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Biomedical subjects

F E Dreifuss

Publications and source records attributed to F E Dreifuss.

At least 19 recordsLinked to original sources
PubMed1992

Cognitive function--victim of disease or hostage to treatment?

In persons suffering from epilepsy, cognitive functioning may be compromised for various reasons, including--first and foremost--the learning and behavioral effects of the conditions causing the epilepsy. In addition, the epilepsy itself may cause changes in the nervous system through the metabolic and excitotoxic effects of the seizures and the neurotransmitter elements involved at the membrane level. The effect of the treatment modality, be it pharmacologic or surgical, may also play havoc with cognitive function. The neurobehavioral effects of antiepileptic drugs, although probably less important with the newer agents than in the past, must be considered, especially in polypharmacy, as recent reports have indicated. With increasing data, the effects of various surgical procedures on the cognitive elements of human behavior are becoming better recognized.

Anticonvulsants↗
PubMed1991

Felbamate for partial seizures: results of a controlled clinical trial.

Felbamate (2-phenyl-1,3-propanediol dicarbamate) has a favorable preclinical profile in animal models of epilepsy. We present the results of a double-blind, randomized, placebo-controlled clinical trial in patients with partial seizures. Criteria for entry included a requirement for four or more partial seizures per month despite concomitant therapeutic blood levels of phenytoin and carbamazepine. Fifty-six patients (mean age, 31.4 years; 32 men, 24 women) completed the trial. The mean seizure frequencies for the 8-week periods analyzed were felbamate = 34.9, placebo = 40.2. Felbamate was statistically superior to placebo in seizure reduction, percent seizure reduction, and truncated percent seizure reduction. The mean felbamate dosage was 2,300 mg/d. Plasma felbamate concentrations ranged from 18.4 to 51.9 mg/l, mean = 32.5 mg/l. Adverse experiences during felbamate therapy were minor and consisted primarily of nausea and CNS effects. This trial indicates that felbamate is safe and effective in the treatment of comedicated patients with severely refractory epilepsy.

Adult↗
PubMed1991

Toxic effects of drugs used in the ICU. Anticonvulsant agents.

Anticonvulsant agents are often placed into two groups: those that complicate drug administration in a relatively predictable manner and those that cause idiosyncratic reactions that are relatively unpredictable, unheralded, and frequently quite severe. This article examines the toxic effects of anticonvulsant drugs used to treat diseases commonly seen in the intensive care unit (ICU), where the situation is complicated by the severity of the primary pathologic condition, which frequently involves the use of drugs that may have a significant effect on the blood levels and efficacy of the anticonvulsant drugs. Complications associated with the route of drug administration and their signs and symptoms are also discussed.

Anticonvulsants↗
PubMed1990

The epilepsies: clinical implications of the international classification.

From the earliest days of neurology, the classification of epileptic seizures into those generalized from the beginning and those with a definable localization in the cortex from the onset has added to knowledge about the function of the nervous system. Further elaboration of the classification of seizures into those localized to the six-layered isocortex and those whose elaboration involves regions of the brain involved with consciousness and memory has provided the basic focus for the burgeoning subspecialty of epilepsy surgery. It is increasingly apparent that the etiology of a seizure disorder is of at least equal or of greater significance than the nature of the seizures it spawns and is the product not only of localization in the nervous system but also of causative factors with implications reaching into areas of genetics, higher cortical function, and intelligence. The prognosis concerning the outcome of the epilepsy under consideration is based on all of these facets. This pathophysiological substratum, of which the seizure is only the presenting symptom, constitutes the epilepsy or epileptic syndrome on which the formulation of a rational treatment plan is based.

Adolescent↗
PubMed1989

Classification of epileptic seizures and the epilepsies.

Recent activity in the classification of epileptic seizures and in the classification of the epilepsies has been based on the ability to identify accurately (1) individual seizure types, (2) the progression of one type of seizure into another during the course of a single seizure, and (3) the repertoire of different seizures and other symptoms allowing the identification of epileptic syndromes. Much of this activity has resulted from the technologic advances in video recording, long-term electroencephalographic monitoring, and the incorporation of both into the clinical armamentarium.

Epilepsies, Partial↗
PubMed1989

Juvenile myoclonic epilepsy: characteristics of a primary generalized epilepsy.

Juvenile myoclonic epilepsy (JME) is a primary generalized epilepsy that affects approximately 7% of adolescent and adult epilepsy patients. JME is characterized by myoclonic seizures alone or combined with generalized tonic-clonic seizures or absence seizures. Seizures are precipitated by sudden awakening, sleep deprivation, photic stimulation, and alcohol consumption. The ictal electroencephalogram (EEG) shows a typical 4- to 6-Hz polyspike and wave pattern; the interictal EEG may be normal. Valproate controls seizures in approximately 80% of JME patients and is recommended for successful management of this disorder.

Anticonvulsants↗
PubMed1989

Valproic acid hepatic fatalities. II. US experience since 1984.

We have analyzed the usage pattern of valproate and the associated hepatic fatalities that have been reported in the 2 years since our first study evaluating US experience during the period 1978-1984. In this follow-up study (1985-1986), we have observed a nearly fivefold decrease in the incidence of hepatic fatality during a time when the overall use of valproate has increased significantly. The dramatically decreased incidence, from 0.93 per 10,000 (1/10,000) in 1978-1984 to 0.20 per 10,000 (1/49,000) in 1985-1986 appears to be due to changes in the prescribing patterns of physicians, prompted by greater awareness of low-risk versus high-risk patients. More patients are receiving valproate as monotherapy, considerably more low-risk patients are being treated with valproate, and fewer high-risk patients (0 to 2 years old) are being treated with valproate. During 1985-1986, no hepatic fatalities were reported in any patients above the age of 10 years, regardless of whether valproate was administered as monotherapy or polytherapy. The altered exposure pattern, with an increased use of monotherapy, appears to have had a positive impact on the number of hepatic fatalities (four among 198,000 patients treated during 1985-1986) and contributed to a decreased rate of valproate-associated hepatic fatality.

Adolescent↗
PubMed1988

Side effects of valproate.

In the management of epilepsy, selecting an antiepileptic drug appropriate for each individual patient requires matching the patient's clinical needs with the agent's specific pharmacologic attributes. In many situations, the final choice of an antiepileptic drug is based upon an agent's side-effect profile. Because side-effect profiles emerge gradually as the number of patients treated expands from the thousands to the hundreds of thousands, it is helpful to periodically update our perspective of side effects of antiepileptic drugs. For valproate, the frequency of side effects has been reduced by monitoring serum levels, using improved formulations, and limiting use in patients who have been identified as having a high risk for the development of a serious side effect.

Behavior↗
PubMed1988

Arachnoid cysts in a brother and sister.

We describe a brother and sister with microcephaly and mental retardation who were shown by cranial CT scan to have almost identical unilateral arachnoid cysts. The occurrence in sibs suggests the possibility of a genetic basis for at least some cases of arachnoid cysts.

Adolescent↗
PubMed1988

Syndromes of epilepsy in childhood and adolescence.

This report concerns the more commonly recognized epileptic syndromes that have their onset or entire clinical course in childhood and/or adolescence. It hopes to demonstrate the close relationship between the classifications of epileptic syndromes. It will also discuss how knowledge of the epileptic syndromes will enhance the management plan for the patient with epilepsy.

Adolescent↗