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J M Pellock

Publications and source records attributed to J M Pellock.

At least 55 records · Page 3Linked to original sources
PubMed1997

New antiepileptic drugs in children: present and future.

The pharmacologic management of epilepsy has progressed greatly during the last decade. New medications are available for the management of refractory patients, and more are being developed. For some patients, these productions offer added efficacy, better tolerability, and some pharmacodynamic advantages. Since preapproval studies include few pediatric trials, the final role of these medications in the treatment of childhood epilepsy will be dictated by additional studies and postmarketing experience.

Anticonvulsants↗
PubMed1997

New drug therapy for acute seizure management.

Several new agents have recently become available for the long-term treatment of epilepsy. Until now, there has been little change for the acute management of seizures. Three new agents may alter our present practice. Fosphenytoin has recently been approved as a substitute for parenteral phenytoin. It provides similar efficacy without the risk for infusion site injury while allowing greater flexibility in intravenous solutions. Intravenous valproate adds flexibility for patients on valproate, allowing patients to be rapidly loaded. In addition, it will prevent patients from having to change seizure medications when intervening medical illness or surgery do not allow medications by mouth. Viscous diazepam solution for rectal administration will allow for safe and effective treatment for seizures at home and will potentially decrease emergency department services and hospitalization.

Acute Disease↗
PubMed1997

In whom does status epilepticus occur: age-related differences in children.

PURPOSE: Status epilepticus (SE) is an uncommon but potentially life-threatening seizure. It is most common in children. Little is known about the differences within the pediatric age group in terms of the type of patient seen with SE. METHODS: We analyzed the records of 394 children aged 1 month to 16 years who were part of two large studies of pediatric SE conducted in Bronx, New York, and Richmond, Virginia. The 394 children had a mean age of 4.4 years and included 349 (89%) with an initial episode of SE. RESULTS: Status epilepticus was most common in younger children with >40% of cases occurring in those younger than 2 years. The distribution of causes was highly age dependent. More than 80% of children younger than 2 years had SE of febrile or acute symptomatic origin, whereas cryptogenic and remote symptomatic causes were most common in older children (p < 0.001). One hundred fifty-eight (40%) of the cases were known to be previously neurologically abnormal, including 35 (21%) of 169 younger than age 2 years and 123 (55%) of 225 older than 2 years (p < 0.001). One hundred seventy-seven (45%) children had a history of seizures including 142 (41%) of the 349 children with a first episode of SE. A history of seizures was present in 34 (20%) of those younger than 2 years and 143 (64%) of those older than 2 years (p < 0.001). The effect of age remained significant even when the analysis was limited to those with SE of cryptogenic or remote symptomatic origin. CONCLUSIONS: There is a strong effect of age on the frequency and etiology of SE, as well as on the type of child who has SE. In young children, SE occurs primarily in children who are neurologically normal and with no history of unprovoked seizures. In older children, SE occurs primarily in those who are known to have prior unprovoked seizures and who are often also neurologically abnormal.

Adolescent↗
PubMed1997

Lamotrigine.

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Anticonvulsants↗
PubMed1997

Overview of lamotrigine and the new antiepileptic drugs: the challenge.

Lamotrigine, like all antiepileptic drugs, can be effective when used as monotherapy or adjunctive therapy. In general, adverse effects are reduced when monotherapy is employed. The most frequent adverse effect prompting withdrawal of lamotrigine is rash. This potentially life-threatening adverse effect occurs more frequently in children, is increased when a rapid dose titration schedule is employed, and is greater when lamotrigine, is prescribed in combination with valproate. The availability of lamotrigine and other antiepileptic drugs represents a major advance for the treatment of childhood epilepsy. The challenge in using all of the new antiepileptic drugs, including lamotrigine, is to balance the expected improved efficacy with the potentially serious adverse effects.

Acetates↗
PubMed1996

Safety and tolerance of multiple doses of intramuscular fosphenytoin substituted for oral phenytoin in epilepsy or neurosurgery.

BACKGROUND: Safety, tolerability, and pharmacokinetics of fosphenytoin sodium, a water-soluble phenytoin prodrug, were investigated after a temporary substitution of intramuscular fosphenytoin for oral phenytoin sodium in 240 epileptic or neurosurgical patients taking oral phenytoin sodium (100-500 mg/d). METHODS: Patients were randomly assigned to 1 of 2 parallel groups. During screening and follow-up, patients were maintained on a regimen of oral phenytoin at an individualized dose. During treatment, the phenytoin-treated patients received intramuscular placebo and their prescribed dose of oral phenytoin; the fosphenytoin-treated patients received oral placebo and intramuscular fosphenytoin equimolar to their phenytoin dose. RESULTS: Both groups had similar types and frequencies of mild to moderate adverse events. Fosphenytoin was as well tolerated as intramuscular placebo at the injection site. Intramuscular fosphenytoin equimolar to a patient's oral phenytoin dose produced equal or greater plasma phenytoin concentrations. CONCLUSIONS: Dosing adjustments are not required when intramuscular fosphenytoin is temporarily substituted or oral phenytoin therapy is resumed. Intramuscular fosphenytoin is a safe and well-tolerated alternative to oral phenytoin when oral administration is not feasible.

Aged↗
PubMed1996

A decade of modern epilepsy therapy in institutionalized mentally retarded patients.

OBJECTIVE: To evaluate epilepsy therapy in an institutionalized mentally retarded (MR) population involved in a long-term program to reduce anti-epilepsy drugs. DESIGN: An open 10-year study in 244 epileptic MR patients. An interim evaluation was performed in 1987 and a final evaluation in 1991. PATIENTS: MR patients, with a history of symptomatic generalized and partial seizures, at Southside Virginia Training Center (SVTC), Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services. METHODS: In 1981, an evaluation was made of the clinical condition and anti-epilepsy drug (AED) therapy for each patient. AED therapy was tapered for patients who were seizure-free, performance-impairing agents were discontinued for patients receiving polytherapy, and therapy was re-evaluated for patients with poor seizure control. Adverse drug reactions were quantitatively assessed and sedative agents reduced. The staff was educated regarding identification of seizures and adverse drug reactions. RESULTS: A 19% reduction in polytherapy was accomplished. AEDs were discontinued in 12.7% of patients, however, nearly half required reinitiation of therapy. The percentage of patients receiving monotherapy increased from 36.5% to 58.1% with no observed loss in seizure control. Administration of barbiturates was reduced and a decrease in sedation was observed. Some patients required an increase in drug dosage. The drug reductions remained successful for up to 10 years. CONCLUSIONS: Anti-epilepsy drugs for many institutionalized MR patients can be simplified from polytherapy to monotherapy without loss of seizure control and resulting in improved quality of life. A reduction in drug-related toxicities may be accomplished by removal or reduction in barbiturate use.

Adolescent↗
PubMed1996

Utilization of new antiepileptic drugs in children.

Studies of the newer antiepileptic drugs suggest that they are exciting additions with improved efficacy and a perhaps decreased toxicity in certain types of refractory childhood epilepsy. In some very rare syndromes only anecdotal reports exist and further study is needed. Issues of tolerability, long-term safety in very young children, and effects on learning, behavior and other cognitive functions must be balanced with the possibility of improved efficacy. Additional well-controlled studies taking into account both seizure types and epilepsy syndromes are very much needed in neonates, infants, school aged children and adolescents.

Acetates↗
PubMed1996

A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia.

This report presents the initial analysis of a prospective, population-based study of status epilepticus (SE) in the city of Richmond, Virginia. The incidence of SE was 41 patients per year per 100,000 population. The frequency of total SE episodes was 50 per year per 100,000 population. The mortality rate for the population was 22%, 3% for children and 26% for adults. Evaluation of the seizure types for adult and pediatric patients demonstrated that both partial and generalized SE occur with a high frequency in these populations. Based on the incidence of SE actually determined in Richmond, Virginia, we project 126,000 to 195,000 SE events with 22,200 to 42,000 deaths per year in the United States. The majority of SE patients had no history of epilepsy. These results indicate that SE is a common neurologic emergency.

Adolescent↗
PubMed1996

Fosphenytoin use in children.

Phenytoin is widely used for the prevention and treatment of acute seizures in children. Although it has the advantage of being available in parenteral form, it cannot be given through the i.m. route. Furthermore, problems with venous accessibility and maintenance may complicate i.v. administration of phenytoin in newborns and very sick infants. Fosphenytoin, a new phenytoin prodrug, can be safely administered through the i.m. route, and, because of the physical characteristics of its formulation, it offers advantages over phenytoin for i.v. administration. Clinical studies with i.v. and i.m. fosphenytoin demonstrate that the efficacy, safety, and pharmacokinetics of this drug are similar in 5- to 18-year-old children and in young adults. The safety and pharmacokinetic profile of i.v. and i.m. fosphenytoin in younger children and infants is currently being investigated.

Adolescent↗
PubMed1996

Diagnosis and treatment of epilepsy in children and adolescents.

Seizures have a variety of aetiologies and may have various manifestations. Some are recurrent and represent the different types of epilepsy, whereas others are isolated events. Descriptions of various epileptic seizures, as well as their corresponding electroencephalograms (EEGs), have recently led to a unifying international classification of epileptic seizures and epilepsy syndromes. These classifications are extremely important for the practitioner working with the paediatric patient, as they allow for optimal evaluation and treatment. This article reviews the epilepsies and epilepsy syndromes with special attention to age of onset and prognosis. Special circumstances such as status epilepticus, which represents a true medical emergency, are reviewed. The first step in the pharmacological management of seizures is to establish the diagnosis of epilepsy. The recurrence of seizures (or the risk), seizure type and specific syndrome help guide initial treatment choices. There is no drug of choice, but some drugs have proven more effective for certain types of seizure. Monotherapy is preferable, and combination therapy should only be used if monotherapy with first-line drugs fails. Candidates for the newer antiepileptic drugs (e.g. felbamate, gabapentin, lamotrigine and vigabatrin) include patients resistant to older agents or who are unable to tolerate them. The exact place in therapy of these newer agents is uncertain, but in many patients they provide better seizure control and are better tolerated.

Acetates↗
PubMed1995

Safety of intravenous valproate.

This multicenter, open-label trial was designed to study the safety of intravenous (IV) sodium valproate in patients with epilepsy. All 318 patients (previously treated with antiepileptic drugs) were hospitalized for seizure control or anticipated seizures. The protocol allowed physicians to set the number of infusions and treatment duration. Adverse events, laboratory studies performed, and seizure activity were documented on case report forms. The patients' mean age was 34.4 years (range, 2-87 years). The most common reason for admission was lack of seizure control (235 patients, 185 of whom were admitted for video-electroencephalographic monitoring). The median dosage of valproate was 375 mg infused over 1 hour. The median number of doses was four, given over 2 days. In 54 patients (17%), transient adverse events were reported. The most frequent were headache, reaction at the injection site, and nausea (2.2% each); somnolence (1.9%); vomiting (1.6%); and dizziness and taste perversion (1.3% each). No persistent or severe hematologic or serum chemistry abnormalities were found. Vital signs were not significantly affected by the IV infusion of valproate. At the dosages and rates of administration studied, intravenous valproate appears to be safe and well tolerated.

Adolescent↗
PubMed1995

Epidemiology of status epilepticus.

This study presents a review of the epidemiology of status epilepticus (SE) in Richmond, Virginia, U.S.A. The data summarize some of the first population-based information on the natural presentation of SE in a controlled community setting. SE occurred with an absolute incidence rate of 41 patients per 100,000 residents per year in Richmond. The frequency of total SE occurrences was 50 patients per 100,000 residents per year. Overall mortality in this population was 22%. Absolute incidence and occurrences of SE in this population were shown to be underestimates due to the inability, for multiple reasons, to document all cases of SE. Based on the Richmond data, the number of SE cases, frequencies of occurrence, and deaths per year occurring in the United States were estimated to be 102,000-152,000, 125,000-195,000, and 22,000-42,000, respectively. In Richmond, nonwhites had a much higher incidence of SE than did whites. Partial SE was the most common form of seizure initiating SE. Age and etiology were also found to contribute to mortality. Infants <1 year of age had the highest incidence of SE, but the elderly population represented the largest number of SE cases. This study provides a review of the first prospective, population-based, epidemiological data on SE and shows that SE is a major medical and neurological emergency in both academic and community hospital settings.

Adolescent↗
PubMed1995

Antiepileptic drug therapy in the United States: a review of clinical studies and unmet needs.

The goal of epilepsy treatment is complete seizure control with minimal adverse drug reactions. Because no drug is entirely free of adverse effects, the clinician must aim for a balance between efficacy and tolerability. In approximately 40% of patients, however, monotherapy with conventional antiepileptic drugs either is not tolerated or does not provide optimal seizure control. Polypharmacy may be necessary in as many as 30% of patients. As clinicians look to new agents that may produce an overall improved quality of life, they must continue to balance efficacy and adverse effects in evaluating the usefulness of the new vs the established drugs.

Anticonvulsants↗