[Severe rachitic osteopathy during long-term anticonvulsant treatment].
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Clinical findings of patients with polyneuropathy during treatment with anticonvulsant drugs are referred and cases are demonstrated concerning differential diagnosis of subclinical polyneuropathy as well as phenytoinophthalmoplegia.
The variety of drug induced patterns of pathological eye movements is reviewed with emphasis on hydantoins, barbiturates, carbamazepine, benzodiazepines, amitriptyline and alcohol. These different substances may be analogous or distinct in their site of action within the labyrinths, brain stem and cerebellum. Ocular oscillations are described in correlation to drug uptake or serum levels such as positional, downbeat, gaze evoked, periodic alternating nystagmus as well as saccadic pursuit, slowing down of saccades, alteration of VOR gain or suppression by fixation, internuclear and complete ophthalmoplegia. Most of the ocular motor disturbances are possibly due to a pharmacologically induced transient dysfunction of the vestibulo-cerebellar flocculus loop.
In a retrospective study the results of therapy in 60 children with so-called benign partial epilepsies are reported. It has been shown that the assessment of the therapeutic effect has to include the EEG, especially in epilepsies with atypical course. Carbamazepine has no effect on the EEG, in epilepsies with atypical course (atypical benign partial epilepsy, Landau-Kleffner syndrome, epilepsy with continuous spikes and waves during slow sleep [CSWS]) carbamazepine usually has no effect either on the seizures or on the EEG, on the contrary, in some cases both may even get worse. In our experience, the drug of choice in all types of benign childhood epilepsy is sulthiame, if necessary in combination with clobazam. Other drugs previously administered, including carbamazepine, should be dropped quickly. If the treatment with sulthiame or sulthiame/clobazam in children with atypical course is not effective, ACTH-therapy should be considered as soon as possible. These results should be confirmed in a prospective randomized study.
In a prospective controlled study 70 children of females with epilepsy and on anticonvulsant medication during pregnancy were investigated. It was shown that epileptic females had stillbirths more frequently than expected. After delivery particularly children on phenobarbitone are sedated. Due to weak suckling this may lead to inadequate food intake. Withdrawal symptoms manifest in affected children as hyperexcitability lasting for weeks. Children of epileptic women on medication are generally smaller, of lower weight and have smaller heads than children from all control groups. Ingestion of more than one anticonvulsant leads to an even more pronounced reduction of infantile body measurements below the expected mean value. Small malformations are observed more frequently after intrauterine exposition to anticonvulsants than in the control groups. Ingestion of more than one anticonvulsant leads to an increase of the number of small malformations in the child than after single drug therapy. Children of epileptic parents are affected more frequently by large malformations than children of nonepileptic parents.
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Essential tremor (ET) affects approximately 4% of the population above 65 years of age. The traditional view that ET is a familial monosymptomatic disorder with a benign prognosis has recently been challenged, as it is now known to be a progressive and clinically heterogeneous condition with sporadic and familial forms. The pathogenesis of ET is not fully understood, though a disordered central mechanism is the most likely site of origin with possible modulation by muscle adrenoreceptors. The limited post-mortem studies have not shown consistent abnormalities in the brains of ET patients. ET is often misdiagnosed as Parkinson's disease, particularly in the older population. Tremor amplitude increases with age, accounting for substantial disability in older people. Current therapy (drugs and neurosurgery) has significant limitations in older people. A better understanding of its pathophysiology in the future will help in developing more effective therapy, including neuroprotective strategies.
A comparative simultaneous evaluation of the Optimate and the TDX analyzers was performed according to guidelines proposed by the National Committee for Clinical Laboratory Standards. Statistically significant (P less than 0.05) better precision was demonstrated for the TDX analyzer with both commercial controls and patient pools. No statistically significant difference was found between the analyzers in terms of linearity, accuracy, and curve stability. Technologists judged the TDX to be superior in ease of start-up and shutdown procedures, loading and unloading, test changeover, time for a stat specimen, and time for an average run. In general, the TDX analyzer required less operator interaction for routine performance, but its consumable expenses were about 50% greater than those for the Optimate analyzer.