Intramuscular administration of phenytoin.
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Epilepsy↗
Biomedical subjects
M Dam
Publications and source records attributed to M Dam.
[Serum phenytoin levels following intramuscular injection in relation to treatment of status epilepticus].
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Adolescent↗
Juvenile myoclonic epilepsy in unexpected age groups.
Juvenile myoclonic epilepsy is a well defined, age related epileptic syndrome. Case reports are presented, demonstrating the onset of this syndrome very early in life as well as in old age. Consequently, since the correct diagnosis is of decisive importance with regard to optimal treatment, the search for this syndrome should not be confined to juvenile patients.
Age Factors↗
A double-blind study comparing oxcarbazepine and carbamazepine in patients with newly diagnosed, previously untreated epilepsy.
Two hundred and thirty-five patients suffering from newly diagnosed epilepsy were randomly allocated to treatment with either oxcarbazepine or carbamazepine in a double-blind multi-centre study. After a titration phase (between 4 and 8 weeks), the optimal individual dose of trial medication was determined and treatment with that dose was continued for another 48 weeks. The criteria for assessment were: efficacy--seizure frequency, EEG tracings, global evaluation; tolerability--side effects observed by the patient or the investigator, laboratory tests; other assessments--blood pressure and heart rate, carbamazepine and 10,11-dihydro-10-hydroxycarbamazepine trough serum levels. The results of the study showed the following: no significant difference in seizure frequency between oxcarbazepine and carbamazepine; no correlation between the therapeutic effect and the EEG findings in either treatment group; oxcarbazepine caused significantly fewer (P = 0.04) 'severe' side effects than carbamazepine; global evaluation of tolerability demonstrated a trend towards the better tolerability of oxcarbazepine; no correlation was observed between either efficacy or tolerability and the actual serum trough levels of antiepileptic drugs; clinically relevant abnormal laboratory test findings were observed in 2 patients, both on carbamazepine. The authors consider oxcarbazepine to be a valuable alternative to carbamazepine, particularly in patients who develop side effects which prevent optimal seizure control.
Adolescent↗
No influence of the antidepressant paroxetine on carbamazepine, valproate and phenytoin.
A single-blind, placebo-controlled, cross-over trial investigating possible interactions between paroxetine, a serotonin re-uptake inhibitor, and carbamazepine (CBZ), valproate (VPA) and phenytoin (PHT) was carried out in 20 outpatients with epilepsy. Patients on long-term treatment with CBZ, VPA, or PHT were given a 7-day placebo treatment, followed by paroxetine co-treatment for 16 days. Side effects were infrequent and mild. Paroxetine caused no changes in the plasma concentrations and all values were within the recommended ranges. No changes in protein binding were found. Plasma concentrations of paroxetine at steady state (8-147 ng/ml) were in the normal range for a 30-mg daily dosing regimen. None of the patients experienced epileptic seizures during the study.
Adult↗
18F-fluorodeoxyglucose positron emission tomography study of brain metabolism in cirrhosis: effect of liver transplantation.
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Adult↗
Late-onset epilepsy: etiologies, types of seizure, and value of clinical investigation, EEG, and computerized tomography scan.
Approximately 25% of patients with epilepsy will have their first seizure after the age of 25 years. These individuals will need special attention with regard to etiology. Brain tumor is one of several causes that may be suspected. The present study of 221 patients with late-onset epilepsy from the University Clinic of Neurology, Hvidovre Hospital, Copenhagen, Denmark, was undertaken to look for means to select those cases in which computerized tomography (CT) scan should be performed. Brain tumor was the cause in 16% and cerebrovascular infarctions in 14%. The major etiological group was the one in which no cause could be detected (38%). Alcohol abuse as the etiology--defined as cases with a history of long-standing alcohol overuse, concomitant signs of alcohol intoxication, and spontaneous recurrent epileptic seizures--made up a group of one-fourth of all the patients with late-onset epilepsy. Comparison of the history, clinical symptoms and signs, EEG abnormalities, and CT scan speaks in favor of some consideration being given to the first three parameters before the CT scan is performed.
Adult↗
Public attitudes toward epilepsy in Denmark.
Social acceptance of persons with epilepsy very often constitutes a considerable problem for patients and their relatives. Nationwide opinion pools on the knowledge of and public attitude toward epilepsy have been taken in several countries, but never in Denmark. We report a Gallup survey of the general knowledge of and attitude toward epilepsy. A representative population of 1,500 persons aged greater than or equal to 15 years was selected in a four-state proportional sampling procedure. Ninety-seven percent of respondents had heard or read about epilepsy, 60% of these knew a person with epilepsy, and 50% had seen an epileptic seizure. The attitudes toward social acceptance and employment of persons with epilepsy were generally favorable, but 7% had objections to social contact between their children and persons with epilepsy in the playground and at school and 7% had objections to equal employment. Familiarity with persons with epilepsy was correlated to questions about attitudes and general knowledge of epilepsy. Such knowledge and public attitude in Denmark are mainly positive, but we believe that a continuous information campaign about epilepsy is essential, especially among youth.
Adolescent↗
Comparison of AccuLevel and TDx: evaluation of on-site monitoring of antiepileptic drugs.
Therapeutic drug monitoring, an important aid in antiepileptic drug (AED) therapy, has a lag time before results are obtained from clinical laboratories. The AccuLevel test is an enzyme immunochromatographic method for quantitative measurement of AEDs including phenobarbital (PB), phenytoin (PHT), and carbamazepine (CBZ), with results available within 20 min. A comparison between AccuLevel and TDx, (fluorescence polarization immunoassay) was conducted in 233 paired blood samples from patients with AED therapy, including 12 Eskimo children receiving treatment in Greenland. Forty-five blood samples were analyzed for PB, 80 for PHT, and 108 for CBZ. Linear regression analysis showed good agreement between the two methods (r = 0.951, 0.958, and 0.945, respectively). The test is easy to perform, but care must be taken to follow the correct procedure, or inaccuracies will result. That happened in some of our results. A reduction in lag time, using on-site drug monitoring, was demonstrated. The AccuLevel is a rapid, accurate, and convenient method for use in AED monitoring.
Anticonvulsants↗
Global coordination of national public health strategies.
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Acquired Immunodeficiency Syndrome↗
Antiepileptic drugs: metabolism in pregnancy.
In an open prospective clinical study, plasma clearance of phenytoin, phenobarbitone and carbamazepine was assessed in 14 epileptic patients during and after pregnancy. Plasma clearance showed a marked increase during pregnancy, reached a maximum just before or after delivery, and then decreased to early pregnancy values. The relative plasma concentration of carbamazepine-10,11-epoxide to that of carbamazepine increased similarly during pregnancy. The protein binding of carbamazepine and the epoxide was not influenced by pregnancy. A higher rate of hepatic drug metabolism, due to alteration of the physiological state in pregnancy is suggested as the most reasonable explanation. No change in seizure frequency was seen, probably because of frequent dose adjustments in order to keep plasma levels within the optimum range.
Adult↗
Influence of interrupted pulmonary lymph drainage on antibody responses in hilar-stripped lungs.
Lung transplantation interrupts hilar lymphatics. This may have an impact on immune responses to antigens entering the lung because the antigens cannot reach the lung-associated lymph nodes where the immune response is generated. We investigated the interruption and regeneration of lymphatics and the influence of this on antibody responses after hilar stripping in rats in three experiments: (1) visual detection of regenerated hilar lymphatics by chromolymphography, (2) observation of transport of carbon particles from the lung to the lung-associated lymph nodes, and (3) assessment of antibody responses after lung immunization with sheep red blood cells. The findings showed that hilar lymphatics were interrupted by hilar stripping and regenerated from day 7 after operation. Transport of particles to the lung-associated lymph nodes was blocked during the first week after operation but returned to normal values thereafter. Serum antibody titers were absent or low in the rats immunized on days 7 and 10 after hilar stripping; subsequently antibody responses gradually recovered in 1 month. We conclude that antibody responses to antigens in hilar-stripped lungs are impaired as long as the antigens cannot be transported through lymphatics from the lung to the lung-associated lymph nodes. These findings can explain in part why pulmonary infections occur so frequently in the initial weeks after lung transplantation.
Animals↗
Effects of flunitrazepam on local cerebral glucose utilization in the rat brain.
Flunitrazepam effects on local cerebral glucose utilization in the rat brain were investigated with the (14C) 2-Deoxy-D-Glucose procedure. The drug decreased glucose utilization in many areas of the rat brain, whereas no increases were observed. In this respect, the metabolic effects of flunitrazepam were different from those of other CNS "depressant" drugs, such as isoflurane and phencyclidine. Compared to the metabolic changes induced by diazepam, flunitrazepam peak effects appeared later and involved a greater number of regions.
Animals↗