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Anticonvulsant Therapy (anticonvulsant + therapy)
Selected AbstractsColor vision and macular recovery time in epileptic adolescents treated with valproate and carbamazepineEUROPEAN JOURNAL OF NEUROLOGY, Issue 7 2006A. Verrotti Visual dysfunction has been reported in patients diagnosed with epilepsy. Some of these visual disturbances may be attributable to either the disease process, or the anticonvulsant therapy prescribed to control the seizures. The aims of our study were to evaluate whether color vision and macular function are impaired in epileptic adolescents, to study if the monotherapy with valproic acid (VPA) and carbamazepine (CBZ) can affect color vision and macular function and to determine the possible relationship between color vision, retinal function and antiepileptic drugs (AEDs) dosage and their serum concentrations. We examined 45 (16 male and 29 female, mean age ± SD, 15.71 ± 2.01 years) Caucasian epileptic patients suffering from various types of cryptogenic epilepsy before the beginning of therapy and after 1 year of VPA or CBZ monotherapy and 40 sex- and age-matched healthy controls. Color vision was assessed by Farnsworth Munsell (FM) 100-hue test and total error score (TES) was evaluated. This test consists of colored caps: the testee has to arrange the caps according to their colors macular function was assessed by nyctometry evaluating initial recovery time (IRT) and summation method (SM). This test evaluates visual acuity after a period of intense illumination of macula. Analysis of variance was used to evaluate the difference between controls and patients; moreover, Pearson's correlation test have been performed. Before the beginning of therapy, there were no differences in color vision and macular function between controls and epileptic patients. After 1 year, the patients, treated with VPA or CBZ, showed a deficit in FM 100-hue test. At nyctometry, all patients showed no significant variation of macular function between baseline evaluation and second evaluation at end of the follow-up. Our study demonstrates that, in our group of epileptic patients, epilepsy per se does not affect color vision and retinal function. In contrast, after 1 years of therapy with VPA and CBZ these patients showed a deficit in FM 100-hue test although nyctometry evaluation continued to be normal allowing to exclude an impairment in macular function. Further investigations are required to determine the pathophysiological alteration(s) that are at the basis of color perception defects. [source] CLINICAL COMPARISON OF LORAZEPAM VS.JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue S1 2004DIAZEPAM IN THE CONTROL OF CANINE SEIZURES Lorazepam is a long-acting benzodiazepine that interacts with a high degree of affinity for the GABA receptor complex. This high affinity binding in turn leads to a prolonged duration of action. There are no published clinical studies documenting its duration of action in dogs or its ability to control seizures. The purpose of this study was to compare the duration of seizure control of lorazepam with diazepam in 16 dogs presenting in status epilepticus or with active cluster seizures. Previous seizure history and anticonvulsant therapy was not a consideration for inclusion into this study. Animals were excluded if there was a known metabolic, toxic or traumatic cause of the seizure. Dogs were randomly assigned to receive either lorazepam (0.2 mg/kg IV) or diazepam (0.5 mg/kg IV), and the clinicians were blinded as to which drug they were administering. The duration of the study was 12 hours from the time of drug administration, and the animals were monitored for any indication of seizure activity, including generalized motor activity, focal motor activity (e.g., movement of facial or limb musculature) and change in the level of consciousness. The study ended at 12 hours post-study drug administration or when the dog seized before the end of the 12 hour study period. The results indicated no significant difference between lorazepam versus diazepam with regard to median seizure-free interval (2.8 h for diazepam versus 3.4 h for lorazepam, p=0.58 by log rank test), or with regard to percent seizure-free for the duration of the observation period (1/8 for lorazepam versus 3/8 for diazepam, p=0.51 by Fisher's exact test). There was also no difference between the 2 drugs regarding the number of animals in which seizures were initially controlled (6/8 in each group). Lorazepam used at this dose does not appear to result in a significant increase in duration of seizure control for dogs with status epilepticus and cluster seizures. Additional studies may be warranted using higher doses of lorazepam. [source] Stimulus size and the variability of the threshold response in the central and peripheral visual fieldOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 6 2002L. S. Kim Purpose:, The investigation of the peripheral visual field has shown considerable interest for the investigation of field loss attributed to anticonvulsant therapy. The purpose was to determine the within-visit between-subject, the between-visit between-subject, and the between-location variability of the threshold response in the normal eye with increase in stimulus eccentricity out to 60° as a function of stimulus size. Methods:, Forty-eight normal subjects attended for a total of three visits (mean age = 49.5 years, SD = 18.9, range 22,84 years). At the first visit, one randomly assigned eye of each subject was examined with the Humphrey Field Analyzer 750 (Carl Zeiss, Jena, Germany) and the Full Threshold algorithm using Programs 30,2 and 60,4 and stimulus sizes III and V. The combination of stimulus size and of program, and the order of the combination within- and between-sessions, were randomized for each subject. The results of the first visit were considered as a familiarization period and were discarded. The protocol at the second and third visits was identical to that at the first visit for each subject. Results:, The ratio of the SD of the group mean sensitivity was determined at each stimulus location for stimulus size III compared with stimulus size V for Programs 30,2 and 60,4 at visit 3. The SDs were greater than unity for Program 30,2 (p < 0.0001) and for Program 60,4 (p < 0.0001) indicating greater variability for the size III stimulus. The SDs were also greater than unity for the central inner zone (p < 0.0001), central outer zone (p < 0.0001) and peripheral inner zone (p < 0.0001). The ratios in the peripheral outer zone were not quite greater than unity (p = 0.054). The ratios increased with increase in eccentricity by up to 2.7 times between 15° and 30° eccentricity and by up to 2.7 times between 30° and 60° eccentricity. The group mean ratio did not vary significantly between the two visits for Program 30,2 stimulus size III (p = 0.563), Program 60,4 stimulus size III (p = 0.935) and for Program 60,4 stimulus size V (p = 0.005). However, the group mean SD was lower at visit 3 compared with visit 2 for Program 30,2 stimulus size V (p = 0.0004). The SDs associated with the extreme peripheral locations in the superior and nasal fields were smaller for stimulus size III because the threshold was frequently attenuated by lid and facial contour. Conclusions:, Considerably narrower confidence limits for normality for the peripheral regions of Program 30,2 and for 60,4 are demonstrated with the use of Goldmann size V. [source] Afebrile benign convulsions with mild gastroenteritis: a new entity?ACTA NEUROLOGICA SCANDINAVICA, Issue 2 2009A. Verrotti Afebrile seizures in children usually necessitate investigations in order to determine the etiology and estimate the prognosis. Recently, convulsions that are described as benign but afebrile have been documented in children, in association with diarrhea, and are now recognized as a distinct entity. Benign afebrile seizures with mild gastroenteritis are defined as convulsions accompanying symptoms of mild diarrhea without dehydration or electrolyte derangement and without fever before and after the seizures in healthy children without meningitis, encephalitis or encephalopathy. The convulsions are short, symmetrical, generalized tonic,clonic seizures, occurring in clusters. Laboratory studies (full blood count, blood glucose, creatinine, serum electrolytes, cerebrospinal fluid, bacterial and viral cultures) are usually normal, and other investigations (neuroimaging and electroencephalogram) are not necessary. Prognosis is always favorable (normal psychomotor development, no recurrences of seizures), and anticonvulsant therapy is not warranted. Recognition of this benign infantile convulsion avoids extensive evaluation and long-term anticonvulsant therapy; physicians may reassure the parents regarding the lack of long-term sequelae. In conclusion, this type of seizure seems to be a new entity, but it awaits a correct place in the large group of infantile convulsion disorders. [source] Valproic acid blood genomic expression patterns in children with epilepsy , a pilot studyACTA NEUROLOGICA SCANDINAVICA, Issue 3 2004Y. Tang Objective , Valproic acid (VPA) is a commonly used anticonvulsant with multiple systemic effects. The purpose of this pilot study is to examine the blood genomic expression pattern associated with VPA therapy in general and secondly VPA efficacy in children with epilepsy. Materials and methods , Using oligonucleotide microarrays, gene expression in whole blood was assessed in pediatric epilepsy patients following treatment with VPA compared with children with epilepsy prior to initiation of anticonvulsant therapy (drug free patients). Results , The expression of 461 genes was altered in VPA patients (n = 11) compared with drug free patients (n = 7), among which a significant number of serine threonine kinases were down-regulated. Expression patterns in children seizure free on VPA therapy (n = 8) demonstrated 434 up-regulated genes, many in mitochondria, compared with VPA children with continuing seizures (n = 3) and drug free seizure patients (n = 7). Conclusion , VPA therapy is associated with two significant and unique blood gene expression patterns: chronic VPA monotherapy in general and a separate blood genomic profile correlated with seizure freedom. These expression patterns provide new insight into previously undetected mechanisms of VPA anticonvulsant activity. [source] | ||||||||||