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Biomedical subjects

P Jallon

Publications and source records attributed to P Jallon.

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

Epilepsy in developing countries.

On June 6th and 7th, 1996, an international workshop on specific aspects of epilepsy in the developing world was organized in Geneva by the chairman of the ILAE Commission of Epilepsy in Developing Countries, P. Jallon, involving members of the ILAE, the World Health Organization (WHO), and a network of people who work with epilepsy patients in developing countries. Those taking part included all the members of the ILAE Commission on Epilepsy in Developing Countries, the chairmen of the ILAE Commissions on Tropical Diseases, Epidemiology, Education, Economics, and Drugs, as well as the president, treasurer, and past president of the ILAE; and the president of the IBE, Hanneke de Boer. There were representatives from Eastern European countries (Russia, Slovenia, Turkey), South America (Brazil, Colombia, Uruguay, Ecuador, Venezuela), Africa (Ethiopia, Senegal, South Africa, Togo, Tunisia), and Asia (India, Indonesia, Pakistan, Sri Lanka, The Philippines and China). Representatives from WHO joined the meeting on the last day (Drs. L. Prilipko, A. Janca, and C. L. Bolis). Three major topics were considered--epidemiology, medical assessment, and therapeutic aspects as well as some economic and social aspects of the disease. A second mission of this meeting was to work with WHO representatives to develop a program for action to care for people with epilepsy in these countries.

Adolescent↗
PubMed1997

The problem of intractability: the continuing need for new medical therapies in epilepsy.

Treatment of epilepsy, one of the most common neurologic disorders, has evolved from "institutional" polytherapy to "dogmatic" monotherapy, and, most recently, to "rational" polypharmacy. The introduction of bromides for the treatment of epilepsy was followed first by phenobarbital and then by phenytoin as therapeutic options. Although attempts to combine medications were legion, none was supported by studies that demonstrated the benefit of such combinations. The issue of adverse effects became a principal argument in favor of monotherapy. Monotherapy, using newly developed drugs, avoided problems due to drug interactions but was ineffective in 20-30% of patients. A greater understanding of basic disease mechanisms and developments in molecular biology have led to an increased number of effective drugs for the estimated 6-12% of patients with epilepsy whose condition is intractable. Clinical research continues to build on the work of basic scientists in attempting to develop treatments based on a desire to move beyond the palliative and to affect the causative mechanisms of the disease. Novel medical approaches now under exploration include the use of drugs with complementary mechanisms of action, stimulation of various components of the nervous system, biochemical manipulations, focal intracerebral drug perfusion, and gene therapy.

Anticonvulsants↗
PubMed1997

[Epilepsy and the heart].

The relations between epilepsy and heart are complex and expressed in two opposite sides. (1) Cardiac arrhythmias may provoke epileptic seizures but these seizures are, in this case, syncopal attacks. Nevertheless, in the past, these clinical features have been individualized as "cardiac epilepsy" or epilepsy in cardiacs. However, true epileptic seizures could be observed in the course of a syncopal attack and a syncope may complicate the issue of an epileptic seizure. (2) On the other hand, epileptic seizures may provoke severe cardiac arrhythmias. The incidence rate of sudden death in patients with epilepsy is estimated to be 1/1000 patients. The exact neural mechanisms in cardiac arrhythmias seizures could explain only some of the sudden unexpected deaths observed in epileptic patients. The role of antiepileptic drugs on cardiac conduction as well as the effects of seizures or status epilepticus on the myocardium are other enigmatic aspects of the relations between epilepsy and heart.

Arrhythmias, Cardiac↗
PubMed1997

[Monotherapy and polytherapy use of anti-epileptic drugs. Development of views].

The evolution of our approach to the treatment of epilepsy has occurred in three stages: at the turn of the century, when epilepsy was increasingly entering into the mainstream of Neurology, pharmacotherapy of epilepsy was limited to the bromides. Subsequently, phenobarbital used in 1912 and then phenytoin, discovered in 1932, remained, for many years, the only therapeutic options. To increase the chances of complete suppression of seizures, it appeared logical to use both medications together. This approach was used for many years despite the advent of carbamazepine and sodium valproate. In 1976, the first studies appeared indicating the advantages of using monotherapy from the start. Not only did this approach show itself to be effective, but there was a marked decrease in the incidence of side-effects engendered by polytherapy. Nevertheless, despite o carefully instituted monotherapy, between 20 and 30 p. cent of patients still had seizures refractory to treatment. A new era in antiepileptic drug development has created new hope in the management of epilepsy. Based on a better understanding of the disease process and scientific development in molecular biology, we are able to provide a more rational polypharmacy, taking into account their pharmacodynamic interactions and their relatively high cost.

Anticonvulsants↗
PubMed1996

[Geographical distribution of epilepsy in the world].

Based on more than one hundred epidemiological studies we evaluated the frequency of epileptic seizures and epilepsy itself. Worldwide, there appears to be unequal distribution of disease incidence and prevalence. It seems that the incidence of epilepsy in developing countries would be greater than that in the industrialized world and that the differences in prevalence observed between the developing and the industrialized countries could be epidemiologically significant. Once the methodological biases that might account for these differences have been eliminated, it is probable that the differences in incidence and prevalence could be explained by specific risk factors. Particular regional distribution of the disease would then reflect local risk factors and, therefore represent epidemiological markers of particular regional or endemic infections, hereditary predispositions, early interventions during management of childbirth and childhood development or even the natural course of the disease.

Adult↗
PubMed1995

[Drug-resistant epilepsy in adults].

Various estimation of the proportion of difficult-to-treat epileptic patients is given in the literature. It varies from 5 percent to 25 percent, because of imprecise meaning of pharmacoresistancy and similar terms. There is no such thing as a unique pharmacoresistant epilepsy. Persisting seizures despite antiepileptic drug prescription does not necessarily mean refractory seizures. Seizures may be drug-resistant for a limited period only, or be intermittent, or be a long-lasting condition. Seizure frequency may remain unchanged, or decrease, more or less. Toxicity of AEDs must be considered. Unbearable side effects are a limiting factor for maintaining some active drugs. In practice, the term pharmacoresistancy may be used when seizures occur in spite of a convenient therapy, whatever their frequency, and whatever the resulting handicap. Predictive factors for intractibility may be considered under four headings, i.e. seizure types, patient, epileptic syndrome, and antiepileptic drugs. Most of the elements of the first three groups are available immediately after the first seizure and response to treatment may be estimated one or two years later. Outcome of an epilepsy may be evaluated, or guessed, rather early. This is crucial for management of epileptic patients.

Adult↗
PubMed1994

[Epilepsy in adults and elderly subjects. Epidemiological aspects, therapeutic strategies].

The important and quite amazing increase in frequency of epileptic seizures and epilepsy in patients older than 60 years is now recognized as a valid epidemiologic phenomenon. This has been emphasized in the last epidemiologic studies performed with an identical methodology in our industrialized countries. This could in part be explained by the growth of the aged population, by the ageing itself and by a larger exposition to the various risk factors existing at this age. The first is represented by cerebrovascular diseases, but cerebral involution--per se--is surely involved. Prescription of antiepileptic drugs in these patients has to be adapted to the individual cautiously. Pharmacokinetics and pharmacodynamic variations are more frequent than in other populations. On the other hand, drug interactions seem to be more frequent and severe because of the polytherapy prescribed for multiple other diseases. Intellectual or sensorial decline may explain the imperfect compliance observed in these patients.

Adult↗
PubMed1994

Propofol in the management of refractory status epilepticus: a case report.

Status epilepticus is one of the most frequent neurological emergencies in the intensive care unit. Standard treatment includes intravenous barbiturates, benzodiazepines and phenytoin. However, drug coma is sometimes necessary to control refractory status epilepticus. We report such a case, successfully treated by intravenous propofol coma to EEG burst suppression.

Clonazepam↗
PubMed1994

Electroencephalogram and epilepsy.

In spite of its low degree of specificity and its poor sensibility, the electroencephalogram has remained, for half a century, the epileptologist's working tool. In this paper, the places of simple activation procedures are recalled, especially sleep activations. Recent studies have shown that EEG is important in diagnosis assessment and in treatment management.

Adolescent↗
PubMed1993

Pathological left-handedness. Left-handedness correlatives in adult epileptics.

Factors associated with left-handedness were examined in a large sample of adults who suffered with epileptic seizures (n = 446) in an attempt to delineate the concept of pathological left-handedness. Three main pathological factors were found associated with left-handedness: (i) right-hemiparesis of early onset; (ii) cognitive deficit; (iii) evidence of left-hemisphere disease on clinical examination. Familial sinistrality was also associated with left-handedness, independently of the above-mentioned pathological factors. Results support a clear-cut distinction between normal and pathological left-handedness. This distinction seems presently important for the evaluation of the great number of anomalies proposed to be associated with left-handedness.

Adult↗
PubMed1993

Upper limb injuries and handedness plasticity.

In a questionnaire survey of 9591 men between 17 and 27 years of age, there was an association between present handedness score and report of an earlier injury causing a temporary shift of hand use. The proportion of weak right-handers was higher among those who reported injuries. Overall, there was no association between left-handedness and injuries. Nevertheless, injuries occurring before the school attendance age, which concerned only a very small fraction of the respondents, were associated with an increased frequency of left-handedness. The data emphasize the plasticity of human handedness, and do not suggest that innate left- or non-right-handedness is a risk factor for accident occurrence.

Adolescent↗
PubMed1991

[Evaluation of the prevalence of epilepsy in a military selection centre].

In France, all men aged 18 to 27 must enter the national military service. This enables epidemiological studies to be carried out in the field of childhood and adolescence diseases. We verified the diagnosis of epilepsy claimed by young recruits in a selection centre. The prevalence rates were evaluated at 2.87 to 3.8 per 1000. These figures are slightly inferior to the national exemption rate but close to the epilepsy prevalence rate in adolescence. The various biases in methodology and results are discussed.

Adolescent↗
PubMed1990

[What to do after the first epilepsy seizure?].

It is never easy to decide on the action to be taken after a first epileptic seizure, the main question being; to treat or not to treat? To initiate a treatment implies that the epileptic nature of the seizure has been ascertained on the basis of strict clinical and electroencephalographic criteria. Apart from the specific causal treatment of some seizures, the prescription of a long-term antiepileptic therapy depends on the risk of relapse, which is always difficult to evaluate. The patient's age and family and his profession are factors which should never be neglected.

Anticonvulsants↗
PubMed1990

An epidemiological reconsideration of the Geschwind-Galaburda theory of cerebral lateralization.

To contribute to the Geschwind-Galaburda theory of cerebral lateralization, we examined the relationship of left-handedness to allergic disorders and stuttering, using epidemiological data of two French samples, one of which (N = 9591) is representative of the French male population between 17 and 24 years of age. Results showed a higher frequency of stuttering but not of allergic disorders in left-handers. Extreme right-handedness was observed to be significantly associated with a lower frequency of allergic disorders; response bias might explain such a relationship. Findings were confirmed after allowing for potential confounding factors, such as age and education. In both samples, stuttering and allergic disorders were significantly related.

Adolescent↗