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Biomedical subjects

Leif Gjerstad

Publications and source records attributed to Leif Gjerstad.

7 recordsLinked to original sources
PubMed2003

[Treating epilepsy].

Epilepsy is not one single disease but a major symptom in a wide variety of brain disorders, hence better referred to as the epilepsies. Treating epilepsy requires expert knowledge about the disorders themselves and the various treatment options. The basis for optimal treatment is a correct diagnosis of the patient's type epilepsy and identification of seizure-provoking factors. The need for chronic drug treatment must be weighted against possible side effects. Several different drugs may be effective for a given type of seizure or epilepsy but drug effectiveness must be considered in relation to interactions and possible adverse effects. Even with optimal drug treatment, only about two thirds of patients achieve complete seizure control. In selected cases surgical treatment is very effective and should be considered in all patients who do not achieve seizure control within two years after having tried relevant antiepileptic drugs in optimal concentrations.

Adult↗
PubMed2003

[Women and epilepsy].

Women with epilepsy have several gender-specific problems, first of all related to pregnancy and childbirth. They do, however, also meet with several other, less well-recognised specific problems. Many women have a marked change in seizure frequency in relation to their menstrual cycle, and menstrual disorders and polycystic ovaries induced by the use of antiepileptic drugs (AEDs), or by the condition itself, are more frequent in women with epilepsy. Cosmetic side effects of AEDs including weight gain, hair loss and skin problems can significantly reduce compliance in drug treatment and thus affect seizure frequency. Enzyme-inducing AEDs reduce the effectiveness of oral contraceptives and may lead to unplanned pregnancies. A higher incidence of sexual problems in women with epilepsy has also been reported. In menopause, the seizure frequency may change in parallel with the endocrine changes and some AEDs may facilitate the development of osteoporosis. Better understanding and awareness of these problems among patients and health care professionals can relieve many of the gender-specific problems in women. The goal is to tailor the treatment to the needs of the individual woman.

Anticonvulsants↗
PubMed2003

[Pregnancy and birth in women with epilepsy].

More than 90 % of all women with epilepsy who take antiepileptic drugs (AEDs) will undergo normal pregnancies and give birth to children free of birth defects, though mothers on AEDs have two to three times higher incidence of malformations. Uncertainty exists regarding which AEDs are the most teratogenic. Valproate and carbamazepine have been associated with neural tube defects and phenytoin with cleft lip/palate and heart and urogenital defects. All women taking valproate and carbamazepine are advised to take 4 mg/day of folic acid at least one month before pregnancy and during the first trimester. Other women with epilepsy in fertile age are recommended to take 0.4 mg/day. Vitamin K 10 mg/day should be given the last 4 weeks to women on liver enzyme-inducing AEDs. During pregnancy, ultrasound should be performed around weeks 12 and 17. Amniocentesis for a-fetoprotein should be offered at week 15 to women using valproate and carbamazepine. Most women with epilepsy do not experience any change in seizure frequency during pregnancy and have normal vaginal deliveries. Use of monotherapy, lowest effective dose and retard formulations of AEDs, are advised during pregnancy. A seizure during labour is very rare, seen in 1-2 % of cases. Breast-feeding is encouraged for most AEDs, although barbiturates and benzodiazepines may have sedative effects on the infant. Pregnancy is generally safe in women with epilepsy, but preconception counselling and close collaboration during the pregnancy between the gynaecologist and the neurologist is warranted.

Abnormalities, Drug-Induced↗
PubMed2003

[What is epilepsy?].

Explore the source record for details and available documents.

Diagnosis, Differential↗
PubMed2002

Psychiatric comorbidity and hostility in patients with psychogenic nonepileptic seizures compared with somatoform disorders and healthy controls.

PURPOSE: To investigate the prevalence of psychiatric comorbidity and level of anxiety, depression, and aggression in patients with psychogenic nonepileptic seizures compared with those in patients with somatoform disorders and healthy controls. METHODS: Twenty-three patients with psychogenic nonepileptic seizures (PNESs) and 23 age- and sex-matched patients with somatoform disorders (SDs) underwent a clinical and a semistructured psychiatric interview (MINI) and filled in the Hospital Anxiety and Depression scale (HAD) and the Aggression Questionnaire (AQ). Twenty-three sex- and age-matched controls without psychopathology also underwent a clinical interview and completed the HAD and AQ. RESULTS: PNES reported more minor head injuries in the past than did the two comparison groups, and more unspecific EEG dysrhythmias were observed on EEG. Twenty-one PNES patients and 18 with SDs had comorbid psychiatric diagnoses. However, the mean number of comorbid psychiatric diagnoses was higher in the PNES group (1.9 +/- 0.3 compared with 1.5 +/- 0.5 in the SD group; p = 0.003). Ten PNES patients additionally had a somatoform pain disorder, and seven had an undifferentiated somatoform disorder. Both patient groups reported significantly higher levels of anxiety, depression, and anger than did the healthy controls, but the PNES patients had significantly higher level of hostility than both comparison groups. CONCLUSIONS: Increased psychiatric comorbidity is known to be associated with poorer response to regular interventions, and hostility is associated with more hostile coping patterns, often interfering with treatment compliance. Thus the increased prevalence of soft neurologic signs and comorbid psychiatric disorders and increased hostility as well in the PNES group, emphasizes that assessment and treatment of patients with PNES referred to a tertiary center requires an integrated approach involving both neurologic and psychiatric resources.

Adult↗
PubMedDate not supplied

Effects of chronic valproate treatment on reproductive endocrine hormones in female and male Wistar rats.

Valproate (VPA) has been claimed to induce endocrine disorders in both sexes in humans. There is sparse information regarding the mechanisms behind these disturbances. By using an animal model, we wanted to study the effect of valproate on hormonal function in non-epileptic rats. Female rats were given 0 (vehicle control, n=15), 200mg/kg (n=15), or 300 mg/kg (n=20) valproate twice daily by gavage for 90 days, resulting in mean valproate concentrations within the therapeutic range 4-6h after the last dose given. Serum testosterone concentrations remained unchanged, while estradiol levels were significantly reduced in both treatment groups, leading to significantly increased testosterone/estradiol ratios. Follicle stimulating hormone (FSH) levels remained unaltered in valproate treated rats, whereas the luteinizing hormone (LH) concentrations were reduced at the lowest valproate dose. Male rats received 0 (vehicle control, n=15), 200mg/kg (n=15), or 400mg/kg (n=20) valproate twice daily by gavage for 90 days, resulting in mean valproate concentrations within the therapeutic range 4-6h after the last dose. Serum testosterone levels were not significantly changed, but there was a highly significant increase in FSH and LH concentrations at the high dose. In conclusion, the study demonstrates a drug-induced effect of valproate on endocrine function in both male and female rats. The results indicate that the drug exerts its effect primarily at the gonadal level, although a centrally mediated effect cannot be ruled out.

Administration, Oral↗