N. Buchanan

Pseudoseizures (non epileptic attack disorder)—clinical management and outcome in 50 patients

The present report outlines the clinical management and outcome of 50 patients with pseudoseizures who, for practical reasons, are divided into acute and chronic groups. The former group, perhaps not surprisingly, fared better than the latter. Management consisted primarily of confrontation with the diagnosis with additional psychotherapy of various degrees of intensity. Overall, 46% of patients taking anticonvulsants either came off their medication or had it reduced. It was encouraging to observe that 76% of the 50 patients derived significant benefit for management with, on follow up, 80% of the acute group and 28% of the chronic group becoming seizure free and 34% of the latter group improving significantly. Early diagnosis and management are important in dealing with the problem of pseudoseizures and appear to produce a good outcome, associated, in general terms, with a less satisfactory outcome in those in whom the problem is chronic.

Lamotrigine: clinical experience in 93 patients with epilepsy

This open study reports the use of lamotrigine in 93 adults and children with drug resistant epilepsy. Lamotrigine was used predominantly as add‐on therapy and outcome was assessed by the patient, parents and carers and the physician in terms of reduction of seizure frequency, drug side effects, and importantly with this drug, improvement in quality of life. Twenty five of the 93 patients (26.9%) studied were rendered seizure free with the addition of lamotrigine to their therapy. This was especially the case for patients with complex partial seizures, generalised seizures secondary to brain damage, primary generalised epilepsy and the Lennox Gastaut syndrome. Quality of life improvements were especially striking in patients with seizures secondary to brain damage and in the Lennox Gastaut Syndrome. Twenty eight patients ceased lamotrigine, 13 due to lack of effect and the remainder due to side effects. Lamotrigine is a potentially very useful anti‐epileptic medication in persons with complex partial seizures, but also in primary generalised epilepsy, the Lennox Gastaut syndrome and especially in those individuals who have seizures subsequent to brain damage.

Liver function tests in persons receiving anticonvulsant medications

Liver function tests were carried out in 206 adults and children taking anticonvulsants to ascertain the prevalence of biochemical abnormalities in asymptomatic patients. It was observed that serum gamma-glutamyl transpeptidase was elevated in 74.6% of patients, alkaline phosphatase in 29.7% and alanine aminotransferase in 25.2% of cases. These figures are similar to those previously reported in the literature and probably reflect hepatic enzyme induction by the anticonvulsants. It is suggested that there is no value in the routine performance of liver function tests in patients with epilepsy. However, such patients should be informed of the symptoms of hepatic dysfunction and asked to report for liver function tests should they have such symptoms.

Oscillometric and intra‐arterial blood pressure measurements in the neonate: a comparison of methods

ABSTRACT. A number of methods exist to measure neonatal blood pressure, one of which involves oscillometric principles. This method is the functional basis of the Dinamap 847 which has been studied for accuracy and reproductibility in 398 paired comparisons with direct arterial measurements in nine neonates. The correlation between the Dinamap and direct arterial pressure values were excellent, although for systolic blood pressure the Dinamap tends to underestimate by 2.4 ± 3.9 mm Hg. The present study has shown the Dinamap to be a clinically reliable instrument for measuring neonatal blood pressure.

Vigabatrin use in 72 patients with drug-resistant epilepsy

OBJECTIVE To determine the efficacy of a new anti-epileptic medication vigabatrin in adults and children with drug-resistant epilepsy. DESIGN AND SETTING An open, uncontrolled study in a tertiary referral clinic setting with vigabatrin used as add-on therapy. SUBJECTS All persons with intractable epilepsy, predominantly with complex partial seizures, with or without secondary generalization. MAIN OUTCOME MEASURES Outcome was assessed by the patient and physician in terms of reduction of seizure frequency and severity balanced against drug side effects. RESULTS Of 72 patients studied, seven are seizure-free and a total of 41/72 (57%) continue to take vigabatrin as they are deriving benefit therefrom. The results were most striking in patients with complex partial seizures with, or without, secondary generalization (65.6 and 60.9% ongoing treatment, respectively). Most of the 31 patients who ceased taking vigabatrin did so due to a lack of effect, but 9/31 did so because of adverse events: behavioural change, increased seizure frequency and oedema. CONCLUSIONS Vigabatrin has a definite role to play in the management of persons with intractable complex partial seizures where standard anti-epileptic therapy has failed to achieve control.

Changes in response to metrazole during fever in juvenile rats; a new model for febrile convulsions?

ABSTRACT— Previous models for febrile convulsions have used environmentally induced hyperthermia as the stimulus to induce convulsions. Changes in response to metrazole during yeast‐induced fever in juvenile rats are reported here. Animals were more susceptible to metrazole during the rising phase of fever but showed some resistance to its convulsant effects once the fever was established and following defervescence. It is suggested that this may form the basis of a physiologically more appropriate model for the study of the pathogenesis of febrile convulsions.

Compliance with immunization programmes

ABSTRACT. An immunization history was obtained from 122 sets of parents whose children attended a hospital casualty department. Actual records of immunization were traced through General Practitioners and/or local councils for 93 of the children; this latter group represents the study sample. Of the 93 children studied, only 15% were found to be adequately immunized including measles immunization. Analysis of the data suggests that parental understanding of the meaning of immunization had little impact on immunization compliance. This might imply that a major health education programme, of a different type to that presently being employed, is needed.

Therapeutic drug monitoring in childhood.

Information on the concentration of a drug in the blood or body fluids is now regarded as an integral part of medical practice. This process of determining drug concentrations, entitled Therapeutic Drug Monitoring (TDM), has evolved as information on the wide interindividual responses to drug therapy has grown. Such variations relate to numerous factors including drug absorption, metabolism and elimination, all of which have become better understood over the past two to three decades. In children, there are the added factors imposed by growth and changing body composition. Therapeutic drug monitoring is based on the principle that, for some drugs, there is a close relationship between the plasma level of the drug and its clinical effect. Where such a relationship does not occur, TDM is of little value. It is also of little value where a clinical end point is either easier to measure or is more reliable than assessment of the serum drug concentration. Over the past few years, TDM has become increasingly popular, especially with the advent of relatively simple kit methods for measuring drug concentrations in plasma. Whilst this has been a major advance and has allowed TDM to be practised more extensively, it has also meant that TDM can now be performed so easily that it runs the risk of being overused and becoming part of ‘a routine workup’ as for a number of routine biochemical tests. This review discusses the general principals of TDM and its practical application in the management of children.

Intravenous cephamandole pharmacokinetics and intramuscular bioavailability in neonates

ABSTRACT. Cephamandole pharmacokinetics during the first week of life, in term neonates, have been defined. The results of these studies allow a dosage recommendation of 25 mg/kg 12 hourly intravenously or 8 hourly intramuscularly. Cephamandole when administered intramuscularly was shown to be bioavailable (80.9 ± 16.4%).