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Biomedical subjects

R C Scott

Publications and source records attributed to R C Scott.

At least 19 recordsLinked to original sources
PubMed2005

Meningitis is a common cause of convulsive status epilepticus with fever.

AIMS: In children with convulsive status epilepticus (CSE) with fever, to determine the likelihood of acute bacterial meningitis (ABM), the proportion that are treated with antibiotics, and the proportion that have diagnostic CSF sampling. METHODS: Patients with an incident episode of CSE with fever were identified as part of an ongoing prospective population based study of CSE in childhood. RESULTS: There were 49 incident cases of CSE in the first six months. Ascertainment was 96%. Twenty four had CSE with fever, 16 had early parenteral antibiotics, nine had diagnostic CSF sampling, and four had ABM. The population risk of ABM in CSE with fever was significantly higher than that of short seizures with fever (17% v 1.2%). CONCLUSIONS: The classical symptoms and signs of ABM may be absent in CSE with fever. A high index of suspicion for ABM in the child with CSE with fever is paramount. The most appropriate management is suggested to be early parenteral antibiotics and a lumbar puncture when there are no contraindications.

Anti-Bacterial Agents↗
PubMed2004

A systematic review of the epidemiology of status epilepticus.

Population-based data on the incidence, aetiology, and mortality associated with status epilepticus (SE) are required to develop preventative strategies for SE. Through a systematic review, we aimed to assess the methodological quality as well as similarities, and differences between available population based studies in order to arrive at conclusions on the epidemiology of SE. All population-based studies where primary outcome was incidence, aetiology or mortality of SE were identified through a systematic search and synthesized. Methodological quality of studies were independently rated by two examiners using a unique scoring system. Seven population-based projects on SE yielding nine published reports and five abstracts were reviewed. Quality scores were in the range of 19-34 with a possible maximum of 40 (kappa scores 0.67-1.0). The incidence of SE has a bimodal distribution with peaks in children aged less than a year and the elderly. Most SE were acute symptomatic. Short-term mortality was 7.6-22% and long-term mortality was 43%. Age and aetiology were the major determinants of mortality. There are few population-based studies on SE but most are of good quality. Most studies are primarily or exclusively based on adult populations. There is limited information on the association of ethnicity and socio-economic status and SE.

Age Distribution↗
PubMed2004

Inappropriate emergency management of status epilepticus in children contributes to need for intensive care.

OBJECTIVES: To characterise the clinical features, emergency pre-paediatric intensive care (PIC) treatment, and course of status epilepticus (SE) in children admitted to PIC. This may provide insight into reasons for admission to PIC and provide a framework for the development of strategies that decrease the requirement for intensive care. DESIGN: Cross sectional, retrospective study. SETTING: A tertiary paediatric institution's intensive care unit. PARTICIPANTS: The admission database and all discharge summaries of each admission to a tertiary paediatric institution's PIC over a three year period were searched for children aged between 29 days and 15 years with a diagnosis of SE or related diagnoses. The case notes of potential cases of SE were systematically reviewed, and clinical and demographic data extracted using a standard data collection form. RESULTS: Most children with SE admitted to PIC are aged less than 5 years, male to female ratio 1:1, and most (77%) will have had no previous episodes of SE. Prolonged febrile convulsions, SE related to central nervous system infection, and SE associated with epilepsy occur in similar proportions. Contrary to the Advanced Paediatric Life Support guidelines many children admitted to PIC for SE receive over two doses, or inadequate doses, of benzodiazepine. There is a risk of respiratory depression following administration of over two doses of benzodiazepine (chi2 = 3.4, p = 0.066). Children with SE admitted to PIC who had prehospital emergency treatment are more likely to receive over two doses of benzodiazepines (chi2 = 11.5, p = 0.001), and to subsequently develop respiratory insufficiency (chi2 = 6.2, p = 0.01). Mortality is low. Further study is required to determine the morbidity associated with SE in childhood requiring intensive care. CONCLUSIONS: As the risk of respiratory depression is greater with more than two doses of benzodiazepines, clinicians should not disregard prehospital treatment of SE. As pre-PIC treatment of SE is inadequate in many cases, appropriate audit and modifications of standard guidelines are required.

Adolescent↗
PubMed2001

Quantitative magnetic resonance characterization of mesial temporal sclerosis in childhood.

OBJECTIVE: To investigate whether quantitative MR techniques can be used to distinguish between mesial temporal sclerosis in patients with a history of prolonged febrile convulsion and in patients without such a history. METHODS: Quantitative hippocampal T2 relaxometry, hippocampal volumetry, and single voxel (1)H-MRS data were acquired from 16 children who subsequently underwent temporal lobe resections for intractable temporal lobe epilepsy and histologically were shown to have sclerosis of the horn of Ammon. Eight children had a history of prolonged febrile convulsion in early childhood and eight children had other or no associations. RESULTS: Patients with a history of prolonged febrile convulsion had smaller hippocampi (p = 0.02) and prolonged T2 relaxation time (p = 0.03) ipsilateral to the seizure focus when compared with patients without such a history. There was also more side-to-side asymmetry of T2 relaxation time (p = 0.004) and hippocampal volume (p = 0.02) in the patients with a history of prolonged febrile convulsion than in those with other or no associations. No differences between the groups were identified using (1)H-MRS. CONCLUSIONS: These data support the view that there are at least two types of mesial temporal sclerosis. There may be several pathogenetic pathways from initial insult to later mesial temporal sclerosis, and these pathways are, at least in part, dependent on the initial insult.

Adult↗
PubMed1999

Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial.

BACKGROUND: Convulsive status epilepticus is the most common neurological medical emergency and has high morbidity and mortality. Early treatment before admission to hospital is best with an effective medication that can be administered safely. We aimed to find out whether there are differences in efficacy and adverse events between buccal administration of liquid midazolam and rectal administration of liquid diazepam in the acute treatment of seizures. METHODS: At a residential school with on-site medical facilities 42 young people with severe epilepsy were enrolled. Continuous seizures of more than 5 min duration were randomly treated with buccal midazolam or rectal diazepam. If the seizure did not stop within 10 min additional medication chosen by the attending physician was administered. We monitored oxygen saturation and blood pressure for 30 min after treatment. The main outcome measures were efficacy, time from arrival of the nurse to drug administration, time from drug administration to end of seizure, and incidence of adverse cardiorespiratory events. FINDINGS: Buccal midazolam was used to treat 40 seizures in 14 students, and rectal diazepam 39 seizures in 14 students. Midazolam stopped 30 (75%) of 40 seizures and diazepam 23 (59%) of 39 (p=0.16). The median time from arrival of the nurse to administration of medication was 2 min. Time from administration to end of seizure did not differ significantly between the two treatments. No clinically important adverse cardiorespiratory events were identified in the two groups. Buccal midazolam was universally acceptable to the nursing and care staff. INTERPRETATION: Buccal midazolam is at least as effective as rectal diazepam in the acute treatment of seizures. Administration via the mouth is more socially acceptable and convenient and may become the preferred treatment for long seizures that occur outside hospital.

Administration, Buccal↗
PubMed1998

Developmental perspectives on epilepsy.

This paper reviews current knowledge about epileptogenesis in the developing brain. Animal studies indicate that the maturational balance of excitatory and inhibitory neurotransmitter systems should result in an increased susceptibility to seizures. However, the reason for specific age-locked syndromes and the high rate of impairments secondary to early onset epilepsy remain mysterious. Present research activity is directed to prevention and amelioration of these severe cognitive and psychiatric impairments.

Aging↗
PubMed1998

Buccal absorption of midazolam: pharmacokinetics and EEG pharmacodynamics.

PURPOSE: To determine whether buccal/sublingual administration of midazolam (MDL) would lead to detectable venous concentrations and EEG changes in 10 healthy volunteers. METHODS: The study consisted of an open-label and a double-blind phases. Subjects held 10 mg MDL in 2 ml peppermint-flavored fluid or peppermint-flavored placebo in their mouth for 5 min and then spat it out. Cardiorespiratory and EEG monitoring was performed in all subjects. RESULTS: Venous MDL concentrations measured on 10 occasions from 5 to 600 min after administration showed a rapid increase for the first 20-30 min. However, changes in the 8- to 30-Hz frequencies identified by spectral analysis of the EEG showed changes in < or = 5-10 min in test but not in control subjects--more rapid than were expected from the venous absorption data. There were no significant adverse effects. CONCLUSIONS: Our data provide direct evidence of the speed of cerebral effect of a drug. Our results suggest that the buccal/sublingual route of administration should be tested in emergency treatment of seizures as an alternative to the rectal route, over which it has clear practical advantages.

Absorption↗
PubMed1995

Automated grading of venous beading.

The degree of venous beading in ocular fundus images has been shown to be a more powerful predictor of conversion to proliferative diabetic retinopathy than any other type of retinal abnormality. Further, the degree of venous beading has been shown to be well correlated with disease progression. An algorithm for automated grading of venous beading in digitized ocular fundus images is described. Thresholding is used to extract a rough silhouette of the vein. Morphological closing is used to fill any holes in the silhouette arising from either the central light reflex or noise. The silhouette is then "thinned" to find vein centerlines. Each centerline is partitioned into fixed-length segments of 32 pixels. Vein diameters are measured as a function of distance along each segment with the aid of the local centerline orientations. The resulting diameter data are then interpolated and resampled to generate diameter data at constant sampling intervals. A fast Fourier transform is performed on the resulting data to determine the magnitude spectrum of vein segment diameter. A venous beading index is calculated from the distribution of vein diameter frequency components. Performance of the new algorithm is compared to the currently accepted clinical practice of manual grading in a pilot clinical study of 51 subjects. The algorithm is seen to perform well.

Algorithms↗
PubMed1995

Lansoprazole in the prophylaxis of acid aspiration during elective surgery.

We have assessed the efficacy of a single dose of lansoprazole in increasing the pH and decreasing the volume of gastric residue at induction of anaesthesia in adult patients undergoing elective orthopaedic surgery. We studied 66 ASAI-II patients, allocated to one of three groups to receive either placebo (group 1), lansoprazole 30 mg (group 2) or lansoprazole 60 mg (group 3), 8-12 h before induction of anaesthesia. Volume and pH of gastric contents were measured after induction of anaesthesia by aspiration via a 16-French gauge gastric tube. Patients who received lansoprazole had a significantly higher pH than the placebo group (P < 0.01) but there was no difference between the two lansoprazole groups. The volume of gastric residue was significantly smaller (P < 0.01) in both lansoprazole groups compared with the placebo group: 28% of those in group 3 had a pH of gastric residue < 2.5 and volume > 25 ml compared with 30% in group 2 and 63% in group 1, respectively.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1994

The predictive accuracy of in vitro measurements for the dermal absorption of a lipophilic penetrant (fluazifop-butyl) through rat and human skin.

The predictive accuracy of in vitro measurements in estimating dermal absorption has been evaluated in rat and human skin using fluazifop-butyl (FB), a lipophilic model compound, at dosage rates of 2.5, 25, and 250 micrograms/cm2. In vitro studies used rat and human epidermal membranes mounted in static diffusion cells with radiolabeled FB and receptor fluids of 50% aqueous ethanol (Aq Et), 6% polyethylene glycol 20 oleyl ether in saline (PEG), or tissue culture medium (TCM). In vivo rat studies with radiolabeled FB were carried out to parallel previously published human volunteer studies. For rat skin, in vitro measurements with all types of receptor fluid provide an adequate prediction (generally within a factor of 3) of in vivo absorption. Absorption data for human epidermal membranes with a receptor fluid of Aq Et were adequately predictive of the in vivo absorption. In contrast, membranes with PEG or TCM significantly underestimated the in vivo absorption. The results support the conclusion that in vitro studies are useful to predict in vivo dermal absorption in rat and man, when appropriate receptor fluids are used.

Animals↗