PubMed Health⌕ Search

Biomedical subjects

H E Booker

Publications and source records attributed to H E Booker.

At least 19 recordsLinked to original sources
PubMed1983

Reenactment of the triggering situation for the diagnosis of epilepsy.

When a fixed set of ambient circumstances is associated with convulsive or nonconvulsive paroxysmal attacks, reenactment of the situation should be considered as a possible shortcut for reaching a diagnosis. Reenactment determined the diagnosis in 30 of 32 patients with paroxysmal disorders. The referral diagnosis was correct in only 13 of the 32 patients. To be appropriately executed, the reenactment should entail polygraphic recording of at least EEG, ECG, and respiration. Vertex electrodes should be included to avoid overlooking of cortical electrodecremental event. If unsuccessful at the first attempt, reenactment should be repeated.

Adolescent↗
PubMed1979

Plasma renin concentration and phenobarbital levels in patients with epilepsy.

Plasma renin activity, renin concentration, and renin substrate were measured in patients on long-term anticonvulsant medication. An inverse correlation was observed between phenobarbital levels and renin activity or concentration. There was a positive correlation between phenobarbital and renin substrate. Since elevation of renin substrate should have resulted in increased renin activity, it is possible that phenobarbital exerts 2 effects on the renin system: induction of renin substrate synthesis and suppression of renin release.

Adolescent↗
PubMed1977

Interference by p-hydroxyphenobarbital in the 125I-radioimmunoassay of serum and urinary phenobarbital.

A radioimmunoassay for barbiturates is shown to be equally sensitive to phenobarbital and its major urinary metabolite, p-hydroxyphenobarbital, in serum and urine. Interference by the metabolite can be essentially eliminated by selectively extracting phenobarbital into chloroform. The extraction efficiency of the method for phenobarbital was 93+/-2% (SD) over the concentration range studied. Although cross reactivity between barbiturates and their metabolites may be less important in determining cases of barbiturates abuse or overdose, it may be extremely important if data on serum or urine are required for accurate estimates of drug disposition, or in establishing dose/response relationships.

Cross Reactions↗
PubMed1975

Idiosyncratic reactions to the antiepileptic drugs.

Idiosyncratic drug reactions can be defined as those adverse drug effects caused by genetically determined enzymatic abnormalities. For the clinician, however, this definition is too limited, and other rare and unusual adverse reactions to the antiepileptic drugs are discussed, including drug interactions, drug allergies, and organ toxicities, as well as true idiosyncrasies. Responsibility for initial recognition and later diagnosis of these reactions falls heavily upon the clinician. In addition to discussing the more common or serious rare reactions, the epidemiology and general mechanisms underlying the reactions are discussed. Treatment involves drug withdrawal, plus general supportive and specific therapy determined by the type and severity of the individual reaction. If primum non nocere should guide the treatment in general, then secundum non plus nocere should guide the treatment of adverse drug reactions.

Anticonvulsants↗
PubMed1975

Enzymatic immunoassay vs. gas/liquid chromatography for determination of phenobarbital and diphenylhydantoin in serum.

The antiepileptic drugs diphenylhydantoin and phenobarbital were measured in serum by a new commercially available enzyme immunoassay procedure ("EMIT," Syva Corp.). The procedure requires less than 5 min and no more than 50 mul of serum per determination. It is simple; only four steps (pipetting and diluting with an automatic pipettor-dilutor) are required before spectrophotometry. Twenty replicate analyses of a serum containing phenobarbital and diphenylhydantoin gave results with a CV of 6.8% and 9.1%, respectively. Results attained in a large series of patients were compared with results by a gas/liquid chromatographic procedure. For phenobarbital r = 0.97, and for diphenylhydantoin r = 0.98. No false negatives or false positives were encountered.

Chromatography, Gas↗
PubMed1975

Management of the difficult patient with complex partial seizures.

Successful treatment of partial complex seizures (and the epilepsies in general) is a process of management over time and involves several factors. It starts with accurate and adequate diagnostic formulations. To this end the physician must be thoroughly familiar with the ictal manifestations of partial complex and other epilepsies as well as the clinical features of other transient but reversible episodes that might present difficulties in differential diagnosis. The diagnosis is based upon the history of a patient experiencing partial complex seizures, and the most important resource is a careful and detailed history of the ictal events and the circumstances under which they occur. Clinical observation and electrophysiologic monitoring of the patient during attacks, either spontaneous or induced, is the most powerful technique available in cases which present difficult diagnostic problems. In addition to recognition and proper classification of the seizures themselves, diagnosis and treatment of the cause of the seizures, particularly when it is an active disease, is of prime importance. Even after accurate diagnosis, the heterogenous nature of the population of patients with partial complex seizures is such that marked variation in response to treatment with antiepileptic drugs is to be anticipated. The use of these drugs must be individualized and based upon a thorough and working knowledge of their clinical pharmacology. The most frequent mistakes in our experience have been prescribing the drugs in too little doses or for too short a time. Less often the problem is overmedication. The best indicator of the effectiveness of the drugs is the clinical response of the individual patient, and in general each drug should be prescribed in increasing doses until either the seizures are controlled or unacceptable degrees of toxicity develop. The use of serum level determinations can be very helpful if not invaluable, particularly in identifying and understanding potential adverse effects of the drugs. Patient noncompliance in adhering to drug schedules is widespread, but usually can be detected by measuring serum levels. Even with the most efficient use of the drugs, however, some patients will be intractable, and elective surgical treatment should be considered. Finally, control of seizure occurrence alone is not necessarily adequate treatment, as many patients will have difficult psychosocial problems associated with their epilepsy. Treatment of such associated problems is necessary on its own merits, but occasionally can result in significant improvement in seizure control.

Adult↗