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Biomedical subjects

G Scollo-Lavizzari

Publications and source records attributed to G Scollo-Lavizzari.

At least 19 recordsLinked to original sources
PubMed1992

[Epilepsy in middle and older age].

Single fits and epileptic illness are more frequent in advanced age; their occurrence reaches the same frequency as in the neonatal period. Their origin and the possibilities of treatment are tightly connected to the process of ageing, a fact that requires special consideration. The main reasons for new epileptic attacks in the group of age 65 or more are structural changes, i.e. ischemic infarctions, tumors and atrophic involution. For certain patients, the use of antiepileptic drugs may be limited by unavoidable side effects. Complete cure of the attacks in advanced age is rare, but with a well selected treatment sufficient control is often possible.

Aged↗
PubMed1991

[Confusional states following administration of short-acting benzodiazepines (midazolam/triazolam)].

The authors report about six patients, who after the intake of Midazolam or Triazolam suffered from an oneiroid-confusional state in which they carried out complex acts and for which an anterograde amnesia existed. In addition to these drugs, one female patient was under the influence of alcohol and one male patient of Bromazepam. Two of the patients suffered of emotional conflicts. The possibility of disinhibition of suicide and other impulses is named. The authors recommend caution in prescribing these benzodiazepines of ultrashort action.

Adult↗
PubMed1991

Risks and benefits of therapy with flumazenil (Anexate) in mixed drug intoxications.

Flumazenil, the first specific benzodiazepine (BZD) antagonist, is one of the most innovative drugs to become available within the last few years. Flumazenil is indicated for the reversal of the centrally depressant effects of BZDs, in BZD-induced anaesthesia, in BZD sedation in intensive care and in patients comatose after drug overdoses including BZDs. A conference of experts experienced in the treatment of mixed drug overdoses by various means, including flumazenil, was held in order to try to reach a consensus regarding the safe use of flumazenil in this indication. From the knowledge and experience gained to date, it was concluded that flumazenil may be useful and safe in the treatment of suspected BZD and mixed drug overdoses, provided that the appropriate precautions are observed.

Antidepressive Agents, Tricyclic↗
PubMed1990

[Diagnostic and therapeutic aspects of the initial epileptic seizure].

We present the concept of an 'epileptic syndrome' which is important for prognostic statements and the application of appropriate therapeutic measures. We then discuss the epileptic seizure and the assessment of suspected seizure, indications for admission to a hospital, diagnostic measures (EEG, CT scan, laboratory tests, lumbal puncture, MRI scan, PET scan, angiography), therapy and procedures for imminent status epilepticus. Finally, we try to answer the question whether anticonvulsant medication should be instituted after a first epileptic seizure.

Anticonvulsants↗
PubMed1990

Use of flumazenil in intoxicated patients with coma. A double-blind placebo-controlled study in ICU.

In a double-blind placebo-controlled prospective clinical trial we studied the efficacy and safety of the benzodiazepine antagonist, flumazenil. In 23 patients admitted to the Intensive Care Unit with coma due to overdose with benzodiazepines or other sedatives, flumazenil i.v. (up to 2 mg or placebo) was given. In 13 patients given flumazenil the Glasgow Coma Scale (GCS) increased significantly from 4.9 to 7.8 (p less than 0.05). Six of these 13 patients, including mainly benzodiazepine mono-intoxications, needed only one series of injections (up to 1.0 mg flumazenil); the GCS increased thereby from 4.5 to 10.7 within a maximum of 5 min (p less than 0.01). In the remaining 7 patients, needing two series of injections of flumazenil (up to 2.0 mg), GCS did not rise significantly and coma was related to intoxications with nonbenzodiazepine sedatives, flunitrazepam and in one patient, encephalitis. In the 10 patients receiving placebo, the GCS did not change. A significant increase in the GCS from 5.5 to 10.8 (p less than 0.001) was, however, observed when flumazenil (up to 1.0 mg) was given after placebo. In patients with EEG monitoring the changes in waveform pattern paralleled the clinical response. Effects could be detected within 1-2 min after flumazenil injection and lasted up to 45 min. There were no adverse reactions or benzodiazepine withdrawal symptoms. We conclude that flumazenil is an effective and safe drug in the treatment of benzodiazepine overdose. The use of flumazenil is of diagnostic value in mixed-drug intoxications or coma of unknown origin and is of therapeutic importance for reversal of benzodiazepine intoxications.

Adolescent↗
PubMed1989

[Epilepsy yesterday, today and tomorrow].

In this overview the current state of knowledge concerning epilepsy is presented: diagnosis, classification, etiology, pathogenesis and therapy. The change in these aspects during the past epochs of medical history is described. Suggestions as to future prospects are discussed.

Anticonvulsants↗
PubMed1989

Computed tomography, electroencephalography, and clinical features in the differential diagnosis of senile dementia. A prospective clinicopathologic study.

The accuracy of computed tomography, electroencephalography, and clinical features in the differential diagnosis of senile dementia was studied prospectively. Out of 50 demented patients, autopsy revealed 32 cases with either senile dementia of the Alzheimer's type (SDAT), multi-infarct dementia (MID), or a combination of both. Eighteen patients had dementia caused by other diseases. Based on a combination of computed tomography, electroencephalography, and clinical features, senile dementia of the Alzheimer's type was differentiated from all 50 patients, with a specificity of 83% and a sensitivity of 80%. Focusing on senile dementia of the Alzheimer's type, multi-infarct dementia, or a combination of both, specificity decreased to 65% and sensitivity to 47%. Comparing the different methods, multi-infarct processes were diagnosed with a higher sensitivity by the clinical features (73%) than by computed tomography (18%) or electroencephalography (18%). None of the methods validly differentiated multi-infarct dementia from a combination of multi-infarct dementia and senile dementia of the Alzheimer's type.

Aged↗
PubMed1988

The clinical anti-convulsant effects of flumazenil, a benzodiazepine antagonist.

The clinical anti-convulsant effect of flumazenil in epilepsy has been demonstrated: (i) by acute i.v. administration under EEG control in an epileptic patient who had been previously heavily sedated with diazepam; (ii) in patients undergoing pharmaco-EEG studies whereby spike and wave counts were diminished following oral administration of 10 mg of flumazenil; and (iii) in a series of 27 epileptic patients treated chronically for periods of up to 42 months with flumazenil as monotherapy or as addition to basic therapy. The daily dose ranged from 10-90 mg. Before treatment all patients presented with frequent seizures and had an abnormal EEG. In these patients the anti-convulsant effect was good or very good in 70% of the previously untreated (naive) patients and in about half of the patients who had epilepsy of long duration and had been treated already with standard anti-convulsants. Side-effects with flumazenil were generally mild in nature and rarely led to discontinuation. About one-third of the patients expressed a feeling of well-being while under therapy with flumazenil. A possible mechanism of action is discussed.

Adolescent↗
PubMed1987

Prognostic value of EEG in post-anoxic coma after cardiac arrest.

The authors themselves studied 26 patients. The EEGs were classified in terms of increasing severity in 5 categories. Incorporating over 400 cases from the literature, the authors correlated the initial EEG findings with the clinical outcome following cardiac arrest. Grade I EEG findings (normal alpha with theta-delta activity) imply a very good prognosis. A complete remission can be expected in most cases. Grade II (dominant theta-delta activity with detectable normal alpha) and grade III (dominant theta-delta activity without detectable normal alpha) findings have no definite prognosis. Grade IV [low-voltage delta, possibly with short isoelectric intervals; dominant, monomorphic, non-reactive alpha-activity (alpha coma); periodic generalized phenomena (spikes, sharp waves, slow waves with very low background activity)] and grade V (very flat to isoelectric EEG) findings have a very serious prognosis.

Adolescent↗
PubMed1987

[Value of the EEG in the prognosis of post-anoxic coma following cardiocirculatory arrest].

The EEGs of 26 patients who remained at least 6 hours in coma after cardiovascular arrest were analyzed. The first EEG was recorded within few days after reanimation, classified in a 5-grade scale of increasingly severe impairment and compared with the final clinical outcome. On the basis of the present study and of a review of 408 EEG findings reported in similar investigations in the literature we conclude that the EEG can be useful in predicting the outcome of patients in postanoxic coma states: the EEG should be recorded at earliest 8-12 hours but within 2 days after reanimation, a barbiturate intoxication and hypothermia should be excluded. The classification of the recordings in a 5-grade scale has proven to be helpful and accurate in predicting the outcome: Grade I EEG findings imply a very good prognosis, a complete remission can be expected in most cases. Grade II and III findings have no definite prognosis: the EEG should be repeated one or two days later, a favorable outcome is to be expected only with rapid improvement of the tracing. Grade IV and Grade V findings have a very serious prognosis: complete recovery has been described episodically, most in the pediatric population and with findings of alpha-coma.

Adolescent↗
PubMed1985

Benzodiazepine antagonist (RO 15-1788) in ethanol intoxication: a pilot study.

In 1983, we reported on the excellent efficacy of the benzodiazepine antagonist RO 15-1788 in cases of acute intoxication with diazepam in intensive care medicine. Upon observing a positive effect in a patient who had taken alcohol as well as diazepam a study aiming at establishing the beneficial effect of RO 15-1788 in alcoholic intoxication was started. In the meantime, we discovered a significant amelioration of the cerebral disturbance in patients suffering from hepatic coma by the same benzodiazepine antagonist. The preliminary results of a multicenter study reflecting the beneficial effect of RO 15-1788 in cases of alcohol intoxication will be presented.

Adolescent↗
PubMed1985

Benzodiazepine antagonist Ro 15-1788 in self-poisoning. Diagnostic and therapeutic use.

Thirteen patients with benzodiazepine overdosage received the specific benzodiazepine antagonist Ro 15-1788. Intravenous administration of 1.5 to 10 mg reversed the central nervous system depression induced by different benzodiazepine compounds within one to two minutes of injection. These case reports indicate that Ro 15-1788 may be an effective tool in the primary management of self-poisoning.

Adult↗
PubMed1984

[Prolonged coma caused by diazepam sedation in ventilated patients. Diagnostic and therapeutic use of the benzodiazepine antagonist Ro 15-1788].

Repeated administration of diazepam in two ventilated patients had caused drug cumulation and coma over several days. In both cases central nervous depression could be demonstrated by the benzodiazepin antagonist Ro 15-1788 which induced reversal of coma. Estimation of plasma concentrations in a 70-year-old female patient 150 hours after the last administration showed a diazepam concentration of 437 ng/ml and a desmethyl-diazepam concentration of 483 ng/ml. The calculated elimination half-life of these substances were 109 and 403 hours. In the second case benzodiazepin could be demonstrated in urine for 10 days after withdrawal of medication. These observations suggest that diazepam is not a suitable drug for prolonged sedation in artificially ventilated patients. The benzodiazepin antagonist Ro 15-1788 represents a valuable diagnostic aid in ascertained or suspect cases of benzodiazepin intoxications. It can also be used therapeutically for reversal of central nervous depression.

Aged↗
PubMed1984

The anticonvulsant effect of the benzodiazepine antagonist, Ro 15-1788: an EEG study in 4 cases.

An EEG study was carried out in 4 epileptic patients. In each case, Ro 15-1788 caused the disappearance or marked reduction of the epileptic potentials. In 1 case the patient had been pretreated with diazepam; in the other cases there had been no prior benzodiazepine treatment. In the first case, it is possible that Ro 15-1788 acted by abolishing a paradoxical effect of diazepam; in the other cases, we postulate an intrinsic anticonvulsant effect of Ro 15-1788. This investigation would suggest further study of Ro 15-1788 in epileptic patients for clarification of its anticonvulsant properties. In addition, evaluation of its action on the sedation caused by benzodiazepine antiepileptic medication is suggested.

Action Potentials↗