bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coprescription of Triptans With Potentially Interacting Medications: A Cohort Study Involving 240 268 Patients
Authors: Tepper Stewart , Allen Christopher , Sanders David , Greene Alison , Boccuzzi Stephen 
Published: March 2003

Background Little information exists about the actual prescription of triptans within large, geographically diverse populations, in terms of demographic characteristics and co‐prescriptions with other medications with potential interactions.Objectives To investigate the demographic characteristics associated with triptan use, and examine the rate of co‐prescription of triptans with specified pharmacologic agents with the potential for drug interactions.Methods This study examined the rate of co‐prescription of triptans available in the US up to May 2001 (sumatriptan, naratriptan, rizatriptan, and zolmitriptan) with specified agents with potential for drug interactions. A cohort of 240,268 patients receiving pharmacy benefits from Merck‐Medco (N  =  65  +  M) was followed over a one‐year period. This analysis included patients who received at least two triptan prescriptions during the study (6/00‐5/01). Ninety‐one percent of the cohort remained on the same triptan during the study period. ‘Co‐prescription’ was defined as any fill for a medication that was contraindicated or could potentially adversely interact with a triptan, obtained between and during the first and last triptan fills throughout the study period.Results Mean patient age was 43 (SD  ±  11.6) and 82% were female. Twenty‐one percent were co‐prescribed selective serotonin reuptake inhibitors, reflecting the considerable co‐morbidity of migraine and depression. Patients taking triptans were almost never co‐prescribed monoamine oxidase inhibitors (0.02%), and co‐prescription of ergots was also low (1.45%). Less than one percent (0.45%) received cimetidine while taking zolmitriptan, while 2.7% of patients taking rizatriptan 10 mg also took propranolol. While agents unavailable in the U.S. were not evaluated in this cohort, six percent of patients were treated with potent CYP 3A4 inhibitors, which would not be expected to cause any problems with the triptans in the survey. However, such agents are specifically contraindicated for use with one triptan (eletriptan), recently launched in the EU, suggesting that continued vigilance will be necessary to avoid coprescription of medicines with the potential for producing adverse side effects.Conclusions Triptan use mirrors migraine demographics. The frequency of co‐prescription of triptans with SSRIs is about 20%. Continued vigilance will be necessary to avoid co‐prescription of medicines with the potential for producing adverse drug events.
Material‐Specific Memory Changes after Anterior Temporal Lobectomy as Predicted by the Intracarotid Amobarbital Test
Authors: Chiaravalloti Nancy D. , Glosser Guila 
Published: March 2003

Summary:  Purpose: The intracarotid amobarbital test (IAT) has been shown to predict verbal memory changes after anterior temporal lobectomy (ATL). Seeking to extend these findings, we examined two questions: (a) What is the relationship between material‐specific aspects of IAT memory and material‐specific memory changes after ATL? and (b) Which IAT memory score(s) optimally predict memory changes after surgery, the memory score after injection ipsilateral to the seizure focus, the memory score after injection contralateral to the seizure focus, or the IAT asymmetry score, comprising the ipsilateral minus contralateral injection scores?Methods: Seventy left hemisphere language‐dominant patients undergoing ATL for treatment of medically refractory seizures were administered a verbal and visuospatial recognition memory test before surgery and 3 weeks after surgery. IAT memory recognition scores for words and designs were used to predict verbal and visuospatial memory changes after surgery.Results: After surgery, left ATL patients declined in verbal memory, whereas right ATL patients declined in visuospatial memory. IAT total recognition memory scores (collapsed across all types of materials) and IAT word memory scores were associated with postoperative verbal memory decline. This relationship was significant for the IAT ipsilateral injection memory scores and the IAT hemispheric asymmetry scores. IAT memory performances were not related to visuospatial memory changes.Conclusions: Results indicate IAT memory measures to be related to postoperative verbal, but not visuospatial, memory change. A specific relationship was found between postoperative verbal memory change and IAT verbal memory after injection ipsilateral to the seizure focus, when relying primarily on the contralateral hemisphere. This finding is consistent with the functional reserve model of memory change in ATL.
Idiopathic Generalized Epilepsies: Do Sporadic and Familial Cases Differ?
Authors: Briellmann Regula S. , Torn‐Broers Yvonne , Berkovic Samuel F. 
Published: March 2003

Summary:  Purpose: Genetic factors are the only identified cause of idiopathic generalized epilepsies (IGEs), but the majority of cases do not have affected first‐degree relatives. Here we investigate whether subjects with sporadic and familial IGE differ in terms of antecedent events and clinical and EEG features. Differences would support the hypothesis of a different etiology for sporadic cases, which has implications for choice of subjects for genetic association studies.Methods: We analyzed 98 patients with IGE, diagnosed on clinical and EEG criteria. All patients and, if possible, one relative were interviewed, with special emphasis on potential antecedent events and family history. Patients with first‐degree relatives affected with epileptic seizures were regarded as “familial,” and the other patients were regarded as “sporadic.”Results: Of the 98 IGE patients, 32 (33%) patients were familial. The risk for seizures was 13.2% for siblings, and 7.7% for parents. The distribution of the IGE subsyndromes, the presence of antecedent events, and other electroclinical features did not differ between familial and sporadic IGE groups.Conclusions: No differences were found between familial and sporadic IGE patients. This does not the support the hypothesis that sporadic and familial IGE cases have separate etiologies.
Unsuspected Atypical Hemispheric Dominance for Language as Determined by fMRI
Authors: Spreer J. , Quiske A. , Altenmüller D. M. , Arnold S. , Schulze‐Bonhage A. , Steinhoff B. J. , Schumacher M. 
Published: March 2003

Summary:  Purpose: We sought to illustrate the value of functional magnetic resonance imaging (fMRI) in the presurgical assessment of hemispheric dominance for language by means of an illustrative case report.Methods: fMRI with two language paradigms was performed in a right‐handed patient without familial sinistrality suffering from a left frontal focal epilepsy.Results: Both fMRI paradigms revealed unequivocally lateralized right hemispheric activation. Atypical language representation was confirmed by Wada test. The further presurgical workup could be restricted to subdural strip recordings instead of the initially intended grid implantation. After resective surgery, no language deficits were apparent.Conclusions: Hemispheric dominance for language should be assessed by fMRI in all patients before surgery in areas potentially relevant for language in either cerebral hemisphere. fMRI may influence the further diagnostic workup and should be performed before other invasive diagnostic procedures.
Manic Episode in Epilepsy and Bipolar I Disorder: A Comparative Analysis of 13 Patients
Authors: Kudo T. , Ishida S. , Kubota H. , Yagi K. 
Published: March 2003

Summary: Purpose: To determine whether the manic episode of patients with epilepsy has different characteristics from manic episode of patients with bipolar disorder.Methods: Interictal manic episodes in patients with epilepsy (epilepsy group) were compared with mood disorders in patients with bipolar I disorder (bipolar group), as defined by the DSM‐IV. There were 13 patients (five women and eight men) in each group.Results: Five epilepsy patients had relatives with epilepsy and/or convulsions, and four bipolar patients had relatives with mood disorders. In the epilepsy group, two had substance‐related or organic factors associated with the episodes besides epilepsy, and two exhibited a postictal manic state that had the same symptoms as those of their interictal manic episodes. Ten patients of the epilepsy group had dependent–childish behavior. The epilepsy group had fewer severe mood episodes than the bipolar group. Ten epilepsy patients had fluctuating mood disturbances, and eight had rapid cycling of mood episodes. The epileptogenic zone was in the frontal and/or temporal lobes of eight patients and in multiple lobes of two others; it could not be localized in the three remaining patients.Conclusions: The clinical features of the interictal manic episodes in the epilepsy group were different from those in the bipolar group. The manic episodes of the epilepsy group appeared heterogeneous in their causal factors. An epileptogenic zone in the frontal and temporal lobes seems to play an important role in the mood episodes of the majority of patients with epilepsy.
Ictal Automatisms with Preserved Responsiveness in a Patient with Left Mesial Temporal Lobe Epilepsy
Authors: Park S. A. , Heo K. , Koh R. , Chang J. W. , Lee B. I. 
Published: March 2003

Summary:  Purpose: To describe the possible mechanism of ictal automatisms with preserved responsiveness (APRs) in a patient with left mesial temporal lobe epilepsy, which had not been reported previously.Methods: Ictal EEGs recorded from bilateral foramen ovale electrodes with scalp–sphenoidal electrodes were analyzed in respect to the ictal semiology.Results: The patient had a right hemispheric language dominance in the dextral. Electroclinical analysis revealed that the onset of oroalimentary automatisms coincided with the involvement of the left mesial and lateral temporal structures by spreading ictal discharges. The ictal discharge spreading was limited to the ipsilateral hemisphere throughout the seizure, which explained the intact consciousness and preserved responsiveness of the patient.Conclusions: This case suggests that APRs take place in seizures originating from the nondominant temporal lobe, during which ipsilateral mesial and lateral temporal structures are diffusely involved without spreading to the contralateral side.
The Midline Thalamus: Alterations and a Potential Role in Limbic Epilepsy
Authors: Bertram Edward H. , Mangan Patrick S. , Zhang DeXing , Scott Carol A. , Williamson John M. 
Published: March 2003

Summary:  Purpose: In limbic or mesial temporal lobe epilepsy, much attention has been given to specific regions or cell populations (e.g., the hippocampus or dentate granule cells). Epileptic seizures may involve broader changes in neural circuits, and evidence suggests that subcortical regions may play a role. In this study we examined the midline thalamic regions for involvement in limbic seizures, changes in anatomy and physiology, and the potential role for this region in limbic seizures and epilepsyMethods: Using two rat models for limbic epilepsy (hippocampal kindled and chronic spontaneous limbic epilepsy) we examined the midline thalamus for evidence of involvement in seizure activity, alterations in structure, changes in the basic in vitro physiology of the thalamic neurons. We also explored how this region may influence limbic seizures.Results: The midline thalamus was consistently involved with seizure activity from the onset, and there was significant neuronal loss in the medial dorsal and reuniens/rhomboid nuclei. In addition, thalamic neurons had changes in synaptically mediated and voltage‐gated responses. Infusion of lidocaine into the midline thalamus significantly shortened afterdischarge duration.Conclusions: These observations suggest that this thalamic region is part of the neural circuitry of limbic epilepsy and may play a significant role in seizure modulation. Local neuronal changes can enhance the excitability of the thalamolimbic circuits.
Psychosocial Aspects of Epilepsy in Oman: Attitude of Health Personnel
Authors: Al‐Adawi Samir , Al‐Ismaily Salem , Martin Rodger , Al‐Naamani Aziz , Al‐Riyamy Kassim , Al‐Maskari Masoud , Al‐Hussaini Ala'Aldin 
Published: March 2003

Summary:  Purpose: To assess with a questionnaire the awareness and attitudes of the doctors in Oman toward epilepsy. Attitudes of society toward epilepsy have a wide‐ranging influence, affecting issues as diverse as compliance with treatment and doctor–patient communication. Recent studies in both developing and developed countries suggest that within the medical profession, there is a lack of knowledge and negative attitudes toward people with epilepsy (PWE). There are no equivalent studies for Oman or the Arab world.Methods: The questionnaire included queries on the backgrounds of the physicians, including their training and qualifications, the main sources of their knowledge of epilepsy, as well as their perceptions of the attributes and care requirements of PWE.Results: Sixty‐two percent (n = 121) of those questioned, who were medical personnel working in different regions of Oman, responded. The results suggest that, despite coming from diverse cultural backgrounds and nationalities, the practicing doctors in Oman gained knowledge of epilepsy much earlier than did their counterparts in developed countries. The majority of the respondents thought that PWE have more propensities toward dysfunctional personality and behavioral characteristics than do “normal” people. On questions relating to public image, our respondents opined that, although the general public is negative toward PWE, the realities regarding PWE should be publicized because PWE are capable of having a normal family life and being an integral part of society.Conclusions: In spite of having an earlier exposure to seizures and sympathetic acceptance of PWE, negative views still persist on matters related to cognitive and behavior domains. It is concluded that a developing country such as Oman must inculcate more realistic perceptions and attitudes among their doctors toward PWE.
High and Low Perceived Self‐Control of Epileptic Seizures
Authors: Spector Shiri , Cull Christine , Goldstein Laura H. 
Published: March 2003

Summary:  Purpose: To define behaviours and to identify psychological, demographic, and epilepsy‐related variables associated with high as opposed to low perceived self‐control of seizures.Method: In a semistructured interview, 100 adults with intractable seizures were asked about their seizure precipitants and attempts at self‐control of seizures. They also completed four psychological questionnaires. Latent Class Analysis was used to analyse the interview data to create two groups, High Controllers and Low Controllers, who were then compared on demographic, epilepsy, and psychological characteristics.Results: Being able to identify and seeking out low‐risk‐for‐seizure situations, avoiding high‐risk‐for‐seizure situations, and making attempts at seizure inhibition were seizure behaviours that discriminated High from Low Controllers. The general probability of being a High Controller was greater than that of being a Low Controller. Perceived high self‐control of seizures was associated with low chance‐health locus of control. For Low Controllers, current age, age at onset of seizures, and duration of epilepsy history were related to psychological variables. A significantly higher proportion of the Low Controllers than High Controllers were women.Conclusions: Many people with intractable seizures do not accept their epilepsy as a condition over which they have no control. Perceived self‐control of seizures, however, involves a complex interaction between epilepsy and psychological factors, with health locus of control an apparently important discriminator between High and Low Controllers.
Visual Field Loss Associated with Vigabatrin: Quantification and Relation to Dosage
Authors: Hardus P. , Verduin W. M. , Engelsman M. , Edelbroek P. M. , Segers J. P. , Berendschot T. T. J. M. , Stilma J. S. 
Published: March 2003

Summary:  Purpose: To describe the correlation between visual field loss and the duration, dosage, and total amount of vigabatrin (VGB) medication in a group of patients with epilepsy. Co‐medication of antiepileptic drugs (AEDs) and compliance were also studied.Methods: Ninety‐two patients (53 male and 39 female) taking VGB medication in the past or the present, attending the Outpatient Epilepsy Clinic in Utrecht, were examined with the Goldmann perimeter. The amount of visual field loss was calculated by the Esterman grid method and by a new method, with which the percentage surface loss of the visual field is measured. A complete drug history was compiled, specifying the amount and duration of VGB medication. Concomitant AED medication was noted. Serum levels of AEDs were determined.Results: Linear regression showed the total amount of VGB as the most significant parameter to predict visual field loss (p < 0.001). Further, men were more affected than women (p = 0.026). Compliance was good, and other AEDs did not influence the results.Conclusions: Because prolonged use of VGB medication is correlated with the amount of visual field loss, VGB should be prescribed only when there are no alternatives. In such cases, we recommend an examination of the peripheral visual field before starting therapy and a repeated examination every 6 months.
Antiepileptic Drug Therapy and Its Management in Sudden Unexpected Death in Epilepsy: A Case–Control Study
Authors: Nilsson L. , Bergman U. , Diwan V. , Farahmand B. Y. , Persson P‐G. , Tomson T. 
Published: March 2003

Summary:  Purpose: Because frequent seizures constitute a major risk factor for sudden unexpected death in epilepsy (SUDEP), the treatment with antiepileptic drugs (AEDs) may play a role for the occurrence of SUDEP. We used data from routine therapeutic drug monitoring (TDM) to study the association between various aspects of AED treatment and the risk of SUDEP.Methods: A nested case–control study was based on a cohort consisting of 6,880 patients registered in the Stockholm County In Ward Care Register with a diagnosis of epilepsy. Fifty‐seven SUDEP cases, and 171 controls, living epilepsy patients, were selected from the cohort. Clinical data including data on TDM were collected through medical record review.Results: The relative risk (RR) of SUDEP was 3.7 (95% CI, 1.0–13.1) for outpatients who had no TDM compared with those who had one to three TDMs during the 2 years of observation. RR was 9.5 (1.4–66.0) if carbamazepine (CBZ) plasma levels at the last TDM were above and not within the common target range (20–40 μM). High CBZ levels were associated with a higher risk in patients receiving polytherapy and in those with frequent dose changes. Although the subgroup of patients with high CBZ levels was small (six cases of 33 with CBZ therapy), and the result should be interpreted with caution, no similar associations were demonstrated for phenytoin plasma levels and risk of SUDEP. No association was found between SUDEP risk and within‐patient variation in AED levels over time.Conclusions: Polytherapy, frequent dose changes, and high CBZ levels as identified risk factors for SUDEP all point to the risks associated with an unstable severe epilepsy. It is unclear whether high CBZ levels per se represent a risk factor or just reflect other unidentified aspects of a severe epilepsy. Our results, however, prompt further detailed analyses of the possible role of AEDs in SUDEP in larger cohorts and suggest that reasonable monitoring of the drug therapy may be useful to reduce risks.
Contribution of the MHC Class II Antigens to the Etiology of Infantile Spasm in Mexican Mestizos
Authors: Suastegui Roberto A. , De La Rosa Gabriela , Carranza Juan M. , Gonzalez‐Astiazaran Adalberto , Gorodezky Clara 
Published: March 2003

Summary: Purpose:Infantile spasms (ISs) are age‐dependant epileptic seizures, which may be flexor, extensor, lightning or nods, or mixed. The aim of this study was the analysis of genetic factors within the human leukocyte antigen (HLA) complex associated with ISs.Methods:Sixty‐five patients diagnosed according to the established international criteria were compared with 229 healthy individuals; all of them were Mexican Mestizos. Five families were also analyzed (seven affected and five healthy sibs); HLA class I and class II antigens were typed using the standard microlymphocytotoxicity methods.Results:The findings showed female gender preference (2:1). Two thirds were symptomatic, and prevalent seizures were of mixed type (67%). A strong association with HLA‐DR17 was detected in the IS group (pc < 0.01; OR = 3.6; EF = 0.20). DR17 was also found increased in the symptomatic patients (p = 0.009; OR = 3.16) and in those with other types of seizures (p = 0.001; OR = 2.0). Conversely, HLA‐DQ6 was significantly decreased (pc < 0.002; PF = 0.37) in the total and in the symptomatic groups (p < 0.01). Haplotype linkage was not confirmed in the families; however, those with more than one affected sib shared at least one haplotype.Conclusions:These findings suggest the contribution of DR locus to the susceptibility and the participation of DQ region in the resistance to IS. Severity seems also to be influenced by HLA‐DR17, and therefore class II typing may be a helpful tool for disease prognosis.
AUStralian Study of Titration to Effect Profile of Safety (AUS‐STEPS): High‐Dose Gabapentin (Neurontin) in Partial Seizures
Authors: Beran Roy , Berkovic Samuel , Black Andrew , Danta Gytis , Dunne John , Frasca Joseph , Grainger Keith , Kilpatrick Christine , McKenzie Roderick , McLaughlin Daniel , Schapel Graham , Somerville Ernest 
Published: March 2003

Summary:  Purpose: To evaluate the safety, tolerability, efficacy, and impact on quality of life of gabapentin (Neurontin; GBP) as adjunctive therapy in patients with refractory partial seizures.Methods: AUS‐STEPS was an open‐label, multicenter, prospective study in patients experiencing partial seizures who were inadequately controlled with one to three concurrent antiepileptic drugs (AEDs). GBP treatment was titrated to a maximum of 4,800 mg/day, over a treatment period of 24 weeks, to achieve an efficacious and tolerable dosage. Efficacy was assessed by seizure‐frequency data. Quality of life was evaluated by using the QOLIE‐10 questionnaire, and safety was assessed by adverse‐event reports and clinical laboratory findings.Results: A total of 176 patients received treatment with GBP, with 174 evaluable for intention‐to‐treat (ITT) efficacy analysis. A reduction of >50% in overall seizure frequency was observed in 93 patients (53%). There was a small (4.6%) overall improvement in QOLIE‐10 score. The most frequent adverse events were dizziness (31%), fatigue (29%), somnolence (27%), headache (21%), and ataxia (20%), with no major increase seen in adverse events necessitating discontinuation as the dose of GBP was titrated upward.Conclusions. This study indicates that patients with partial epilepsy may be effectively treated with GBP at dosages of 4,800 mg/day, without altering the safety profile of the drug.