CBZ period in 25 patients (52%); and a preference for OCBZ in 23 patients (48%). We consider OCBZ at least as effective as CBZ with a slightly better tolerability. In severe cases, the wider therapeutic window might improve seizure control.

Adolescent↗
PubMedDate not supplied

Relationship between dose and serum concentrations of carbamazepine, phenytoin, phenobarbital, and primidone in a Sri Lankan population compared with a European population.

Concentrations of carbamazepine, phenytoin, phenobarbital, and primidone have been measured by high pressure liquid chromatography (HPLC) in serums of 177 Sri Lankan epileptic patients. Relationships between concentrations and dose per kg body weight of these drugs have been compared with those of patients in the Netherlands, using a matching procedure. Although variabilities in dose-concentration ratios were somewhat larger in Sri Lanka than in the Netherlands, no evidence was found of a systematic difference in pharmacokinetics between both populations.

Adolescent↗
PubMedDate not supplied

Lateralized effects of subclinical epileptiform EEG discharges on scholastic performance in children.

The interaction between lateralization of subclinical epileptiform discharges and cognitive tasks was investigated in 21 children (12 girls and 9 boys, mean age 10.6 years). Seventeen had a diagnosis of epilepsy (partial or secondarily generalized). Testing was by reading, arithmetic, and intelligence subtests during continuous telemetric EEG and video monitoring. Children with left-sided discharges had significantly lower reading performance than children with right-sided discharges. During reading, epileptiform discharges occurred relatively less frequently and with a shorter total duration over the left hemisphere than the right. This supports the view that cognitive tasks suppress epileptiform discharges when they activate a region of the brain within the epileptogenic zone. Discharges from other epileptogenic zones not directly activated by the tasks are increased, however.

Achievement↗
PubMedDate not supplied

Fetal rest-activity cycles and chronic exposure to antiepileptic drugs.

Rest-activity patterns were studied in fetuses exposed to antiepileptic drugs (AEDs) and in control fetuses at three intervals during pregnancy: 20, 32, and 38 weeks. At 20 weeks, periods of rest and activity were distinguished on the basis of fetal motility. Trunk, head, and arm movements were totaled. Periods of absence of movements for greater than 3 min were found in 20 of 31 recordings from AED-exposed fetuses compared with 11 of 20 recordings from controls (p greater than 0.05). The duration of these periods of inactivity did not differ significantly between the two groups. At 32 and 38 weeks, information on fetal motility and fetal heart rate (FHR) were combined to recognize rest-activity patterns according to the fetal behavioral state concept. At 32 weeks, three true fetal behavioral states were found for the study group, while there were none in the control group. Coincidence 1F through 4F occurred significantly less frequently at 32 weeks than at 38 weeks, regardless of whether fetuses were AED-exposed or not: 59% vs. 82% for the study group and 59% vs. 80% for the controls. At 38 weeks, true fetal behavioral states appeared in 20 of 34 fetuses exposed to AEDs and in 17 of 35 controls (p greater than 0.05). The sequence in which parameters changed within state transitions was found to follow the same preferred pattern in both groups. For transitions from behavioral state 1F (quiet sleep) into 2F (active sleep) the FHR pattern changed significantly earlier than fetal body or eye movements, while for the reverse transitions the FHR pattern changed significantly later (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Preliminary assessment of the efficacy of Org 6370 in photosensitive epileptic patients: paradoxical enhancement of photosensitivity and provocation of myoclonic seizures.

Photosensitivity has proved to be a useful model to study the acute effects of experimental antiepileptic drugs (AEDs). The photosensitivity range is usually diminished or even abolished after administration of a known or experimental AED. An increase in photosensitivity, an unexpected reaction, was found in four photosensitive epileptic patients after oral ingestion of 500, 100, or 50 mg of Org 6370. Moreover, the three patients receiving doses of 100 and 500 mg reported nausea, dizziness, restlessness, and an increase in spontaneous epileptic seizures (myoclonus and in one patient a generalized tonic-clonic convulsion). The side effects coincided with peak Org 6370 serum levels. Our findings indicate that in the photosensitivity model experimental drugs with proven anticonvulsant properties in animals may increase rather than decrease the degree of patient photosensitivity. Photosensitive patients may represent a special subgroup of epileptic patients and therefore need to be classified as such.

Administration, Oral↗
PubMedDate not supplied

Fetal heart rate patterns and chronic exposure to antiepileptic drugs.

Fetal heart rate (FHR) characteristics of fetuses exposed and not exposed to antiepileptic drugs (AEDs) were studied. FHR is considered to reflect central nervous system (CNS) integrity. Three intervals during pregnancy were investigated: 20, 32, and 38 weeks. At 32 and 38 weeks, FHR was studied in relation to quiet (C1F) and active (C2F) sleep periods. For each tracing, a baseline was determined and accelerations and decelerations were identified. To assess FHR variability, the long-term irregularity, interval difference and absolute beat-to-beat indexes, and the bandwidth were calculated for 30-s intervals between accelerations and decelerations. No marked differences were noted between study and control groups concerning basal FHR and the occurrence of accelerations. For FHR derived from the fetal ECG, all indexes of FHR variability and the bandwidth were lower for the study group as compared with the control group, although the differences did not reach statistical significance. Our study shows that chronic prenatal exposure to AEDs does not seriously interfere with modulation of fetal heart rhythm by the CNS.

Anticonvulsants↗
PubMedDate not supplied

Clinimetric analysis of treatment objectives and clinical status: individualized treatment in epileptic patients.

The achievement of treatment objectives for patients with epilepsy, as defined by the treating clinicians, was compared with scoring of clinimetric indexes. Patients with the treatment objectives "complete seizures remission" or "treatment impairment/benefit balance" were included in this study. The clinimetric indexes were also compared with a clinical status rating, as assessed by the clinician. No correlation was observed between clinimetric indexes and achievement of the treatment objective. The difference noted in outcome of treatment objectives and index scores may have resulted because the indexes were group-intended and the clinician's judgment was individual-oriented. The clinician's assessment of clinical status of the patient did correlate with the composite index of impairments (CII), however, a clinimetric scale for severity of impairments caused by epilepsy. The advantage of the CII over the clinical status rating is that the CII is constructed with objective data and shows the cause of change observed during follow-up.

Adolescent↗
PubMedDate not supplied

Generalized convulsive status epilepticus: causes, therapy, and outcome in 346 patients.

We report data from 346 admissions for generalized tonic-clonic convulsive status epilepticus (GC-SE); 68% had had epilepsy previously. Outcome was determined by underlying cause, SE duration of > 4 h, the presence of more than one medical complication, and the quality of therapy and management. Clonazepam (CZP), diazepam (DZP), and phenytoin (PHT) were most frequently used for treatment.

Adolescent↗
PubMedDate not supplied

Double-blind placebo-controlled, neuropsychological and neurophysiological investigations with oxiracetam (CGP 21690E) in memory-impaired patients with epilepsy.

A double-blind placebo-controlled between-patient study was carried out to assess the effects of oxiracetam (CGP 21690E) on memory function in patients with epilepsy. During a 12-week period, either oxiracetam (800 mg t.i.d.) or placebo was given to 30 patients. Twenty-four of the patients had a partial epilepsy. Most patients were on monotherapy carbamazepine. Effect of oxiracetam on memory and related cognitive functions were assessed, using a computerized neuropsychological testing method, while concomitant electrophysiological changes were investigated with routine EEG registration, power spectrum analysis and auditory evoked event-related potentials (P300). Subjective evaluation of well-being was quantified with a mood rating scale. The results did not show any meaningful changes in memory function. This finding is in line with the subjective patient reports and the P300 measures.

Adolescent↗