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Tim Betts

Publications and source records attributed to Tim Betts.

9 recordsLinked to original sources
PubMed2003

Clinical experience of marketed Levetiracetam in an epilepsy clinic-a one year follow up study.

Levetiracetam is a new anti-convulsant with impressive pivotal trial credentials. We examined its effectiveness in refractory clinic patients with epilepsy with a year's follow up. Six months after initiation 32% of the patients were seizure free, and 26% at one year. By the end of the 12 months follow up 77% of patients were still taking the drug, having gained benefit from it: 23% had dropped out due to intolerable side effects, seizure increase or lack of efficacy. There is evidence that the drug is broad spectrum and as effective in primary generalised epilepsy as in partial onset epilepsy. Our audit of its use and effectiveness has led us to position it as our first choice add-on drug if the initial monotherapy drug fails.

Anticonvulsants↗
PubMed2002

Patients treated with vigabatrin exhibit central visual function loss.

PURPOSE: To investigate visual function in the central 10 degrees in patients who have undergone vigabatrin (VGB) antiepileptic drug (AED) therapy with the aim of identifying a clinical regimen for assessing central visual function. METHODS: The sample comprised 12 epilepsy patients (mean age, 38.6 +/- 11.7 years) who had been treated with VGB (either as monotherapy or polytherapy). A number of central visual-function tests were carried out for each eye, including high-contrast LogMAR visual acuity, short-wavelength automated perimetry (SWAP 10-2), spatial contrast sensitivity (CSV-1000), and Farnsworth-Munsell (FM) 100-hue colour discrimination. RESULTS: The group mean cumulative VGB dose was 5,086 +/- 3,245 g. The average SWAP 10-2 mean deviation (MD) for the group was -3.24 +/- 3.23 dB; 14 eyes of eight patients showed defects (range, -1.62 to -9.46 dB). The square root of the group mean total error score for FM 100-hue was 7.42 +/- 3.84; nine eyes of five patients were classified as abnormal with an unsolved colour axis suggestive of complex drug interactions. For contrast sensitivity, 15 eyes of eight patients yielded abnormal results in one or more spatial frequencies. Defects were more prominent at higher spatial frequencies. Overall, four patients had defects in all three visual-function tests, six patients had mixed defects, and two patients were normal. CONCLUSIONS: Visual-function deficits in epilepsy patients treated with VGB are present in the central 10 degrees of the retina. We recommend a battery of investigations, including SWAP 10-2 and spatial contrast sensitivity testing, to assess central visual function.

Adult↗
PubMed2002

Epilepsy patients treated with antiepileptic drug therapy exhibit compromised ocular perfusion characteristics.

PURPOSE: Reduced cerebral blood flow and decreased cerebral glucose metabolism have been identified in patients with epilepsy treated with antiepileptic drug (AED) therapy. The purpose of this study was to determine whether ocular haemodynamics are similarly reduced in patients with epilepsy treated with AEDs. METHODS: Scanning laser Doppler flowmetry was used to measure retinal capillary microvascular flow, volume, and velocity in the temporal neuroretinal rim of 14 patients diagnosed with epilepsy (mean age, 42.0 +/- 0.9 years). These values were compared with those of an age- and gender-matched normal subject group (n = 14; mean age, 41.7 +/- 0.3 years). Student's unpaired two-tailed t tests were used to compare ocular blood-flow parameters between the epilepsy and normal subject groups (p < 0.05; Bonferroni corrected). RESULTS: A significant reduction in retinal blood volume (p = 0.001), flow (p = 0.003), and velocity (p = 0.001) was observed in the epilepsy group (13.52 +/- 3.75 AU, 219.14 +/- 76.61 AU, and 0.77 +/- 0.269 AU, respectively) compared with the normal subject group (19.02 +/- 5.11 AU, 344.03 +/- 93.03 AU, and 1.17 +/- 0.301 AU, respectively). Overall, the percentage mean difference between the epilepsy and normal groups was 36.31% for flow, 28.92% for volume, and 34.19% for velocity. CONCLUSIONS: Patients with epilepsy exhibit reduced neuroretinal capillary blood flow, volume, and velocity compared with normal subjects. A reduction in ocular perfusion may have implications for visual function in people with epilepsy.

Adult↗
PubMed2002

Epilepsy and the ovary (cutting out the hysteria).

This review touches on the historical links between epilepsy, seizures and the uterus and ovaries which have fascinated and misled physicians since Greco-Roman times. It then examines present knowledge of ovarian function and its effect on epileptic activity and vice versa before exploring the modern controversy about polycystic ovaries and the polycystic ovary syndrome, epilepsy and anticonvulsant medication. Based on present evidence, women with epilepsy are more prone to develop polycystic (polyfollicular) ovaries than other women due to the epilepsy itself. But women with epilepsy related polycystic (polyfollicular) ovaries are vulnerable to the effects of sodium valproate (possibly particularly during adolescence) and may develop the polycystic ovary syndrome: this is reversible if the valproate is withdrawn. Lamotrigine and carbamazepine seem to prevent the development of the syndrome.

Adult↗
PubMed2002

Case reports.

Explore the source record for details and available documents.

Adult↗
PubMed2002

The epilepsy nurse specialist--expendable handmaiden or essential colleague?

The benefits of a specialist epilepsy nurse in the management of people with epilepsy are still in question. Evidence from controlled clinical trials suggests that patients supported by a nurse specialist are well informed and have a high degree of satisfaction. However, no significant effect on health status or the number of seizures has been yet demonstrated, although this is not the primary function of most epilepsy specialist nurses. The recent International League Against Epilepsy (ILAE) British Branch meeting in Liverpool (April 2001) dedicated a one-day symposium to epilepsy nursing including a debate on the effectiveness of 'the epilepsy specialist nurse--warm fuzzy feeling or evidence based?'. Although it was agreed that evidence-based research is limited, the case studies and data presented, throughout the symposium, highlighted the varying role of the epilepsy specialist nurse in supporting both the specialist physician in epilepsy care, the non-specialist physician and the primary care physician in patient communication. This paper provides an overview of the presentations given at the symposium, including those on nursing research and publishing.

Epilepsy↗
PubMed2002

The cost of everything and the value of nothing: nursing case histories.

A series of three nursing case histories related to epilepsy care are presented to demonstrate the range of clinical nursing activity in an epilepsy clinic and to pose the question whether any of these activities, deemed essential by both clinician and nurse, would be thought appropriate if cost effectiveness of nursing care was merely measured by a significant reduction in seizure frequency. The conclusion drawn is that a specialist epilepsy nurse in an epilepsy clinic is an invaluable member of the team, who frees the medical member of the team to concentrate on those duties which need medical input: but, using currently applied outcome criteria, it would be difficult to justify the nurse's cost effectiveness. Measures that do this accurately and fairly must be developed.

Adolescent↗
PubMed2002

Epilepsy--doctor's dilemma, lawyer's delight? Medico-legal consequences of practising in the field of epilepsy report of an International League against Epilepsy British Branch meeting--Edinburgh, April 2000.

Six cases are described where the medical management of a person's epilepsy was brought under legal scrutiny. Lessons learnt from this educational exercise include improving doctor patient communication, the function of a Coroner's Court, when is misdiagnosis negligent, the vagaries of expert witnesses, should failure to diagnose a tumour be blamed on the physician or the service when facilities are inadequate, is failure to recognise a rare drug interaction, failure to warn against an interaction, or failure to take a proper history, negligent? The conference also examined the legal ramifications of the nurse/doctor relationship in epilepsy care, the place of epilepsy guidelines and, due to its interactive nature, reflected on the audience's epilepsy knowledge, which, in places seemed significantly deficient. It was a gripping educational exercise.

Adolescent↗