Biomedical subjects

J DeToledo

Publications and source records attributed to J DeToledo.

7 recordsLinked to original sources

PubMed2001

Fosphenytoin: pharmacokinetics and tolerance of intramuscular loading doses.

PURPOSE: Fosphenytoin (FPHT; Cerebyx) is well absorbed when given intramuscularly (IM). All prior pharmacokinetic studies had the first plasma sample obtained 30 min after IM administration. The objectives of this study were to determine the rate and extent of FPHT absorption and to evaluate the tolerability of IM FPHT compared with IM saline. METHODS: This was an open-label, double-blinded study in which patients received 10 mg/kg dose of IM FPHT in one gluteus and IM saline in the other gluteus. Half the patients received saline injection of equal volume to FPHT (up to 19.5 mL); the other half received 2 mL of saline. Neurologic examination, vital signs, PHT blood samples, injection site examination, and subjective pain scores at injection site were obtained before and at timed intervals for 6 h. RESULTS: Total PHT serum concentrations 10 microg/mL were obtained in 5 min in 14.3% of patients and in 26.3% after 10 min. More than half the patients had therapeutic serum concentrations at 30 min; 45.8% of patients reported no pain at either the FPHT or saline injection site. No significant difference in pain was noted between FPHT and saline injection sites at 60 min and thereafter. Early decrease in blood pressure occurred but was not clinically significant. Classic PHT-induced central nervous system (CNS) side effects were evident in one third of patients within 1 h after injection. CONCLUSIONS: (a) IM FPHT is rapidly absorbed (therapeutic levels achieved as early as 5-20 min). (b) IM FPHT is well tolerated by most patients irrespective of injection volume.

Adolescent↗

PubMed1999

Epilepsy and religious experiences: Voodoo possession.

Epileptic seizures have a historical association with religion, primarily through the concept of spirit possession. Five cases where epileptic seizures were initially attributed to Voodoo spirit possession are presented. The attribution is discussed within the context of the Voodoo belief system.

Adult↗

PubMed1998

Surgical correction of scoliosis in patients with generalized seizures. Risk of vertebral body fracture.

STUDY DESIGN: A retrospective evaluation of the outcome of surgical management of progressive scoliosis in institutionalized patients with frequent, uncontrolled, generalized tonic clonic seizures. OBJECTIVES: To determine the safety and stability of internal fixation devices in patients with progressive scoliosis and intractable seizures. SUMMARY OF BACKGROUND DATA: Progressive scoliosis is a common problem in severely disabled patients. It has been the belief among some spine physicians that the coexistence of intractable seizures with progressive scoliosis is a contraindication for surgery, because most of the thoracic and lumbar spine is fixed and "unyielding" after internal fixations, increasing the risk of vertebral fractures. There have been reports of fracture of fixation devices, particularly Harrington rods, under conditions of massive trauma or mechanical stress, such as seizures. METHODS: The authors reviewed the outcome of six profoundly retarded institutionalized patients with a history of intractable seizures who underwent internal fixation of the spine between 1984 and 1987 because of progressive scoliosis. Seizure types and frequency of convulsion were obtained from the institutional charts. Follow-up radiographs of the spine obtained at 1, 3, and 6 months after the surgery and once a year thereafter were reviewed by the radiologist and orthopedic surgeon with special attention paid to fractures, stability of the fusion, and integrity of the instrumentation. RESULTS: Six patients underwent spinal fusion with internal spinal fixation, four patients with Harrington rods and two with Luque rods. All patients had refractory tonic clonic seizures ranging from 11 to 80 generalized tonic clonic convulsions per year for the 10-year follow-up period after surgery. There were no fractures, subluxation, or pseudoarthrosis of the fused vertebrae or the vertebral bodies adjacent to the fusion. There were no fractures of the instrumentation. CONCLUSIONS: The authors' findings suggest that when appropriate fusion is attained, the use of internal fixation devices is not contraindicated in the management of progressive scoliosis in patients with intractable seizures.

Adolescent↗

PubMed1997

Pharmacokinetics and muscle histopathology of intramuscular valproate.

To determine the safety and pharmacokinetics of parenteral sodium valproate healthy mature greyhound dogs, were given intramuscular injections following intravenous injections. Dosings intravenously and intramuscularly were at 20, 40 and 60 mg/kg in the three groups. Intravenous infusion rates were constant. Sodium valproate solution concentrations of 300, 400 and 500 mg/ml were administered. Intramuscular valproate was quickly absorbed. Bio-availability approached 70%. Half life of 120 min was calculated. Toxic muscle necrosis was observed at all concentrations. Dosing valproate intramuscularly in humans is problematic in view of the muscle damage. Despite tissue damage sodium valproate was well absorbed intramuscularly. The intravenous injection of valproate at high concentrations, large doses and fast infusion rates produced no evidence of cardiotoxicity and levels of 180 micrograms/ml.

Animals↗

PubMed1996

Intravenous administration of fosphenytoin: options for the management of seizures.

Fosphenytoin is a water-soluble disodium phosphate ester of phenytoin that is converted in plasma to phenytoin. Fosphenytoin is compatible with most common i.v. solutions and can be administered safely through the i.m.route. An additional safety factor is the absence of propylene glycol in the fosphenytoin formulation. Propylene glycol is used as a vehicle in the i.v. phenytoin preparation and by itself may produce serious cardiovascular complications. Studies of the pharmacokinetics, safety, and tolerance of i.v. fosphenytoin have demonstrated that fosphenytoin produces phenytoin plasma concentrations similar to those achieved with oral and i.v. phenytoin, but without significant cardiovascular effects and only minimal discomfort at the injection site. Aside from local reactions, the most common adverse events associated with fosphenytoin have been pruritus and reactions typical of phenytoin (e.g., dizziness, somnolence, and ataxia). Fosphenytoin represents a significant advance in the treatment of patients with seizures who require parenteral therapy.

Anticonvulsants↗

PubMed1993

Ocular dysfunction during the amytal suppression test.

We assessed the following parameters of visual function in 16 patients during amytal suppression test (AST): pupillary light response, consensual reflex, pupillary symmetry, monocular reading and monocular visual recognition. Significant visual impairment in the eye ipsilateral to injection (EII) occurred in 7 of 16 patients ranging from blurring to complete, transient loss of vision. We conclude that visual dysfunction of the EII during the AST is common and represents an important component of the test. Intracarotid amytal reaches the EII via ophthalmic artery and probably impairs vision in the EII due to cycloplegia, iridoplegia and retinal suppression.

Amobarbital↗

PubMedDate not supplied

Tonic-clonic seizures: a systematic review of antiepilepsy drug efficacy and safety.

This systematic review of studies of patients with generalized tonic-clonic seizures is an effort to evaluate whether one therapeutic agent is superior to another in terms of reducing seizures and tolerability. Recognizing that assessing relative efficacy is dependent on controlling the specific type of seizure or epilepsy treated, we restricted our review to studies in which the seizure types were clearly identified. Overall, complete control of generalized tonic-clonic seizures was achieved in 53% of treated patients. The percentage of patients who became seizure free was not significantly different with carbamazepine, phenytoin, or valproate. When patients who had a partial onset of their generalized tonic-clonic seizures were grouped, complete control was achieved in 48% with carbamazepine, 49% with phenytoin, and 52% with valproate. Overall, carbamazepine, phenytoin, and valproate appear to have similar efficacy in the treatment of tonic-clonic seizures, with complete control reported in 51%, 50%, and 55% of patients, respectively. The best response in primary generalized seizures was with valproate, with 61% reported as seizure free. Acute and dose-related central nervous system side effects occurred with equal frequency with carbamazepine, phenytoin, and valproate treatment. These side effects diminished after chronic exposure. Overall, 9.9% of patients discontinued treatment due to adverse effects. The lowest incidences of clinically important side effects and rash were reported in patients treated with valproate.

Anticonvulsants↗