[Indications for monotherapy or polytherapy in epilepsy].
Explore the source record for details and available documents.
Anticonvulsants↗
Biomedical subjects
P Loiseau
Publications and source records attributed to P Loiseau.
Long-term prognosis in two forms of childhood epilepsy: typical absence seizures and epilepsy with rolandic (centrotemporal) EEG foci.
Findings in children seen between 1955 and 1965 during the year of onset of typical absence seizures (90 patients) or rolandic epilepsy (79 patients) were analyzed by actuarial methods. One hundred and eighteen patients were followed for more than 15 years. Rolandic epilepsy is a true benign epilepsy ending with puberty. Although school and family problems are common during the acute stage of the disease, the social adaptability of such patients is excellent. We considered only typical absences occurring as a first epileptic sign in normal children. Myoclonic or atonic absences have a poor prognosis. Many patients with simple and automatic absences experience remission 15 years after withdrawal of medication. The overall cessation rate in those experiencing absences was only 57.5%, however, and 36% of patients developed tonic-clonic seizures. Social adaptability was often inadequate. Simple and automatic absences (constituting a homogeneous group) are not truly a benign form of epilepsy, even though prognosis for those afflicted is better than that for those with other forms of primary generalized epilepsy.
Adolescent↗
Nuclear inclusions in oculopharyngeal dystrophy. An ultrastructural study of six cases.
Nuclear inclusions in striated muscle from patients with oculopharyngeal dystrophy have been detected recently. We carried out ultrastructural examinations of biopsy specimens on 5 patients with oculopharyngeal dystrophy and we also reexamined a former case. In these 6 cases we found filamentous inclusions in a few nuclei. These inclusions seem to be characteristic of this disease as they have never been seen elsewhere.
Aged↗
No effect of food intake on clobazam absorption.
The kinetics of clobazam taken 3 h before, during, and 3 h after a standard hospital meal were studied in six healthy volunteers. Peak plasma levels were significantly lower when the drug was taken with or after meals suggesting that the rate of absorption was reduced by food. The mean area under the concentration vs time curve was not affected by the time of drug administration indicating that the meal had no effect upon the extent of absorption.
Adult↗
Double-blind crossover trial of progabide versus placebo in severe epilepsies.
In this double-blind, two-period, crossover trial with randomized treatment assignment, progabide (+/- 30 mg/kg/day) and placebo were compared as add-on to standard therapy in 20 "therapy-resistant" epileptic patients (11 males, nine females; age range, 7-47 years). The duration of each treatment period was 6 weeks. Crossover was performed gradually over 3-4 days. Twenty-four patients entered the study: three dropped out for reasons unrelated to progabide effects; one dropped out during the placebo period because of increased seizure frequency. Of the 20 patients who completed the study, 14 had partial, two partial plus secondary generalized, and four generalized seizures. Preexisting antiepileptic treatment consisted of one antiepileptic drug (AED) in three, two AEDs in eight, three AEDs in five, and four AEDs in four patients (mean, 2.5 AEDs/patient). The following parameters were recorded at biweekly intervals: (a) efficacy parameters--total seizure count, counts of each seizure type, and global clinical judgment; (b) safety parameters--adverse drug effects, brief clinical and neurological examinations, and laboratory tests; and (c) plasma concentrations of progabide and of the associated AEDs. Twelve patients were considered to be improved (p less than 0.01) with progabide by global clinical judgment compared with two patients improved with placebo. Nine patients of 20 had a 48-100% reduction of total seizure count in the verum period, leading to a significant reduction of total seizure number and of complex partial seizures in the verum period as compared with the placebo period (p less than 0.05). Adverse effects were reported or observed in 10 patients during the progabide period and in five patients in the placebo period. The side effects were generally mild and consisted of somnolence in four cases and of tremors, dry mouth, troubles of equilibrium, anorexia, euphoria, depression, and anxiety in individual patients; a 15-20% reduction of the progabide dose was required in two cases only. No treatment-related alterations in results of laboratory tests were observed.
Adolescent↗
Learning impairment in epileptic patients.
In order to evaluate immediate recall and learning in epileptic patients, four tests were chosen: Wechsler's memory span for digits, graphic reproduction of geometric figures from the Wechsler Memory Scale, learning of a list of words from the Rey Memory Scale, and recognition of these words. These tests were performed on 200 epileptic patients over the age of 15 years, without defined cerebral lesions, and with a normal or subnormal social adjustment. Memory impairment was analyzed with respect to the following variables: seizure frequency, seizure type, duration of the disorder, and anticonvulsant medication. Patient data were compared with values obtained for a population of 100 normal subjects matched for age and level of education. Comparison between epileptics and controls clearly demonstrated a statistically significant memory impairment in the group of patients. However, the reasons for these poor performances are not clear, and none of the studied parameters (type of epilepsy, frequency of seizures, duration of the disease, and medication), if considered alone, accounts for this impairment.
Adolescent↗
Prognosis of partial epileptic seizures in the adolescent.
Actuarial analysis was applied to the notes of 235 patients having a partial seizure for the first time between the ages of 12 and 18 years to establish the best predictive indicators of outcome. Among the factors considered to affect significantly the outcome were the seizure type (elementary or complex symptomatology), the initial EEG, the seizure frequency, the etiological factors, and an association with generalized seizures. Sex, age of onset, and topography of EEG paroxysmal abnormalities had no significance. An algorithm allows the prediction of the prognosis of these seizures at two different times immediately after a first seizure in some cases and after a 1-year survey in others.
Actuarial Analysis↗
[Benzodiazepines in the treatment of epilepsy].
Diazepam and clonazepam when given by intra- veinous or rectal route are the first-choice treatment of epileptic status. They are active in 80 per cent of cases whatever is the form of the status with a better efficacy in generalized seizures. Clonazepam, chlorazepate, nitrazepam and clobazam are also prescribed as chronic treatment of various forms of epilepsy. However tolerance and side-effects on higher nervous functions are frequent. In the state of the art benzodiazepine utilisation is limited as add-on therapy in severe epilepsies. They may have broader indications in monotherapy.
Anti-Anxiety Agents↗
[Epilepsy: epidemiology, economic data].
Explore the source record for details and available documents.
Adult↗
[Epidemiology of epilepsy].
Explore the source record for details and available documents.
Adolescent↗
[(3-Alkylhydroxy)phenylsulfides with antilipemic activity].
Explore the source record for details and available documents.
Animals↗
[Is it preferable to prescribe 1 or 2 daily doses of sodium valproate?].
Enteric-coated tablets containing 1 500 mg of sodium valproate (VPA) were administered in a randomized fashion either once or three times a day for 7 days to 6 healthy adult volunteers. Plasma total VPA levels and unbound fractions of the drug were determined 2-hourly on the last day of each treatment. Peak plasma concentrations were higher, and minimum plasma concentrations lower with one single dose than with three doses. In subjects who received three doses, the concentration curves tended to plateau, with higher AUC values. However, none of the differences observed reached statistical significance. The clinical implications of these pharmacokinetic data are discussed.
Adult↗
Liquid chromatography determination of clobazam and its major metabolite N-desmethylclobazam in human plasma.
A specific procedure for the analysis of clobazam and N-desmethylclobazam in plasma is described. Reversed-phase liquid chromatography was performed on a Radial-pak cartridge using a mixture of 45% acetonitrile and 55% buffer solution (pH 7); the ultraviolet detector was set at 254 nm. The method used diazepam as internal standard and diethylether as extraction solvent. The calibration curves are linear between 50 and 500 ng/ml for clobazam and between 100 and 1000 ng/ml for N-desmethylclobazam. The day-to-day precision of the procedure at clobazam plasma concentrations of 50, 250, and 500 ng/ml generated coefficients of variation of 2.2, 6.6, and 11.3%, respectively. No interference occurred in plasma from patients treated with various drugs. The method has been used to study the pharmacokinetics of clobazam and N-desmethylclobazam in patients receiving oral clobazam.
Adult↗
[New approaches to the study of memory impairment in epileptics].
Some memory functions were evaluated in 56 adult epileptic patients. A memory battery scale with verbal and visual material was used. Patients' scores were statistically worse than those of controls matched according for age and cultural level. No differences were observed between generalized and complex partial epilepsies. Left interictal E.E.G. abnormalities were correlated with verbal efficiency impairment. Length of illness and seizure frequency were consistently correlated with poor memory ability. Surprisingly antiepileptic drugs were not a major factors. However, none of these parameters if considered alone accounts for this impairment, which is obviously multifactorial. These poor memory performances are mainly due to a learning decrement. Epileptic patients have difficulties to learn but they well remember what they have learnt.
Child↗
[Sodium valproate, platelet dysfunction and bleeding (author's transl)].
Haemorrhagic tendencies, thrombocytopenia and/or platelet dysfunction have been reported in patients under sodium valproate (VPA) treatment for epilepsy. The true incidence and significance of these side-effects are discussed in the present paper based on case reports and systematic enquiries. The following conclusions emerge: VPA is responsible for thrombocytopenia and platelet dysfunction. These side-effects are dose-related, and the daily dosage should never exceed 40 mg/kg. Their mechanism is obscure and several explanations have been put forward. The effects of VPA on blood platelets may be considered as idiosyncratic in nature and have little clinical relevance unless patients contract an infectious disease or require surgery; only in such cases would a coagulation study be required.
Blood Platelet Disorders↗
[So-called benign epilepsy of later childhood].
Explore the source record for details and available documents.
Child↗
[Cerebral emboli due to subclinical heart disease. Value of thorough investigations (author's transl)].
In a series of 250 cases of cerebral vascular accident, the authors have selected 12 patients whose embolus appeared to have originated in the heart, although this could not be confirmed by clinical examination, ECG, Holter system monitoring and echocardiographic studies. Angiocardiography, complemented or not by His bundle exploration and/or coronary arteriography, revealed the presence of a heart disease likely to produce emboli in 11 cases, and in 8 cases, this was prolapsed mitral valve. These 11 cases represent 4.5% of the whole series and 22% of cases with emboli of suspected cardiac origin. Thorough cardiological studies, therefore, seem to be justified in young adults presenting with stroke. The high incidence of prolapsed mitral valve is in keeping with recently published data.
Adolescent↗
[Epileptics with EEG independent multifocal spike discharges (author's transl)].
Retrospective data on 77 epileptic patients allowed the following conclusions: Epilepsies with EEG independent multifocal spike discharges are mainly observed in children. Partial unilateral or generalized seizures are encountered. No relationship exists between the EEG foci and the seizure pattern. Acquired cerebral lesions are common. Multifocal spike discharges are functional foci, appearing and disappearing without close correlation with the evolution of seizures. They are an age-dependent expression of a disease which extends far beyond the seizures. They have to be absolutely distinguished from stable epileptic foci found in multifocal epilepsies.
Aging↗