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M R Trimble

Publications and source records attributed to M R Trimble.

167 records · Page 10Linked to original sources
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Discontinuation of phenytoin, carbamazepine, and valproate in patients with active epilepsy.

The effects of discontinuing individual antiepileptic drugs (AEDs) in patients with active epilepsy who are receiving combination therapy have not been studied systematically. We report a double-blind, prospective study of discontinuation of phenytoin (PHT), carbamazepine (CBZ), and valproate (VPA) in 70 patients with chronic active epilepsy. Each drug discontinuation was randomized to one of two relatively fast rates of reduction, and a control group of 25 patients continued with stable therapy. Patients who had CBZ removed had a significant increase in seizures that was maintained for 4 weeks after the end of drug reduction, and 10 of these 23 patients had to restart therapy with CBZ. There was no significant change in seizure numbers in the other groups. Two patients discontinued from VPA had to restart the drug; none had to restart PHT. The optimal rates of reduction of CBZ remain uncertain. There was no evidence for a clinically or temporally distinct burst of "discontinuation seizures" in any group. Any marked increase in seizures always resolved on reintroduction of the discontinued drug.

Carbamazepine↗
PubMedDate not supplied

Effects of removal of phenytoin, carbamazepine, and valproate on cognitive function.

Changes in cognitive function were noted in a double-blind, prospective, placebo-controlled study of discontinuation of phenytoin (PHT), carbamazepine (CBZ), and valproate (VPA) in 58 patients with active epilepsy, receiving multiple antiepileptic drugs (AEDs). A control group of 25 patients continued with existing therapy. A simple test battery, which would be directly applicable to a clinical setting, with measures of mental speed, attention, performance of a learned skill, short-term memory, concentration, and simple coordinated hand movements was used. Cognitive assessments were made before and at the end of discontinuation of a drug and 4 weeks later. Simple motor skills became faster on discontinuation of PHT, CBZ, and VPA (p less than 0.0005), with a further improvement in the subsequent 4 weeks (p = 0.03) and no significant difference between the AEDs. Performance on a measure of attention and concentration improved on discontinuation of PHT (p = 0.005) and did not alter with removal of CBZ or VPA; the improvement in the PHT discontinuation group was significantly different from that in the control group (p = 0.001). These results suggest that all three AEDs studied may adversely affect motor function and that PHT may be more deleterious to function in higher cognitive tasks than in CBZ or VPA.

Adolescent↗
PubMedDate not supplied

Effects of vigabatrin on cognitive function and mood when used as add-on therapy in patients with intractable epilepsy.

Cognitive function and mood of patients with epilepsy who received 2 g/day vigabatrin (GVG) in addition to their usual antiepileptic drugs (AEDs) was assessed on two occasions: before start of treatment (baseline) and 4 weeks after start of treatment. A battery of selected psychological tasks measuring attention, mental speed, motor speed, central cognitive processing, and perceptuomotor performance was used, along with standardized, objective mood assessments. A comparison group (n = 15) of patients receiving stable medication was also tested to evaluate practice effects of the psychometric tests. Administration of 2 g/day GVG significantly decreased response time on a test of central cognitive processing ability (arithmetic). No adverse effect was noted on any other test of cognitive function or mood.

Adult↗
PubMedDate not supplied

Functional diseases.

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History, 16th Century↗