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Anticonvulsant drugs and cancer. A cohort study in patients with severe epilepsy.

Over 2000 epileptic patients admitted to the Chalfont Centre for Epilepsy between 1931 and 1971 and taking anticonvulsants were followed up to the end of 1977. Mortality between 1951 and 1977 was greatly in excess of that in the general population of England and Wales in that period allowing for age and sex. Some of the excess was directly attributable to epilepsy, but there were also more deaths from suicide and circulatory, respiratory, and malignant disease than would be expected. Apart from the brain and central nervous system, no particular site had a significant excess of tumours. In particular, there were no liver tumours (and only one gallbladder carcinoma). This makes it unlikely that the liver tumours produced on feeding phenobarbitone to mice are indicators of major human risk.

Adolescent↗

Anticonvulsant therapy in small animals.

Successful control of seizures with anticonvulsant drugs reflects a balance in achieving seizure control while minimizing undesirable drug side effects. Variability in the disposition of anticonvulsants and interaction among them are important confounders of successful therapy. This article will provide a review of selected anticonvulsants, focusing on drugs most likely to control seizures in small animals. The proper use of anticonvulsants will be discussed, with emphasis on differences in individual drug disposition, detection of these differences, and rational approaches to responding to these differences by dose modification. The primary target of discussion will be treatment of generalized, tonic clonic seizures, the most common type afflicting small animals. Opinions regarding anticonvulsive therapy vary among clinicians. Most of the comments and recommendations offered in this discussion reflect observations made from our therapeutic drug monitoring service and completed and ongoing clinical trials that focus on the use of anticonvulsants used either alone or in combination with phenobarbital.

Acetates↗

Drug-induced urolithiasis.

Diagnostic and therapeutic drugs may enhance urolithiasis in one or a combination of ways, including: (1) alteration of urine pH in such fashion as to create an environment that increases the solubility of some lithogenic substances, (2) alteration of glomerular filtration rate, tubular reabsorption, and tubular secretion of drugs of endogenous substances so as to enhance promoters or impair inhibitors of urolithiasis, and (3) precipitation (e.g., drugs or their metabolites) to form a portion or all of a urolith.

Allopurinol↗

Nonconvulsive status epilepticus.

A 49-year-old man presented with dizziness and altered behavior associated with a nonconvulsive seizure. He had a long history of well-controlled tonic-clonic seizures and daily episodes of 10-second staring spells. Despite normal neurological and laboratory examinations, an emergent electroencephalogram showed changes consistent with nonconvulsive generalized status epilepticus.

Anticonvulsants↗

Tremor--easily seen but difficult to describe and treat.

Tremor is a common movement disorder yet many physicians struggle with its terminology as well as with its treatment. Attempts have been made to develop standard terminology and criteria for tremors but this process continues to evolve. In this review, a summary of the currently-proposed phenomenology and syndromic classification of all types of tremor is presented. The diagnosis and management of essential tremor is presented in more detail, as it is the most commonly encountered tremor.

Adrenergic beta-Antagonists↗