[A study on cerebrospinal fluid and saliva to serum concentration ratios of anticonvulsants--Phenytoin, Phenobarbital, Valproic Acid and Primidone in epileptic patients].
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25 microliters plasma, 25 microliters internal standard and 5 microliters sodium dihydrogenphosphate solution are extracted with 100 microliters ethyl acetate. 40 microliters of the extract are mixed with 10 microliters trimethyl-phenyl-ammoniumhydroxide (0.1 mol/l methanol). 3 microliters of this solution are injected for gas chromatography using a nitrogen-specific detector. Trimethyl-phenyl-ammoniumacetate appears to be a satisfactory methylating agent for these drugs in the injection port of the gas chromatograph.
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It is a matter of debate whether beta-blockers or primidone have a better influence on essential tremor. It is also controversial whether essential tremor with synchronous electromyographic activity is influenced by the administration beta-blockers, while tremor with alternating electromyographic activity is influenced by primidone. The aim of this study was to reevaluate the effects of beta-blockers and primidone on essential tremor. We also aimed to evaluate the differential effects of beta-blockers and primidone on tremor with synchronous or alternating electromyographic activity and on tremor in different limb positions. One hundred patients (57 female, 43 male) with essential tremor were included in this study. According to the electromyographic pattern recorded from the antagonistic muscles, the patients were subdivided into group with synchronous (SYN) and group with alternating (ALT) activity. After the initial clinical and electromyographic examinations the patients were randomly assigned first to treatment with propranolol (180 mg daily), or to treatment with primidone (500 mg daily) for 30 days. After a washout period of 20 days the patients were assigned to the other treatment. Our results revealed that the effects of propranolol and primidone on essential tremor and on SYN or ALT tremor were similar. Differences between both drugs existed as regards to better primidone influence on the kinetic and intention tremors and to tremor localized outside the limbs. In conclusion it is better to treat patients with kinetic and intention essential tremor and tremor localized outside the limbs with primidone.
Many patients with essential tremor (ET) develop acute adverse effects to primidone. We investigated the association between CYP2C19 polymorphism (possibly related to primidone metabolism) and the risk for developing essential ET and acute adverse effects to primidone. Leukocytary DNA from 200 ET patients and 300 healthy controls was studied for the genotype CYP2C19 and the occurrence of CYP2C19 allelic variants by using allele-specific PCR amplification and Sma I and BamH I RFLP analyses. The frequencies of the genotype CYP2C19*1/CYP2C19*2 and of the allelic variant CYP2C19*2 were significantly higher in ET patients than in controls. The mean age at onset of ET did not differ significantly between patients with genotypes CYP2C19*1/CYP2C19*2andCYP2C19*1/CYP2C19*1. The frequencies of the genotype CYP2C19*1/CYP2C19*2 and the allelic variant CYP2C19*2 were similar in ET patients who developed acute adverse effects to primidone, in those who tolerated primidone and in controls; the frequencies were also similar in patients with head, voice, tongue and chin tremor compared with controls. These results suggest that heterozygosis CYP2C19*1/CYP2C19*2 is associated with the risk for ET, but not with the age at onset of ET, the presentation of acute side effects of primidone, or the existence of head, voice, tongue or chin tremor.
Plasma concentrations of primidone and its metabolite phenobarbitone were monitored in 9 pregnant epileptic patients treated with primidone (and in 3 cases other antiepileptic drugs) given at constant doses throughout pregnancy and the puerperium. Phenobarbitone plasma concentrations were monitored in another 6 patients given phenobarbitone itself. A trend towards increasing primidone plasma concentrations during the second quarter of pregnancy was evident in all patients, with a concomitant significant decrease in primidone-derived phenobarbitone plasma concentrations. A trend towards a lowering of plasma concentrations of phenobarbitone administered as such was confirmed. These results suggest the usefulness of a careful monitoring of primidone and primadone-derived phenobarbitone during pregnancy and the puerperium. Discrepancies of findings with primidone and phenobarbitone are discussed in view of the possible mechanism involved.
The effect of long-acting propranolol hydrochloride (160 mg/d), primidone (250 mg at night), and clonazepam (4 mg/d) on the resting, postural, and kinetic component of tremor was investigated in ten parkinsonian patients in a double-blind crossover design. Tremor was assessed by patient opinion, clinical scoring, and accelerometer recordings. The amplitude and frequency of tremorgrams were determined by spectral analysis. Most patients preferred long-acting propranolol and chose to continue taking the drug. The mean clinical score for resting and postural tremor was significantly decreased by long-acting propranolol but not by primidone or clonazepam. Long-acting propranolol reduced the mean amplitude of resting tremor by 70% and the mean amplitude of postural tremor by 50%. Mean tremor amplitudes were not changed by primidone or clonazepam. Tremor frequency was unaltered by the drugs. No side effects occurred with long-acting propranolol but adverse reactions were common with primidone and clonazepam. Long-acting propranolol is a useful adjuvant therapy for the tremors associated with Parkinson's disease.
Propranolol and primidone are widely used, effective agents in essential tremor although they are not tolerated by all patients. In the present study, the effectiveness of alprazolam, a triazole analog of benzodiazapine class, and acetazolamide, a carbonic anhydrase inhibitor, were investigated as symptomatic treatments for essential tremor. We studied 22 patients with essential tremor in a double-blind, cross-over, placebo-controlled design. The patients received in random order alprazolam, acetazolamide, primidone and placebo for four weeks, each separated by a two-week washout period. The study demonstrated that alprazolam was superior to placebo and equipotent to primidone, whereas there was no statistically significant difference between acetazolamide and placebo. The mean effective daily dose of alprazolam was 0.75 mg and there was not any troublesome side effect reported by the patients on alprazolam. Alprazolam can be used as an alternative agent in elderly essential tremor patients who can not tolerate primidone or propranolol.
Although animal models, such as electroshock seizures, pentylenetetrazol (PTZ)-induced seizures and the rotorod test, are widely employed in the search for and evaluation of new anticonvulsant drugs, the important role of diverse technical, biological and pharmacological factors in the interpretation of results obtained with these models is often not recognized. In order to delineate factors other than strain, sex, age, diet, climate, and circadian rhythms, which are generally known, a series of studies was undertaken. In the experiments described here, the influence of administration vehicles and drug formulations on bioavailability, potency and time course of anticonvulsant drugs was studied in mice. Two standard anticonvulsant drugs, primidone and carbamazepine, with poor aqueous solubility were used for these experiments, because water insolubility is a common problem in the laboratory evaluation of anticonvulsant agents. Since vehicles, especially organic solvents or detergents, may exert effects of their own, sensitive electroshock and PTZ seizure threshold tests were used for the assessment of vehicle-related actions. Of various aqueous or lipophilic vehicles tested, only glycofurol increased seizure thresholds, when concentrations exceeding 10% were administered. However, even at a concentration of 30%, the solubilizer did not exert measurable effects in the maximal electroshock seizure (MES) test in mice, but markedly potentiated the effect of primidone. In contrast, polyethylene glycol 400 (PEG 400) up to a concentration of 30% did not affect electrical or chemical seizure thresholds nor did it alter the pharmacological potency of primidone. When primidone or carbamazepine were administered as a suspension in a Tween/water vehicle, their anticonvulsant effects were considerably lower compared to injections of the same doses as a solution.(ABSTRACT TRUNCATED AT 250 WORDS)