12th epilepsy int symp. 14: clinical trials

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12th Epilepsy Int Syrnp, 14 Clinical Trials Acta Neurol Scand Suppl79 Vol62 (1980) Iri 1072 \Voodhurv. as ii result of aninial studirs. rerc~nirnen~lc.tl the use of acet;i/ol;iniitle in (onil)in;ition with other ;tntiron\*tr!sants in ptieiits refr:irrory to the latter. 56 children \rith pnd ni;il (39) :ind ternpor;il lobe epilepsy ( 17) rcfritctory to c;irh;ima7epine, were given ;icet:i7ol;tmitle. Of the 39 children with grad nial, 12 were teiiure free and 3 had a 7.557 rrtiuction of their seiiiires ;it 1-4 year follow 111). Of the 17 c-hiltiren with temporal lobe epilepsy 7 were seizure free and 1 h:id ;I 7.5% reduction of seizures at 1-4 year follow up. ’Twenty-four hour carhnmaiepine serum levels (5 simples) wrre ohtained in 36 children while on c;trhani;iiepine (‘LO-2.5 nigikg hotis weight per dav) ;rnd ;ig;iin while on rarbama- repine and :icetwol;iinide. Twentv-four showed ;i signifiant rise in carh;tnlazepine serum levels when acet;iiol;rniitie was xided anti of these I0 developed side effects. which dis:ippe:ired when the cnrh;ini;irepine dosage w;is retlric.eti. Of these 9 children. 5 were teizure free ;it ?year fiill~~ lip. ‘Su1fon;iniitk arid tieriv;itives. A( rt;irol;irnide‘. ( I!J72) 54. 43. Ariticpifr:pric drugs. Eds. I)Af. Woodhurv et al. K;rven I’res\. New \’ork. 14.2 Carbam;izepine (Tegretol@) monotherapy in epilepsy. A retrospective study 1. Gordon Nee, E. n. Andersen & A. Philtxi~t Departments of Neurology. University Hospitals of Hvidovre and Glostrup. (‘Aqxnh;igen. Denmark The effect and side-effects 01. carbarnazepine (Tegretola) in monotherapy (C-M) have been studied retrospectively in 288 patients in whom this therapy was instituted during the years 1973 to 1978. The largest groups of patients comprised those with grand ma1 (39%). psvchomotor epilepsy (23%) and a combination of these (26%). When the study was concluded June 30, 1979, 73% of the patients were still receiving C-M and the median observation time for these patients were I6 months. In 657r of the patients C-M was the treatment of first choice. The effect of therapy was determined hy comparing the number of seiiures during the period Idore C-h.I with the one before the patient was last seen during (;-hi. In 5% there had been no seizut-es for a period before C-M was initiated. and the reason for chiinging therapv was generally side-effects of previous t herapy. A reduction in number nf seinires hy 75- 1007, was found in 79% of the patients with grand mal. in 76% of those with psvchornotor epilepsy and in 67% of those with 1~0th types of seizures. Side-effects necessitating withdrawal were observed in 8% of the patientt. miinly ;illergic rashes. Nine per cent were transferred to other therapy herarise of inadequ;ite c.ontrol ofepilepsv. Epilepsy. Abstracts 7

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Page 1: 12th Epilepsy Int Symp. 14: Clinical Trials

12th Epilepsy Int Syrnp, 14 Clinical Trials Acta Neurol Scand Suppl79 Vol62 (1980)

Ir i 1072 \Voodhurv. as ii result of aninial studirs. rerc~nirnen~lc.tl the use o f acet;i/ol;iniitle in (onil)in;ition with other ;tntiron\*tr!sants i n ptieii ts refr:irrory t o the latter. 56 children \rith p n d ni;il (39) :ind ternpor;il lobe epilepsy ( 17) rcfritctory to c;irh;ima7epine, were given ;icet:i7ol;tmitle. Of the 39 children with g r a d nial, 12 were teiiure free and 3 had a 7.557 rrtiuction o f their seiiiires ;it 1 - 4 year follow 111). Of the 17 c-hiltiren with temporal lobe epilepsy 7 were seizure free and 1 h:id ;I 7.5% reduction of seizures at 1-4 year follow up. ’Twenty-four hour carhnmaiepine serum levels (5 simples) wrre ohtained in 36 children while on c;trhani;iiepine (‘LO-2.5 nigikg hotis weight per dav) ;rnd ;ig;iin while on rarbama- repine and :icetwol;iinide. Twentv-four showed ;i signifiant rise i n carh;tnlazepine serum levels when acet;iiol;rniitie w a s xided a n t i o f these I 0 developed side effects. which dis:ippe:ired when the cnrh;ini;irepine dosage w;is retlric.eti. Of these 9 children. 5 were teizure free ;it ?year f i i l l ~ ~ lip.

‘Su1fon;iniitk arid tieriv;itives. A( rt;irol;irnide‘. ( I!J72) 54. 4 3 . Ariticpifr:pric drugs. Eds. I )Af . Woodhurv et al. K;rven I’res\. New \’ork.

14.2 Carbam;izepine (Tegretol@) monotherapy in epilepsy.

A retrospective s tudy

1. Gordon N e e , E. n . Andersen & A. Philtxi~t

Departments of Neurology. University Hospitals of Hvidovre and Glostrup. (‘Aqxnh;igen. Denmark

The effect and side-effects 01. carbarnazepine (Tegretola) in monotherapy (C-M) have been studied retrospectively in 288 patients in whom this therapy was instituted during the years 1973 to 1978. The largest groups of patients comprised those with grand ma1 (39%). psvchomotor epilepsy (23%) and a combination of these (26%). When the study was concluded June 30, 1979, 73% of the patients were still receiving C-M and the median observation time for these patients were I 6 months. I n 657r o f the patients C-M was the treatment o f first choice. The effect of therapy was determined hy comparing the number of seiiures during the period I d o r e C-h.I with the one before the patient was last seen during (;-hi. In 5% there had been n o seizut-es for a period before C-M was initiated. and the reason for chiinging therapv was generally side-effects of previous t herapy. A reduction in number nf seinires hy 75- 1007, was found in 79% of the patients with grand mal. in 76% of those with psvchornotor epilepsy and in 67% of those w i t h 1 ~ 0 t h types o f seizures. Side-effects necessitating withdrawal were observed i n 8% of the patientt. miinly ;illergic rashes. Nine per cent were transferred to other therapy herarise o f inadequ;ite c.ontrol ofepilepsv.

Epilepsy. Abstracts 7

Page 2: 12th Epilepsy Int Symp. 14: Clinical Trials

121h Epilepsy In! Symp 14 Clinical Trials Acta Neurol Scand, Suppl79 VOI 62 (1080)

14.3 Chlormethiazole (Heminevrin) in status epilepticus in children

S. l.irig;im,,]. Wilson. E. h l . Brett. W. <:. Mar-shall & , I . King

1iospit; i l for Sick (:hiIdiisi~, ( ; w a i t O r n i o i d Slrrct, I.~iiid~iii, I f . K

hi;!jor or ininor .st;ittis epileptic.iis ou iirrcd in I2 c-hiltlren aged 2- 12 years. Their seizurrs were not c-ontrollahle with rontitiuous ititrawnous o r r e d diazepam, or intraniusrular or rect;il p;ir;tldehyde, hut i n t r~ i~~e t io i~s c~lilorriietIii;~~ol~ (Heminevrin) was successful in rontrol- ling the seizures in 1 1 01 t h e 12‘ children. (:lilormettiiaiole was used as a continuous intriivetioits infiisioii whirh coiit;iincd chlorinrthiazole edisylate (H mg/ml). A dose range of 5- I0 ing/i(g/h was used. The dose was ;idjiistcd by titrating the seizures with appropri;ite inl’iisioii rates. Respiratory tlepression ;ind hypotention did not occur. Side effects included fever. head;tche, irritahility, thromhoptilebitis and reartion wit ti plastics. ( Ihg i im et A. llr. Med..]. 19x0; I ; 1.55-6). (:hlorniethiazole has been lourid a useful drug in the treatment of children in status epilepticus refractory t o other aitticOii\,uIsiiiits.

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14.4 Pharmacotherapy of self-induced seizures

1. Overweg & C. D. Rinnie

Instirutit voor EpilepsiehesrrIjding. lleemsrede. The Nethcrlmds

Self-induction of epileptic seizures, generally by mechanisms involving photosensitivity. is often a n intractable problem resistant t o antiepileptic drugs. In many patients self-induction confers no obvious social advantage but is apparently rewarding, which suggests an analogy with electrical self-stimulation in experimental animals. Self-stimulation is commonly blocked by doparnine antagonists including chlorprornazine. An open trial of chlorpromazine therapy was therefore performed in 8 patients with intractahle self-induced seizures. In all instances prolonged telemetric EEG- and video monitoring was performed before and during therapy to establish the incidence of self-induction. Self-induced seizures were apparently abolished in 4 patients and greatly reduced in 3. Partial relapse occurred after 6 to 9 months in two subjects. T h e theoretical implications of these findings will be discussed.

Page 3: 12th Epilepsy Int Symp. 14: Clinical Trials

12th Epilepsy In1 Symp. 14 Clinical Trials Acta NPurol Scand Suppl79 VoI 62 (1980)

.l‘lie stirdy inquiries on the rel;iti(ins Iietwecn ttie existence 01‘ EEG temporid IiKus. ( t i t i c .iI epileptic m;tnifestations and the presence of psycliic disorders. during i t niir:in:~rn~ t w o - ~ c ; t i

period, in 100 males, aged hetween 12 arid 18. with norin;lI intelligence. kl;ilf~ofthe rnerriheis of the sample presented partial o r secondary gener;tlizetl epileptic crises: the other- 1i.tIf did not present critiral manifestations. In hotti groups left and right fix.ality perwiitages wcrr sinii1;ir. wehether in domin;tnt heniisp1:ere or no;. wiih ( rises control or i i o i . in anil)i i l: itoi-y treatment or in interrted regime. (hriterits ;in evolirtictrt of psychic disttirhances are ;~ri;ilvsc~d

i n relation wit11 EEG activity anti the ;ippear;tnce of crisis or not, together with iI:c rc4red

antiepileptic and neriroleptic- pli;trrn;:cottier;t~~y. The expcriment was c;irried out with periodic. EE(; studies, drug - plasmatic control. and c1ir;iiitification scales 01. the various psychic disturbances. We concluded that ttie variation in aggressiveness is signilic:~ntly connected with the nunitxi- of crises and with the focal activity in the left ternpor;tl lolw, ;ind that there is also a significant increase of pswhic tlisturl);iric-es in interned p;ttients.

11.6 Ixvodopa and folk acid in the treatmerit ofepilepsy

K . lnanaga, S. Uetia % k’. Inoue

1)ep;rrtnierir o f psyc-hi;iri-y. KuIuiiic [ !nivcnity tio\piral.

K i i r i i m c ~ C i t y , , ~ ; ~ ~ ~ ~ ~ ~ ~

Studies were made of the therapeutic effects of- folic acid and levcdopa in epileptic- patients. 1.evodopa was administered orally at a dose level of 100-600 rngiday. The antiepileptic drugs which had been used at that time were unchanged. I.evodopa was rntderately effective in three cases, slightly effective in six cases and ineffective in five cases. The sei7ures decreased slightly in frequency in five cases and moderately in two cases. 1t was effective o n psychiatric symptoms in eight cases, such as the lack o f activity and spontaneity. and dysphoria. While on EEG the paroxysmal discharge decreased in frequency in six cases and background activity improved in six cases. Folk acid proved effective for a part o f chronic and prolonged psychiatric symptoms shown hy epileptic patients and hrought o n slight improvement in hyperexcitahility, aggressiveness. had humor and slowness of psychornotor activities. Improvement in mood was also observed. However. incidence of clinical lits increased in three cases. In the EEG. appearanre or increase of spikes was noted i n six cases. The epileptic group showed significantly low folir acid level in hoth serum and rpinal fluid compared with the non-epileptic group.

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Page 4: 12th Epilepsy Int Symp. 14: Clinical Trials

12th Epilepsy Int Symp. 14 Clinical Trials Act6 Neurol Scand Suppl79 Vol62 (1980)

14.7 Baclofen in spastic epileptic patients. A clinical and neurophysiological evaluation

A. C. Declerck.]. Uutten & U. Sijhen-Kiggen

Epilcpsy-~-ciiirc ' K c i n ~ ~ i ~ h : ~ r ~ I i t " . €icrn=. The Neiherlands

T h e efficacy of 'Raclofen" for the treatment of spasricity of central rerehr;il origin in scvcre mentally retarded epileptic patients has heen investigated. A group of 24 patients with organic brain lesions were selected on hase of severe mental retardation (1.Q. < 30-50) combined with spastic hemi- or tetraparesis. clinically complex form of epilepsy and electroencephalographically epileptic activity in more than 5% of the registration-time. I n thu firrf part <I/ the .stu+ I2 patients received Raclofen i.v. in a dosage o f 0. I mgikg My-weight under continuous polygraphic control. The following parameters were measured: - Spasti- city: a decrease of short durations limited to the affected parts ( I I ) ; - Epilepsy: no clinical or electroencephalographic changes; - EEG-background: relaxation pattern without sleep (7); - Serumlevels: no changes. In fhr rrrondporf o[f/w .\fuc!y also 12 patients were trealcd orally with Raclofen 3/day, 15 mg during 4 weeks. ( I m.). The values of the following parameters were compared with those of the period before (8 m.) and after (3 m.) with following results: - Spasticity: marked to slight decrease (7); - Activity of daily living: amelioration (3); - Epilepsy: clinically no changes except 1 and electroencephalographically in one case a slight increase, in another case a marked decrease; - EEG-hickground: relaxation pattern ( 5 ) ; - Serumlevels of anti-epileptic drugs: no constant or significant changes. On the base o f these results we believe that under good control Raclofen can be used by this selective group of epileptic patients.