The newer antiepileptic drugs: carbamazepine and valproic acid.
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Anticonvulsants↗
Biomedical subjects
M Mikati
Publications and source records attributed to M Mikati.
Bilateral total corneal and conjunctival choristomas associated with epidermal nevus.
A 4-year-old boy had been noted from birth to have bilateral masses obscuring the entire outer portion of the eyes. Systemic findings included mild growth retardation, multiple cortical lesions of the distal metaphyseal ends of the lower extremities, and diffuse skin pigmentation of the right side of the body. The epibulbar lesions were excised; on the right side, there was a thin cornea that necessitated corneal transplantation. The diagnosis of composite epibulbar choristomas associated with linear epidermal nevus was established by pathologic examination. This case report as well as a literature review establish the association of epibulbar choristomas with cutaneous linear nevi of the epidermal and sebaceous types.
Biopsy↗
Approach to epilepsy in children.
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Anticonvulsants↗
Rheumatic fever in children: a 15-year experience in a developing country.
Clinical data from 91 patients with rheumatic fever (RF), who were hospitalized at a tertiary hospital in Lebanon between 1980 and 1995, were reviewed retrospectively. Age on hospitalization was 11.1+/-2.9 years (mean +/- SD, range 3-17 years). Nineteen patients were <6 years of age. Manifestations included carditis (93%), arthritis (39%), Sydenham's chorea (2%), erythema marginatum (4%), subcutaneous nodules (1%), fever (62%), arthralgia (55%), and acute congestive heart failure (CHF) on initial presentation (44%). Pericardial effusion occurred in 11%. There was positive family history of RF in 14%. Mitral insufficiency and aortic insufficiency occurred in 67 and 35%, respectively. Both mitral and aortic valves were involved in 30% of cases. Tricuspid insufficiency developed in 3% and pulmonary insufficiency in 1%. Mitral stenosis developed in 19%. Twenty-eight patients underwent surgical intervention: mitral valve repair and commissurotomy in 9/91 (10%), mitral valve replacement in 18/91 (20%), and aortic valve replacement in 9/91 (10%). Overall mortality was 12%: 5 following surgical intervention (3 after mitral valve surgery and 2 after mitral and aortic valve surgery). All patients that died had CHF on initial presentation (p = 0.006). This study includes hospitalized patients with predominant rheumatic heart disease. Initial presentation with CHF is a risk factor for surgical intervention and mortality. A significant high surgical intervention rate is noted that is probably related to the nature of the selected group studied. This study emphasizes the significant morbidity and death in patients with RF and carditis.
Acute Disease↗
Correlation of 99mTc-HMPAO SPECT with EEG monitoring: prognostic value for outcome of epilepsy surgery in children.
Sixteen children who had focal cortical resections for medically intractable epilepsy were preoperatively evaluated with 99mtechnetium-labelled hexamethylpropyleneamineoxime single photon emission computed tomography (99mTc-HMPAO SPECT). Video-EEG monitoring was performed in all patients. Outcome was assessed according to the criteria of Engel et al. [1], at a mean follow up length of 13.4 +/- 8.7 months, in all patients. Interictal SPECT showed appropriate localization in 11/15 cases, of whom nine had a class 1 outcome and two had class 2 and 4 outcomes. Interictal SPECT did not correlate with ictal EEG in 4/15 patients, of whom two had a class 1 outcome, and two had class 3 and 4 outcomes. Two postictal studies obtained in group I showed good correlation with the area of ictal EEG onset, and both patients had a class 1 outcome. Interictal HMPAO SPECT imaging, when positively correlated with the ictal EEG focus or with the site of surgery determined by other means, may have prognostic value for outcome of cortical resections for epilepsy in children. The use of ictal and post-ictal studies shows promise for further improving prognostic information in this population.
Adolescent↗
Double-blind randomized study comparing brand-name and generic phenytoin monotherapy.
Ten patients with well-controlled seizures receiving chronic phenytoin (PHT) monotherapy for seizure prophylaxis completed a randomized double-blind crossover study comparing brand-name and generic PHT. Each patient received the same dose of each preparation for 3 months during which trough PHT concentrations and adverse effects were monitored. The average predose steady-state total PHT concentration was 11.9 +/- 4.9 micrograms/ml during brand-name therapy and 14.2 +/- 8.2 micrograms/ml during generic therapy. The average predose steady-state free PHT concentrations were 0.93 +/- 0.47 micrograms/ml (brand name) and 1.14 +/- 0.64 micrograms/ml (generic), respectively (p less than 0.005). The potency (capsule content) values for the lots used in the study were 99.2% for the brand-name and 104.6% for generic. Because of the nonlinear Michaelis-Menten kinetics of PHT, a 5.4% difference in potency could account for the observed differences in plasma concentrations. When compared with brand-name PHT therapy, the generic drug was associated with an increase in serum concentration. This increase was consistent with the reported difference in capsule content between the generic and brand-name lots used in this study.
Administration, Oral↗
Facilitation of infantile spasms by partial seizures.
We report 16 patients with infantile spasms in whom onset of the clusters of spasms appeared to be triggered by close temporal association with partial seizures. Common features included the presence of focal cerebral lesions in 12 infants (3 were classifiable as cryptogenic); all had partial seizures with EEG localization, clusters of bilateral spasms always preceded by partial seizures, and response to adrenocorticotropic hormone (ACTH) and traditional antiepileptic drugs (AEDs) generally was poor. Three had complete agenesis of the corpus callosum, which argues against interhemispheric callosal spread of focal discharges resulting in the generalized spasms. Surgical cortical resections were performed in 6 of the infants, with good outcomes. This group of patients supports a model in which the spasms, although probably generated at a subcortical level, are facilitated or possibly induced by focal discharges from cortical pathology.
Agenesis of Corpus Callosum↗
Neuroprotective effect of felbamate after kainic acid-induced status epilepticus.
Felbamate (FBM), a newly developed antiepileptic drug (AED), was previously shown to offer some neuroprotective effects against hypoxic injury in both in vivo and in vitro studies. We administered FBM (100 or 300 mg/kg) to 30-day-old rats 1 h after they received a convulsant dosage of kainic acid (KA). Animals were then tested at age 80 days in the water maze, open field, and handling tests. Seizure latency was then tested by flurothyl inhalation. Animals that received 300 mg/kg FBM performed better in all three tests and had longer latencies to flurothyl-induced seizures than did animals that received vehicle. This study suggests that FBM may have some neuroprotective effects after KA-induced status epilepticus (SE).
Animals↗