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Selected AbstractsLithium intoxication secondary to unrecognized pontine haemorrhageACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2001V. Novak-Grubic Lithium prophylaxis carries a substantial risk of medical complications, especially in the case of concomitant medical conditions. We describe a patient with unrecognized cerebrovascular haemorrhage, admitted to hospital due to lithium intoxication. [source] ENDOSCOPIC MANAGEMENT OF BILIARY STRICTURESDIGESTIVE ENDOSCOPY, Issue 2004Yoshitsugu Kubota ABSTRACT Endoscopic stenting, due to being less invasive, is feasible for most patients with biliary strictures; however, presumed efficacy should be balanced against the procedure-related morbidities for an individual patient. Self-expandable metallic stents have a longer patency, but are not retrievable. Therefore, the use of self-expandable metallic stents should be limited to those with unequivocal findings of unresectable malignancy. Plastic stents are indicated for strictures due to benign etiologies and equivocal malignancy. Endoscopic stenting for hilar biliary stricture is challenging. Bilateral hepatic drainage seems ideal but is often demanding to achieve with endoscopic technique, and contrast injection into undrained segments may pose a substantial risk for cholangitis and aggravate prognosis. Therefore, the extent of drainage should be balanced against the procedure-related complications. Preoperative magnetic resonance cholangiopancreatography may help determine feasibility of bilateral drainage or an ,intended and selective drainage' with a single stent and might obviate the possible morbidities. [source] Seismic microzonation of the greater Bangkok area using microtremor observationsEARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 2 2004Rabin Tuladhar Abstract Bangkok, the capital city of Thailand, is located at a remote distance from seismic sources. However, it has a substantial risk from these distant earthquakes due to the ability of the underlying soft clay to amplify ground motions. It is therefore imperative to conduct a detailed seismic hazard assessment of the area. Seismic microzonation of big cities, like Bangkok, provides a basis for site-specific hazard analysis, which can assist in systematic earthquake mitigation programs. In this study, a seismic microzonation map for the greater Bangkok area is constructed using microtremor observations. Microtremor observations were carried out at more than 150 sites in the greater Bangkok area. The predominant periods of the ground were determined from the horizontal-to-vertical (H/V) spectral ratio technique. A microzonation map was then developed for the greater Bangkok area based on the observations. Moreover, the transfer functions were calculated for the soil profile at eight sites, using the computer program SHAKE91, to validate the results from the microtremor analysis. The areas near the Gulf of Thailand, underlaid by a thick soft clay layer, were found to have long natural periods ranging from 0.8s to 1.2s. However, the areas outside the lower central plain have shorter predominant periods of less than 0.4s. The study shows that there is a great possibility of long-period ground vibration in Bangkok, especially in the areas near the Gulf of Thailand. This may have severe effects on long-period structures, such as high-rise buildings and long-span bridges. Copyright © 2003 John Wiley & Sons, Ltd. [source] Treatment of late-stage Sézary syndrome with 2-ChlorodeoxyadenosineINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2002Saskia A. Bouwhuis MD Background, 2-Chlorodeoxyadenosine (2-CdA), a purine adenosine analog, is safe and effective chemotherapy for patients with hairy cell leukemia and low-grade lymphomas. Adverse effects include neutropenia, lymphocytopenia, and infectious complications. Our objective was to evaluate the efficacy of 2-CdA (2,6 seven-day cycles) in the treatment of late-stage, recalcitrant Sézary syndrome. Methods, Retrospective review of medical records of six patients with Sézary syndrome who had received 2-CdA cycles at Mayo Clinic, Rochester between March 1995 and March 2000. Variables assessed from the records included improvement in global appearance, extent of erythroderma, size of lymph nodes, pruritus, and leukocyte, lymphocyte, and absolute Sézary cell counts. Results, Two patients, both with stage III Sézary syndrome, whose previous treatment consisted of only two modalities, responded well to the treatment, with moderate to total clearing of erythroderma and pruritus associated with a significant decrease in Sézary cell counts. The other four patients had only a partial response (one patient) or no response (three patients) to 2-CdA. The mortality rate was 50%. All three patients died of Staphylococcus aureus sepsis. However, only one patient was receiving 2-CdA treatment when he died. The other two patients died 8 and 9 weeks after the last 2-CdA cycle. This high mortality rate is attributed to infectious complications after 2-CdA treatment in patients with recalcitrant disease. Conclusion, 2-Chlorodeoxyadenosine shows efficacy in stage III Sézary syndrome, but it also carries a substantial risk of septic complications and mortality. It can be used if no other suitable alternatives are available. Caution should be exercised in all these patients regarding skin care and avoidance of infections or sepsis. [source] Host culling as an adaptive management tool for chronic wasting disease in white-tailed deer: a modelling studyJOURNAL OF APPLIED ECOLOGY, Issue 2 2009Gideon Wasserberg Summary 1Emerging wildlife diseases pose a significant threat to natural and human systems. Because of real or perceived risks of delayed actions, disease management strategies such as culling are often implemented before thorough scientific knowledge of disease dynamics is available. Adaptive management is a valuable approach in addressing the uncertainty and complexity associated with wildlife disease problems and can be facilitated by using a formal model. 2We developed a multi-state computer simulation model using age, sex, infection-stage, and seasonality as a tool for scientific learning and managing chronic wasting disease (CWD) in white-tailed deer Odocoileus virginianus. Our matrix model used disease transmission parameters based on data collected through disease management activities. We used this model to evaluate management issues on density- (DD) and frequency-dependent (FD) transmission, time since disease introduction, and deer culling on the demographics, epizootiology, and management of CWD. 3Both DD and FD models fit the Wisconsin data for a harvested white-tailed deer population, but FD was slightly better. Time since disease introduction was estimated as 36 (95% CI, 24,50) and 188 (41,>200) years for DD and FD transmission, respectively. Deer harvest using intermediate to high non-selective rates can be used to reduce uncertainty between DD and FD transmission and improve our prediction of long-term epidemic patterns and host population impacts. A higher harvest rate allows earlier detection of these differences, but substantially reduces deer abundance. 4Results showed that CWD has spread slowly within Wisconsin deer populations, and therefore, epidemics and disease management are expected to last for decades. Non-hunted deer populations can develop and sustain a high level of infection, generating a substantial risk of disease spread. In contrast, CWD prevalence remains lower in hunted deer populations, but at a higher prevalence the disease competes with recreational hunting to reduce deer abundance. 5Synthesis and applications. Uncertainty about density- or frequency-dependent transmission hinders predictions about the long-term impacts of chronic wasting disease on cervid populations and the development of appropriate management strategies. An adaptive management strategy using computer modelling coupled with experimental management and monitoring can be used to test model predictions, identify the likely mode of disease transmission, and evaluate the risks of alternative management responses. [source] How should the risk associated with the introduction of biological control agents be estimated?AGRICULTURAL AND FOREST ENTOMOLOGY, Issue 1 2010Earl D. McCoy 1Florida has an exceptional burden of invasive species. The history of the classical biological control of invasive arthropod pest species in the region largely is one of inadequate pre-release testing for nontarget effects. 2A recent analysis indicated that a substantial risk of nontarget effects may exist in Florida, although the risk appears to be confined to a relatively small group of species within approximately ten families and documented cases of nontarget effects are rare, despite previous risky practices. 3Great progress has been made recently in creating an organized framework for dealing with the uncertainty accompanying biological control importations in Florida and elsewhere. We suggest some ways in which balancing the risks and associated costs of releasing a biological control agent against the risks and associated costs of not releasing the agent may be improved. 4Ultimately, experts will need to set some level of acceptable risk, and the ,precautionary principle' has been advanced to guide this process. As it stands, however, the precautionary principle applied to biological control falls short as a guide because it does not provide a prescription for action. 5Florida case histories clearly illustrate both the complexity and urgency related to developing a prescription for action. [source] The Occurrence of Dental Pain and Extractions over a 3-Year Period in a Cohort of Children Aged 3-6 YearsJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2 2008M. Tickle PhD Abstract Objectives: To describe the occurrence of dental pain and extractions in young children in relation to the caries and restoration history of their primary molar teeth. Methods: A prospective cohort study of 739 children aged 2.8 to 6.2 years attending 50 dental practices in the North West of England followed for 3 years. Incidence rates for pain and extraction in primary molar teeth were calculated for children with and without dental caries. Tooth years at risk of extraction or pain were calculated for each primary molar according to whether they were caries-free, carious and unrestored, or restored. Results: A total of 119 (16.1 percent) children had caries at recruitment and 157 developed caries during follow-up. Each year approximately one in five children with caries, but only one in 100, who was caries-free, presented with dental pain. In the whole population, each year, approximately one in 40 children had a primary molar tooth extracted but in children with caries it was one in 10. In the total cohort, incidence of pain was higher in unrestored carious teeth than restored, but incidence of extraction was higher in restored than in unrestored teeth. Conclusion: The majority of children attending general dental practice remained caries-free and did not experience pain or extraction over 3 years. Children with caries had a substantial risk of developing pain or having an extraction. The study was unable to demonstrate that restoring carious primary molar teeth prevents pain and extraction. [source] Detecting year-of-birth mortality patterns with limited dataJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 1 2008S. J. Richards Summary., Late life mortality patterns are of crucial interest to actuaries assessing risk of longevity, most obviously for annuities and defined benefit pension schemes. The stability of public finances is also affected, as the governments have very substantial risk of longevity in the form of state benefits and public sector pension schemes. One important explanatory variable for late life mortality patterns is year of birth. Previous work has demonstrated various techniques for detecting such patterns, but always with long time series of mortality rates. The paper describes two alternative ways to detect such patterns, even with missing population data or the absence of a time series. The paper finds support for the idea that different birth cohorts have different rates of aging. [source] Serious Bacterial Infection in Recently Immunized Young Febrile InfantsACADEMIC EMERGENCY MEDICINE, Issue 12 2009Margaret Wolff MD Abstract Objective:, The objective of this study was to investigate the prevalence of serious bacterial infection (SBI) in febrile infants without a source aged 6,12 weeks who have received immunizations in the preceding 72 hours. Methods:, The authors conducted a medical record review of infants aged 6,12 weeks with a fever of ,38.0°C presenting to the pediatric emergency department (ED) over 88 months. Infants were classified either as having received immunizations within the 72 hours preceding the ED visit (recent immunization [RI]) or as not having received immunizations during this time period (no recent immunization [NRI]). Primary outcome of an SBI was based on culture results; only patients with a minimum of blood and urine cultures were studied. Results:, A total of 1,978 febrile infants were studied, of whom 213 (10.8%) had received RIs. The overall prevalence of definite SBI was 6.6% (95% confidence interval [CI] = 5.5 to 7.7). The prevalence of definite SBI in NRI infants was 7.0% (95% CI = 5.9 to 8.3) compared to 2.8% (95% CI = 0.6 to 5.1) in the RI infants. The prevalence of definite SBI in febrile infants vaccinated in the preceding 24 hours decreased to 0.6% (95% CI = 0 to 1.9). The prevalence of definite SBI in febrile infants vaccinated greater than 24 hours prior to presentation was 8.9% (95 CI = 1.5 to 16.4). The relative risk of SBI with RI was 0.41 (95% CI = 0.19 to 0.90). All SBIs in the RI infants were urinary tract infections (UTI). Conclusions:, Among febrile infants, the prevalence of SBI is less in the initial 24 hours following immunizations. However, there is still a substantial risk of UTI. Therefore, urine testing should be considered in febrile infants who present within 24 hours of immunization. Infants who present greater than 24 hours after immunizations with fever should be managed similarly to infants without RIs. [source] Forecasting volatility for options valuationOPEC ENERGY REVIEW, Issue 3 2006Mahdjouba Belaifa The petroleum sector plays a neuralgic role in the basement of world economies, and market actors (producers, intermediates, as well as consumers) are continuously subjected to the dynamics of unstable oil market. Huge amounts are being invested along the production chain to make one barrel of crude oil available to the end user. Adding to that are the effect of geopolitical dynamics as well as geological risks as expressed in terms of low chances of successful discoveries. In addition, fiscal regimes and regulations, technology and environmental concerns are also among some of the major factors that contribute to the substantial risk in the oil industry and render the market structure vulnerable to crises. The management of these vulnerabilities require modern tools to reduce risk to a certain level, which unfortunately is a non-zero value. The aim of this paper is, therefore, to provide a modern technique to capture the oil price stochastic volatility that can be implemented to value the exposure of an investor, a company, a corporate or a Government. The paper first analyses the regional dependence on oil prices, through a historical perspective and then looks at the evolution of pricing environment since the large price jumps of the 1970s. The main causes of oil prices volatility are treated in the third part of the paper. The rest of the article deals with volatility models and forecasts used in risk management, with an implication for pricing derivatives. [source] Maternal age and preterm births in a black populationPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2 2000Edem E. Ekwo Babies born to teenagers aged 15,19 years have a substantial risk of dying within the first year of life. Although associated socio-demographic factors may account for an increase in the risk of adverse reproductive outcomes for teenagers, there is a concern that young maternal age may also be a biological risk factor. We examined the effects of maternal age of primiparous black women on the incidence of preterm births using data from 6072 black women delivering between 1989 and 1995 at an urban perinatal network of 17 hospitals and health centres serving residents in a well-defined geographical area. Maternal age was grouped as: 15, 16,17, 18,19, 20,24, 25,29 or 30 years age groups. The 20,24 age group with the highest number of births and lowest preterm rate was used as the reference age. Preterm birth was defined as delivery < 37 completed weeks of gestation. Of the 6072 infants born to the cohort, 1170 (19.3%) were preterm. The unadjusted odds for a preterm birth for the 15-year-olds (odds ratio [OR] = 0.97; 95% confidence interval [CI], 0.69,1.36), for the 16- to 17-year-olds (OR = 1.21; CI = 0.94, 1.57) and for the 18- to 19-year olds (OR = 1.15, CI = 0.92, 1.43) were not significantly different from that for the reference group. The risk for the 25-to 29-year-old mothers was 1.26 times [CI = 1.05, 1.50] and for the > 30-year-old mothers 1.28 times [CI = 1.07, 1.52] that for the reference group. Adjustments using logistic regression analysis for the effects of maternal smoking, drug abuse during pregnancy, insurance status, having prenatal care and median family income from census tract of residence did not result in a significantly increased risk for preterm birth or low birthweight for the teenage groups compared with the reference group. We conclude that primiparous teenage black mothers do not have an inherent biologically increased risk for preterm births. [source] Survival in young patients with intermediate-/high-risk myelofibrosis: Estimates derived from databases for non transplant patients,AMERICAN JOURNAL OF HEMATOLOGY, Issue 3 2009Sergio Siragusa Recent studies have suggested that allogenic stem cell transplantation (allo-SCT) might be a better treatment option, compared to drug therapy, for young patients with high-/intermediate-risk primary myelofibrosis (PMF). However, there are no controlled studies that validate this contention and allo-SCT is associated with a substantial risk of procedure-related mortality and morbidity. In a retrospective analysis of nontransplant PMF patients, who were both young (age <60 years) and with high-/intermediate-risk disease, 1- and 3-year survival estimates were 87% and 55%, 95% and 77%, 71% and 58%, respectively, involving patients seen at three different centers with expertise in PMF; these data did not appear to be inferior to those published in the context of either myeloablative or reduced-intensity conditioning allo-SCT. These observations underscore the need for controlled studies to accurately assess the value of allo-SCT in PMF. AM. J. Hematol. 2009. © 2008 Wiley-Liss, Inc. [source] Latino farmworker perceptions of the risk factors for occupational skin disease,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 6 2006Thomas A. Arcury PhD Abstract Background Farmworkers in the US constitute a medically underserved population at substantial risk for numerous environmental and occupational health problems. Most US farmworkers are Latino. Skin disease is one health problem to which farmworkers are particularly vulnerable. Interventions to reduce skin disease must be adapted to farmworkers' understanding of such disease, including their beliefs or knowledge of risk factors for skin disease. Methods Structured by the Explanatory Models of Illness framework, this analysis uses a qualitative design based on in-depth interviews with 30 Latino farmworkers (6 females, 24 males) to determine beliefs and perceptions of the causes of common occupational skin diseases in this population. Computer assisted, systematic procedures are used to analyze the verbatim transcripts of these interviews. Results Skin disease is a major concern among farmworkers because it affects work, social interaction, and other aspects of their lives. Farmworker beliefs and perceptions of skin disease causation can be integrated into a general model in which perceived risk factors include sun and heat, chemicals, plants, insects, moisture, hygiene, and contagion. Each of these factors is moderated by the individual's personal susceptibility to that cause. The interaction or combination of two or more factors is thought to amplify their individual effects. Conclusions The farmworker model of skin disease causation suggests important content for health education to reduce skin disease among farmworkers. Am. J. Ind. Med. 2006. © 2006 Wiley-Liss, Inc. [source] Abnormal sterol metabolism in holoprosencephaly,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 1 2010Dorothea Haas Abstract Holoprosencephaly (HPE) is the most common structural malformation of the developing forebrain in humans. The HPE phenotype is extremely variable and the etiology is heterogeneous. Among a variety of embryological toxins that can induce HPE, inhibitors, and other pertubations of cholesterol biosynthesis have been shown to be important factors, most likely because cholesterol is required in the Sonic hedgehog signaling cascade. Decreased levels of maternal cholesterol during pregnancy increase the risk for preterm delivery, but they are not associated with congenital malformations. However, if the fetus is affected by an inborn error of endogenous cholesterol synthesis, a reduction of maternal cholesterol concentration and cholesterol transport over the placenta aggravates the phenotypic expression. Exposure to lipophilic statins in early pregnancy may be associated with a substantial risk for structural CNS defects. © 2010 Wiley-Liss, Inc. [source] Selective intrauterine growth restriction in monochorionic diamniotic twin pregnanciesPRENATAL DIAGNOSIS, Issue 8 2010Dan V. Valsky Abstract Selective intrauterine growth restriction (sIUGR) occurs in 10 to 15% of monochorionic (MC) twins, and it is associated with a substantial increase in perinatal mortality and morbidity. Clinical evolution is largely influenced by the existence of intertwin placental anastomoses: pregnancies with similar degrees of fetal weight discordance are associated with remarkable differences in clinical behavior and outcome. We have proposed a classification of sIUGR into three types according to umbilical artery (UA) Doppler findings (I-normal, II-absent/reverse end-diastolic flow, III-intermittent absent/reverse end-diastolic flow), which correlates with distinct clinical behavior, placental features and may assist in counseling and management. In terms of prognosis, sIUGR can roughly be divided in two groups: type I cases, with a fairly good outcome, and types II and III, with a substantial risk for a poor outcome. Management of types II and III may consist in expectant management until deterioration of the IUGR fetus is observed, with the option of cord occlusion if this occurs before viability. Alternatively, active management can be considered electively, including cord occlusion or laser coagulation. Both therapies seem to increase the chances of intact survival of the larger fetus, while they entail, or increase the chances of, intrauterine demise of the IUGR fetus. Copyright © 2010 John Wiley & Sons, Ltd. [source] Passive induction of hypothermia during transport of asphyxiated infants: a risk of excessive coolingACTA PAEDIATRICA, Issue 6 2009Boubou Hallberg Abstract Background: Induced mild hypothermia is an emerging therapy that has been shown to reduce the combined outcome of death or severe neurodevelopmental disabilities in asphyxiated full-term infants if started within 6 h after birth. Aim: To study the feasibility and safety of inducing hypothermia in asphyxiated infants already at the referring hospital by stopping active warming. Methods: Temperatures during passive induction of hypothermia were prospectively collected from transported asphyxiated infants. Results: Between December 2006 and April 2008, 37 infants of the total birth cohort of 40 350 fulfilled the criteria for hypothermia treatment. Eighteen of 34 infants treated with induced hypothermia were outborn. The rectal temperatures of the infants were 33.0,36.4°C before transport and 31.0,36.5°C on arrival. Six of the infants had a sub-therapeutic (<33.0°C) rectal temperature on arrival. Conclusion: Passive induction of hypothermia by turning off active warming devices is possible, making an earlier start of hypothermia achievable. However, there is a substantial risk of unintended excessive cooling; therefore, continuous monitoring of the central temperature is mandatory when such a strategy is used. [source] Assessment, intervention, and research with infants in out-of-home placementINFANT MENTAL HEALTH JOURNAL, Issue 5 2002Robert B. Clyman Infants constitute a large and increasing proportion of youth in out-of-home placement. These infants have very high rates of medical illnesses, developmental delays, and substantial risks for psychopathology. They receive varying amounts of services from a complex and poorly integrated service system that includes four principal service sectors: the child welfare, medical, early intervention, and mental health service sectors. These service systems are currently undergoing major changes in their policies, organization, and financing, such as the introduction of managed care into the child welfare system. In this article, we provide an overview of what is known about infants in out-of-home placement. We then summarize approaches to infant mental health assessment and intervention from a comprehensive perspective that addresses the infants' multiple problems and acknowledges that they need to receive services from multiple systems that are undergoing rapid change. We conclude by highlighting a number of critical areas in need of research. ©2002 Michigan Association for Infant Mental Health. [source] Reduced-intensity allogeneic hematopoietic cell transplantation: Graft versus tumor effects with decreased toxicityPEDIATRIC TRANSPLANTATION, Issue 3 2003Jennifer E. Schwartz Abstract: The potentially curative role of allogeneic hematopoietic cell transplantation (HCT) in neoplastic and non-neoplastic diseases is offset by the substantial risks of morbidity and mortality from complications of the intensive myeloablative and immunosuppressive preparative regimen. These regimen-related toxicities have restricted allogeneic HCT to young, otherwise healthy individuals without comorbid diseases. Pediatric patients undergoing conventional allogeneic HCT have lower procedure-related mortality but are at risk for non-fatal late effects of the high-dose pretransplant chemoradiotherapy, such as growth retardation, sterility and other endocrine dysfunction. Evaluation of reduced-intensity preparative regimens is the major focus of current clinical research in allogeneic HCT. Reduced-intensity HCT (RI-HCT) relies on the use of immunosuppressive but non-myeloablative agents that allow engraftment of donor cells, which provide adoptive allogeneic cellular immunotherapy and graft versus tumor (GVT) effects, with decreased regimen-related toxicities. Although the experience with RI-HCT in pediatric patients is very limited at this time, results in adults indicate that attenuated-dose preparative regimens allow older patients and those with organ dysfunction to undergo successful allogeneic HCT with acceptable morbidity and mortality. In adults, the potency of the allogeneic GVT effect varies among neoplastic diseases, with better results observed in patients with indolent hematological malignancies or renal cell carcinoma. The effectiveness of RI-HCT as treatment for children with hemoglobinopathies, chronic granulomatous disease and cellular immunodeficiencies is encouraging, and the role of reduced-intensity preparative regimens for allogeneic HCT in pediatric malignancies is under investigation. [source] Uncontrolled epilepsy following discontinuation of antiepileptic drugs in seizure-free patients: a review of current clinical experienceACTA NEUROLOGICA SCANDINAVICA, Issue 5 2005D. Schmidt Purpose,,, We reviewed the impact of planned discontinuation of antiepileptic drugs (AEDs) in seizure-free patients on seizure recurrence and the seizure outcome of reinstituted treatment. Methods,,, A literature review was performed yielding 14 clinical observations of seizure recurrence after discontinuation and its treatment outcome. Results,,, Seizure recurrence rate after AED discontinuation ranged between 12 and 66% (mean 34%, 95%CI: 27,43) in the 13 reviewed studies (no data in one study). Reinstitution of AEDs after recurrence was efficacious between 64,91% (mean of 14 studies, 80%, 95%CI: 75,85%) at follow-up. Mean follow-up ranged from 1,9 years. Seizure outcome of resumed treatment was not different for series in children and adolescents (84%, mean of 4 studies, 95%CI: 75,93) or in adults only (80%, mean of 9 studies, 95%CI: 74,86). Although seizure control was regained within approximately one year in half of the cases becoming seizure free, it took some patients as many as 5,12 years. In addition, in 19% (mean of 14 studies, 95%CI: 15,24%), resuming medication did not control the epilepsy as before, and chronic drug-resistant epilepsy with many seizures over as many as five years was seen in up to 23% of patients with a recurrence. Factors associated with poor treatment outcome of treating recurrences were symptomatic etiology, partial epilepsy and cognitive deficits. Conclusions,,, These serious and substantial risks weigh against discontinuation of AEDs in seizure-free patients, except perhaps for selected patients with idiopathic epilepsy syndromes of childhood or patients with rare seizures. [source] | ||||||||||||||||