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Biomedical subjects

J Bruni

Publications and source records attributed to J Bruni.

At least 19 recordsLinked to original sources
PubMed1998

Efficacy of topiramate.

In controlled clinical trials, topiramate (Topamax) has demonstrated efficacy in refractory patients with complex partial seizures and secondarily generalized tonic-clonic seizures. Approximately 45 percent of 534 patients had a > or = 50 percent reduction in seizure frequency. Limited open label trials have shown that topiramate has broad spectrum activity and may be effective in patients with primary generalized epilepsies. The efficacy of topiramate compares very favourably with the efficacy of other new antiepileptic drugs recently introduced.

Anticonvulsants↗
PubMed1998

Women's issues in the treatment of epilepsy.

BACKGROUND: The management of women with epilepsy involves a number of important issues including conception control, sexual dysfunction and fertility, the effect of seizures on the fetus, possible changes in seizures frequency during pregnancy, potential teratogenic effects of antiepileptic drugs and management issues during pregnancy. The primary goal in the treatment of women with epilepsy remains optimal seizure control in the absence of unacceptable adverse effects. The advantages and disadvantages of the new antiepileptic drugs in women remain to be fully established but these new agents allow a wider choice for improved seizure control.

Abnormalities, Drug-Induced↗
PubMed1998

Outcome evaluation of gabapentin as add-on therapy for partial seizures. "NEON" Study Investigators Group. Neurontin Evaluation of Outcomes in Neurological Practice.

OBJECTIVE: The safety, tolerability, efficacy, and impact on quality of life of gabapentin (Neurontin) as adjunctive therapy to carbamazepine (CBZ) and/or phenytoin (PHT) was assessed in epileptic patients with partial seizures. METHODS: NEON (Neurontin Evaluation of Outcomes in Neurological Practice) was an open-label, prospective, multicentre study conducted in patients on a stable dose of CBZ and/or PHT and experiencing an average of up to 4 complex partial seizures with or without secondary generalization per month, with no seizure-free months. The treatment lasted 20 weeks. Gabapentin was started at 400 mg/day and was individually titrated to effective tolerable dose up to 2400 mg/day. Quality of life was evaluated using the QOLIE-10 questionnaire. RESULTS: A total of 141 patients were enrolled at 36 sites; 114 patients were evaluable for efficacy analyses. The mean maintenance dose of gabapentin was 1600 mg/day (range = 300-3200). A decrease of 50% or more in frequency of complex partial + secondary generalized seizures was observed in 81 (71%) patients (p = 0.0001). Fifty two (46%) patients were seizure-free during the last 8 weeks of treatment. A significant improvement (p < 0.05) was observed in 5 of the 10 questions of the QOLIE-10, as well as in the composite QOL score (p = 0.0002). The most frequent adverse events included somnolence (16%), dizziness (9%), and asthenia (6%). Twenty-five (18%) patients prematurely discontinued the study, 16 (11%) of them due to adverse events. CONCLUSIONS: This study indicates that treatment with gabapentin as adjunctive therapy to standard antiepileptic drugs in this group of patients not only provides significant improvement in seizure control, but also has a positive impact on quality of life. The clinical benefits in efficacy, safety and tolerability demonstrated at 20 weeks are sustained, and no tolerance develops with gabapentin in longer term use.

Acetates↗
PubMed1996

Heightened interference on implicit, but not explicit, tests of negative transfer: evidence from patients with unilateral temporal lobe lesions and normal old people.

The present research investigated alternative explanations of heightened interference in AB-AC learning in individuals with memory loss related to medial temporal lobe dysfunction. In Experiment 1, patients with left or right temporal lobectomy and control subjects were administered the standard AB-AC test. Relative to the other groups, left temporal patients exhibited significant negative transfer that was characterized by large numbers of response intrusion errors. In Experiment 2, groups of community-dwelling old and young adults were administered the standard test and an implicit version in which, during AC testing, subjects were instructed to provide the first word that comes to mind in response to stimulus words. There were no differences between groups on either version. Of particular interest was that both groups made significantly more intrusion errors on the implicit test and did not differ on this measure. It was concluded that exaggerated interference in AB-AC learning, as reflected by response intrusion errors, is related to the use of implicit memory processes rather than a failure of inhibitory mechanisms. Memory-impaired individuals, who have a selective loss of explicit memory, are vulnerable on this task because they rely excessively on implicit memory processes.

Adolescent↗
PubMed1996

Gabapentin.

Gabapentin is a novel antiepileptic drug that has recently been introduced in Canada. Although its mechanism of action remains to be defined gabapentin is effective in a number of seizure models which predict its efficacy in partial and tonic-clonic seizures. Clinical studies support the clinical efficacy of gabapentin as adjunctive therapy in adults with epilepsy with partial and secondarily generalized tonic-clonic seizures. Gabapentin has a favorable pharmacokinetic profile and is generally well tolerated. More clinical data are required on the role of gabapentin in children and additional monotherapy experience is required before the role of gabapentin in the overall treatment of epilepsy can be better defined.

Acetates↗
PubMed1994

Antiepileptic drug selection and adverse effects: an overview.

In choosing an antiepileptic drug, not only efficacy but also potential adverse effects have to be considered. Adverse effects that have to be taken into account include acute and chronic systemic toxicity, cognitive side effects, and teratogenesis. Acute toxicity may be dose-related, allergic or an idiosyncratic reaction. Chronic toxicity may involve the nervous system or other organs. In determining the role of new antiepileptic drugs such as lamotrigine, vigabatrin, felbamate, and gabapentin a proper evaluation of both efficacy and adverse effects is required.

Anticonvulsants↗
PubMed1991

A comparison of the efficacy and tolerability of controlled-release carbamazepine with conventional carbamazepine.

We compared the efficacy and tolerability of controlled-release carbamazepine (CBZ-CR) with conventional carbamazepine (CBZ) in 131 epileptic patients (both men and women, ages 6-65 years) in an open, multicentre, cross-over trial. Patients entered into the trial were previously on CBZ monotherapy or polytherapy. During the first 4 weeks, patients were treated with equivalent daily doses of CBZ and then switched to CBZ-CR for the subsequent 4 weeks. The majority of patients were switched to the more convenient b.i.d. dosing schedule of the controlled-release (CR) preparation without a detrimental effect on seizure frequency or adverse effects. In 44/131 (34%) of patients, the switch to CBZ-CR was accompanied by an improvement in tolerability, primarily due to a reduction in peak-dependent CNS side-effects such as tiredness, double or blurred vision, dizziness and ataxia. At the end of the study, investigators preferred CBZ-CR for 76% of their patients and 70% of the patients preferred CBZ-CR.

Adolescent↗
PubMed1988

Decreased platelet 3H-imipramine binding in Down's syndrome.

Platelet 3H-imipramine binding in 12 subjects with Down's syndrome showed a significantly lower maximal number of binding sites (Bmax) as compared to both unrelated normal and parental controls. No difference in the affinity constant (Kd) was observed. The results support the value of the platelet 3H-imipramine binding assay in the investigation of defects in serotonin metabolism in humans.

Adolescent↗
PubMed1986

Repetitive pseudoseizures incorrectly managed as status epilepticus.

Pseudoseizures should be considered in the differential diagnosis of intractable seizures. Incorrect diagnosis may result in incorrect management, with the patient unnecessarily exposed to side effects of drugs. The authors report on three patients who presented with uncontrolled seizures originally diagnosed and managed as status epilepticus. Electroencephalography performed during provoked attacks led to a diagnosis of pseudoseizures. Psychiatric assessment revealed psychologic disorders. The patients received supportive therapy, and the pseudoseizures stopped.

Adult↗
PubMed1985

Reduction of polypharmacy in epileptic patients.

An attempt was made to reduce polypharmacy in 90 epileptic patients. All patients received their original drug regimen for at least six months and were followed up for a minimum of 16 months after reduction of polypharmacy. In 72 patients (80%), the average number of drugs administered was reduced from 2.75 to 1.49. In 39 of these (54%), a reduction was made to single drug therapy. Either no change or an improvement in seizure control was observed, and side effects decreased in many patients. In 18 patients (20%), medications could not be withdrawn. In nine of these, another drug was required for seizure control. In the remaining nine, more frequent seizures necessitated a return to the previous regimen. The critical variable predicting unsuccessful reduction of polypharmacy was the presence of multiple concurrent seizure types.

Adult↗
PubMed1985

Valproic acid disposition in rabbits during chronic treatment with Escherichia coli endotoxin.

The disposition of valproic acid (VPA) in rabbits was studied after chronic treatment with Escherichia coli endotoxin. Endotoxin (1-2 micrograms/kg) was administered daily to 10 male New Zealand white rabbits for 5 days. On day 5, 50 mg/kg of VPA was given iv during the time of the peak febrile response. Blood samples were drawn at appropriate time intervals and analyzed for free and total VPA levels as well as plasma proteins and free fatty acids. The data were compared with similar control experiments performed 2 weeks before and after endotoxin treatment. Pharmacokinetic analysis indicated that the changes in free VPA clearance after endotoxin were related to the change in the febrile response during chronic treatment (r = 0.77; p less than 0.05); that is, animals which developed tolerance to the febrile response showed elevated drug clearance, whereas nontolerant animals showed decreased clearance of VPA.

Animals↗
PubMed1984

Pharmacokinetic interactions of antiepileptic drugs.

The problem of antiepileptic drug interactions is significant in that many epileptic patients are treated with multiple drug therapy. Moreover, patients may also be receiving additional medication for other concurrent disorders. Most drug interactions are pharmacokinetic, involving changes in absorption, protein binding, metabolism, or excretion. As a result, plasma levels of the antiepileptic drug may decrease leading to exacerbation of seizures. Alternatively, plasma levels may rise resulting in toxic side effects. Similar changes may also occur with drugs given for other disorders. In this paper, possible mechanisms of drug interactions are discussed. This is followed by a description of clinically significant interactions involving phenytoin, carbamazepine, barbiturates, valproic acid, benzodiazepines, and succinimides. Potentially serious drug interactions may be minimized by using as few medications as possible and by regularly monitoring plasma levels of antiepileptic drugs.

Animals↗
PubMed1984

Pharmacokinetics of enteric-coated valproic acid.

Five adult epileptic patients received 1,000 mg of valproic acid (Depakene) in both the regular and the enteric-coated form. Serum valproic acid levels were determined at suitable intervals after drug administration. Pharmacokinetic parameters were equivalent for both preparations except for an absorption lag with the enteric-coated form. The relative bioavailability of the two compounds was similar across the group of patients, although there were marked differences between individual subjects. Close supervision of valproic acid serum levels is suggested after a change in drug formulation.

Adult↗
PubMed1984

Effects of carbamazepine and its epoxide metabolite on amygdala-kindled seizures in rats.

Fourteen animals with stable generalized kindled seizures received three doses of carbamazepine and its epoxide (12.5 to 50 mg/kg IP) in a crossover design. Both compounds suppressed the secondarily generalized convulsion but only affected the partial seizure from the amygdala to a limited extent. The parent drug and the metabolite were equipotent against both seizure types. The results confirm the belief that carbamazepine epoxide has anticonvulsant properties and suggest that it may exert a major therapeutic effect in humans.

Amygdala↗
PubMed1984

Neurological manifestations in systemic sclerosis (scleroderma).

One hundred and twenty-five patients with systemic sclerosis were surveyed for neurological manifestations in a prospective study. Seven (5.6%) were found to have a defined neurologic lesion: 4 with carpal tunnel syndrome and one each with trigeminal neuralgia, mononeuritis multiplex and peripheral neuropathy. Neurological involvement occurs but is uncommon in this connective tissue disorder.

Adult↗
PubMed1983

Treatment of status epilepticus in adults.

Status epilepticus is a medical emergency requiring immediate treatment. General treatment is aimed at restoring physiologic homeostasis, and drug therapy is aimed at arresting the convulsive activity and preventing its recurrence. Concurrent administration of diazepam and either phenytoin or phenobarbital will be effective in most cases. After the status epilepticus has been treated the underlying cause should be investigated and, if possible, treated.

Acid-Base Equilibrium↗