PubMed · 15366192
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Anthony Marson, Sridharan Ramaratnam. 2003. Epilepsy.. https://pubmed.ncbi.nlm.nih.gov/15366192/
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Differences across studies in terms of design features and methodology, clinical procedures, and patient characteristics, are factors that can contribute to variability in the treatment effect between studies in a meta-analysis (statistical heterogeneity). Regression modelling can be used to examine relationships between treatment effect and covariates with the aim of explaining the variability in terms of clinical, methodological, or other factors. Such an investigation can be undertaken using aggregate data or individual patient data. An aggregate data approach can be problematic as sufficient data are rarely available and translating aggregate effects to individual patients can often be misleading. An individual patient data approach, although usually more resource demanding, allows a more thorough investigation of potential sources of heterogeneity and enables a fuller analysis of time to event outcomes in meta-analysis. Hierarchical Cox regression models are used to identify and explore the evidence for heterogeneity in meta-analysis and examine the relationship between covariates and censored failure time data in this context. Alternative formulations of the model are possible and illustrated using individual patient data from a meta-analysis of five randomized controlled trials which compare two drugs for the treatment of epilepsy. The models are further applied to simulated data examples in which the degree of heterogeneity and magnitude of treatment effect are varied. The behaviour of each model in each situation is explored and compared.
Lamotrigine is a broad-spectrum antiepileptic agent. This study describes a simple and sensitive high-performance liquid chromatographic method for the determination of lamotrigine in 50 microl of plasma. Lamotrigine and the internal standard guanabenz were extracted with 1.2 ml of diethyl ether, after the samples alkalinized with 10 microl of sodium hydroxide solution (1N). Chromatographic separation was achieved on a silica column with the mobile phase of acetonitrile-water containing 0.2% phosphoric acid and 0.3% triethylamine (pH 2.7) (84:16, v/v), at a flow-rate of 1 ml/min. The eluant was detected at 225 nm. The retention time was about 6 min for lamotrigine and 7 min for guanabenz. No endogenous substances and concomitant anticonvulsants were found to interfere. Calibration curves were linear from 0.1 to 5 microg/ml. The relative recovery of lamotrigine averaged about 80%. The limit of quantitation was 0.1 microg/ml. The intra- and inter-day precision (expressed as coefficient of variation, CV) was 8.1%, or less, and the accuracy was within 11.5% deviation of the nominal concentration. The method is suitable in pharmacokinetic investigation and monitoring lamotrigine concentration.
Neuroblastoma (NB), a sympathetically derived childhood tumour, shows characteristics of neuronal precursor cells, suggesting a halted differentiation process. We have previously shown that the Notch signalling cascade, a key player during normal neurogenesis, also might be involved in NB differentiation. Valproic acid (VPA), a well-tolerated antiepileptic drug, has been shown to induce differentiation and cell death of NB cells, possibly associated with its recently described HDAC inhibiting activity. Stimulation of NB cells with VPA led to increased cell death and phenotypic changes associated with differentiation, that is, neurite extension and upregulation of neuronal markers. VPA treatment also led to an activated Notch signalling cascade as shown by increased levels of intracellular Notch-1 and Hes-1, mimicking the initial phase of induced differentiation. These results reinforce that VPA potentially could be used in differentiation therapy of NB and that the effects in part could be a consequence of interference with the Notch signalling cascade.