Biomedical subjects
Publications and source records attributed to M Ronthal.
Ten Caucasian patients with perhexiline maleate neurotoxicosis and weight loss are presented. Weight loss preceded symptomatic neuropathy which was detected on electromyography in one patient. Weight loss and neuropathy may be marked, but clinical improvement follows drug withdrawal.
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Early experience with sodium valproate in the treatment of 20 patients with uncontrolled chronic epilepsy is described. It proved to be rapidly and markedly efficient in most of those patients with generalised types of epilepsy and spike-wave abnormalities in the electroencephalogram. In the treatment of focal epilepsies it was relatively unsuccessful. Although it is a little early to assess its full potential, this preparation is the most interesting and useful anticonvulsant to appear in recent times, and may become the drug of choice in the control of petit mal types of generalised epilepsy.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Reproductive and sexual dysfunction in men with epilepsy has been attributed to androgen deficiency. Low serum free testosterone (FT) levels occur in both hypogonadotropic and hypergonadotropic hypogonadism. Antiepileptic drugs (AEDs) have been implicated. Proposed mechanisms include induction of increased sex hormone binding globulin (SHBG) resulting in decreased FT, as well as dysfunction or premature aging of the hypothalamopituitary-gonadal axis. In an investigation comparing serum reproductive steroid levels among 20 men receiving phenytoin (PHT) monotherapy for complex partial seizures, 21 untreated men with complex partial seizures, and 20 age-matched normal controls, total estradiol levels were significantly higher in the PHT group (56.3 +/- 29.4 pg/ml, mean +/- SD) than in the untreated (32.4 +/- 27.4 pg/ml, p less than 0.01) and normal control (34.3 +/- 12.7 pg/ml, p less than 0.05) groups. The physiologically active non-SHBG-bound serum estradiol levels were also significantly higher in the medicated group (45.1 +/- 21.7 pg/ml) than in the untreated (29.9 +/- 17.2 pg/ml, p less than 0.01) and normal control (31.1 +/- 11.4 pg/ml, p = 0.05) groups. These findings suggest that PHT may lower FT by induction of aromatase, enhancing FT conversion to estradiol, as well as SHBG synthetase. Estradiol exerts a potent inhibitory influence on luteinizing hormone secretion and has been suggested to play a major role in negative feedback in men as well as women. Suppression of LH secretion results in hypogonadotropic hypogonadism. Chronically low FT leads to testicular failure and hypergonadotropic hypogonadism. Finally, estradiol has been shown to produce premature aging of the hypothalamic arcuate nucleus, which secretes gonadotropin-releasing hormone.