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Biomedical subjects

R E Strandjord

Publications and source records attributed to R E Strandjord.

At least 19 recordsLinked to original sources
PubMed2002

Homocysteine, malondialdehyde and endothelial markers in dialysis patients during low-dose folinic acid therapy.

OBJECTIVES: Haemodialysis patients have elevated levels of the atherogenic amino acid homocysteine. We wanted to assess the effects of small doses of intravenous folinic acid (the active form of folic acid) on some biochemical risk factors of cardiovascular disease. DESIGN: Longitudinal and open intervention study. SETTING: Two dialysis units in the County of Rogaland. SUBJECTS: All patients on maintenance haemodialysis were invited, and 32 of 35 patients gave their informed consent. INTERVENTIONS: After each dialysis session, the patients were given 1.0 mg of folinic acid intravenously thrice a week for a period of 3 months. Prior to and during the study, all patients were on maintenance supplementation with small doses of vitamins B1, B2, B3, B5, B6 and B12. MAIN OUTCOME MEASURES: Changes in the levels of (i) plasma total homocysteine (p-tHcy) and folate, (ii) circulating endothelium related proteins--markers of endothelial activation and (iii) serum malondialdehyde (S-MDA)--a marker of oxidative stress and lipid peroxidation. RESULTS: The p-tHcy levels were reduced by 37% (P < 0.0001), whilst the serum and erythrocyte folate levels increased by 95 and 104%, respectively (P < 0.0001 for both). The circulating levels of endothelium related cellular adhesion molecules and haemostatic factors remained high and unchanged, except the thrombomodulin (TM) levels increased (P = 0.0004). The high levels of S-MDA were reduced by 26% (P = 0.003). CONCLUSIONS: Low doses of folinic acid given intravenously to dialysis patients reduced their levels of p-tHcy and S-MDA and thus improved their cardiovascular risk profile. The concurrent increment in TM levels was unexpected and of unknown clinical significance.

Creatinine↗
PubMed2001

Antiepileptic drugs as independent predictors of plasma total homocysteine levels.

Low folate levels have consistently been reported in patients with epilepsy on phenytoin (PHT), phenobarbital (PB) and primidone (PRD), while data on valproate (VPA) are conflicting. Furthermore, antiepileptic drugs (AEDs) may be associated with high levels of plasma total homocysteine (p-tHcy). Therefore, we have investigated the levels of p-tHcy, serum folate (S-FA) and erythrocyte folate (E-FA) in patients on PHT, PB and PRD (Group 1, n=21) and VPA (Group 2, n=24). Both groups had their own matched controls. Blood samples were drawn fasting and 6 h post methionine loading (6 h-PML). The Group 1 patients had fasting and 6 h-PML p-tHcy levels significantly higher than their controls (P=0.05 and <0.0001, respectively), and patients without dietary multivitamin supplementation (n=14), had lower fasting S-FA and E-FA levels than their controls (P=0.02 and 0.0003, respectively). The Group 2 patients had fasting and 6 h-PML levels of p-tHcy, S-FA and E-FA not different from their controls. In a multiple stepwise regression model comprising all subjects (n=90), the AEDs of Group 1 and the S-FA levels were independent predictors of p-tHcy levels. Thus, PHT, PB and PRD are associated with high p-tHcy and low folate levels, whereas VPA does not influence S-FA, E-FA and p-tHcy levels in adult patients.

Adult↗
PubMed2001

Folate, homocysteine and methionine loading in patients on carbamazepine.

OBJECTIVES: Some antiepileptic drugs (AEDs) are associated with low levels of serum (S-FA) and erythrocyte folate (E-FA) and high levels of plasma total homocysteine (p-tHcy). We have explored the concentrations of S-FA, E-FA and p-tHcy in patients on carbamazepine (CBZ). The methionine loading test was applied for better assessment of mildly impaired homocysteine metabolism. MATERIAL AND METHODS: The study comprised 42 adult patients on CBZ and 42 matched healthy controls. Blood samples were drawn prior to and 6 h post methionine loading (6 h-PML) (0.1 g/kg body weight). RESULTS: The patients on CBZ had significantly lower concentrations of fasting S-FA and E-FA than the controls (P=0.0004, P=0.003, respectively). Fasting and 6 h-PML p-tHcy concentrations were significantly higher in the patients than in the controls (P=0.03 and P=0.0001, respectively). The methionine loading test identified additional patients with hyperhomocysteinemia undetected by fasting p-tHcy. CONCLUSION: CBZ therapy may be associated with low folate and high p-tHcy levels.

Adolescent↗
PubMed2000

Homocysteine concentrations and methionine loading in patients on antiepileptic drugs.

OBJECTIVES: A few reports have shown elevated fasting total plasma homocysteine (tHcy) in patients taking antiepileptic drugs (AEDs). In this study we determined the influence of AEDs on plasma tHcy levels prior to and following methionine loading. MATERIAL AND METHODS: Thirty-four patients on different AEDs and 34 matched controls were recruited. Blood samples were drawn prior to and 6 h post-methionine loading (6h-PML). RESULTS: The patients on AEDs inducing the cytochrome P450 (carbamazepine, phenytoin, phenobarbital, primidone), had higher fasting and 6h-PML plasma tHcy concentrations than the controls (P = 0.01 and P<0.001). Patients on AED inhibiting the cytochrome P450 (valproate [VPA]), had lower 6h-PML p-tHcy concentrations than controls (P = 0.01). CONCLUSIONS: Our data indicate that not only fasting but also 6h-PML tHcy levels should be determined in order to identify hyperhomocysteinemia among patients on AEDs. Inducer AEDs seem to have an opposite effect than the inhibitor VPA on plasma tHcy, erythrocyte folate and serum folate levels.

Adult↗
PubMed1999

The postpolio syndrome--a critical comment to the diagnosis.

OBJECTIVES: The postpolio syndrome (PPS) is said to comprise symptoms which are characteristic of a specific disorder affecting former polio sufferers many years after their acute disease. Localized muscular weakening with or without attendant pain and atrophy are claimed to separate patients with PPS from persons with unspecific common symptoms from the musculoskeletal system. Therefore our objective was to evaluate the specificity of the symptoms of the PPS. MATERIAL AND METHODS: Eighty-one former polio sufferers were, based on clinical examination and a questionnaire, compared with 116 gender and age matched controls. RESULTS: Significant differences between patients and controls of self-reported muscular weakening and pain in different locations were found. However, the level of similar complaints reported by the controls also was considerable. CONCLUSION: We question the validity of the diagnosis in cases without localized atrophy or other objective signs of denervation.

Adult↗
PubMed1993

Neuroleptic and antiepileptic treatment in the mentally retarded.

The mentally retarded often need concomitant antiepileptic and neuroleptic drug treatment. High doses of neuroleptic drugs may provoke seizures. Antiepileptic drugs may aggravate behavioural problems. The mutual influence of neuroleptic and antiepileptic drug treatment and the effect of seizure control were studied in 20 mentally retarded patients between 1980 and 1989. The treatment was tailored individually, aiming at the lowest effective dose. Carbamazepine was preferred to phenobarbital and phenytoin. The mean defined daily dose (DDD) of neuroleptics and antiepileptics was reduced by 64% and 5%, respectively. Changing the mean DDD of neuroleptics neither correlated significantly with seizure activity nor with the change of the mean DDD of the antiepileptics. Evidently, seizure control may be improved by small neuroleptic doses in some patients. In one patient, however, a non-convulsive status epilepticus was associated with the introduction of neuroleptics. The assumption that carbamazepine has a beneficial effect on behavioural problems was not supported. Apparently, changing the regime of antiepileptics contributed to less neuroleptic requirements, possibly through reduced side-effects and/or improved seizure control. When combining neuroleptics and antiepileptics, interactions should always be considered. The epileptogenic effect of small to standard doses of neuroleptic drugs should, however, not be overemphasized.

Adult↗
PubMed1988

The course of epilepsy during pregnancy: a study of 78 cases.

We have compared frequency and severity of epileptic seizures during pregnancy with the 9 months prior to pregnancy in 66 patients with a total of 78 pregnancies. Data on total number of seizures and major seizures are analysed separately. No statistically significant differences between frequency before and during pregnancy were found. Cases with seizures before pregnancy tended to have seizures during pregnancy, but there was no association between occurrence of seizures prior to pregnancy and increased frequency during pregnancy. There was no evidence that seizures became more severe during pregnancy. No relationship was found between type of epilepsy and change in seizure frequency during pregnancy. The data suggest that our therapeutic interventions may have influenced seizure frequency in at most a minority of cases. Serum concentrations of the anti-epileptic drugs were monitored regularly during pregnancy. Only data on patients on constant drug dosages and, therefore, presumedly with the mildest seizure disorders were analysed. In the majority of cases there was a decrease in drug levels during pregnancy. Most cases tolerated this decrease without an increase in seizure frequency. On the other hand, most cases with increased frequency also had decreased drug levels.

Adolescent↗
PubMed1984

Anticonvulsant drug therapy in human pregnancy: effects on serum concentrations of vitamin D metabolites in maternal and cord blood.

Serum concentrations of the main vitamin D metabolites and of calcium, phosphate, and alkaline phosphatase were determined in each of the three trimesters of pregnancy and in simultaneously obtained maternal and cord blood at delivery in 22 epileptic women treated with diphenylhydantoin or carbamazepine alone or with a combination with one other drug. The results were compared with similarly obtained data from 22 normal pregnancies. Women in both groups received supplements of 400 IU vitamin D3 per day. All the women had 25-hydroxyvitamin D levels within the normal range for healthy adults (greater than 12 ng/ml) throughout pregnancy. The epileptic women had, however, significantly (p less than 0.05) lower median 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels and higher median 25,26-dihydroxyvitamin D values than the reference group. The 24,25-dihydroxyvitamin D concentrations did not differ significantly, but the median ratio of 24,25-dihydroxyvitamin D to 25-hydroxyvitamin D was higher in the epileptic women at the end of pregnancy (p = 0.05). The respective differences in cord serum concentrations reflected those of the mothers at delivery. Serum calcium tended to be lower during epileptic pregnancy, but none were hypocalcemic. The alkaline phosphatase and phosphate values did not consistently differ from those of the reference women. The median alkaline phosphatase level of cord serum was slightly higher in the epileptic group, but the calcium and phosphate levels were similar to the reference values. The various biochemical parameters of the carbamazepine-treated women tended to be intermediate between those of the healthy and diphenylhydantoin-treated groups. Antiepileptic drug therapy appears to affect vitamin D metabolism and calcium homeostasis during pregnancy. The derangements may not be of major clinical significance, however, in vitamin D-supplemented and normally functioning women on long-term low-dose therapy.

24,25-Dihydroxyvitamin D 3↗
PubMed1982

The effect of carbamazepine on serum immunoglobulin concentrations.

Serum IgA, IgG and IgM concentrations were determined in 30 patients with partial epilepsy before and during carbamazepine therapy. None of them had received anti-epileptic drugs prior to the study. The IgA and IgM concentrations decreased significantly during the 1st month of treatment (P less than 0.0001). No further decrease was observed during the subsequent 3 months. 15 patients were followed for 8-30 months. The IgA concentrations remained low, while the IgM concentrations tended to increase. However, the IgM concentrations did not reach the levels which were found before carbamazepine was started. Carbamazepine had no influence on the mean IgG serum concentration. There was no relationship between the IgA and IgM concentrations in serum and the serum concentrations of carbamazepine.

Adolescent↗
PubMed1982

Respiratory disease in patients with epilepsy on single-drug therapy with carbamazepine or phenobarbital.

IgA, IgG and IgM concentrations were determined in sera and nasal washings from 20 patients with epilepsy on single-drug treatment with carbamazepine, in 20 patients on single-drug treatment with phenobarbital and in 26 healthy subjects. There were no significant differences in immunoglobulin concentrations between the groups of patients and the controls. Symptoms of respiratory tract disease were recorded daily during 6 months both in patients and in controls. The mean number of days with symptoms from the respiratory tract was 38.5, 36.6 and 27.9 in the patients on carbamazepine, phenobarbital and the controls, respectively. The differences were not statistically significant. The individuals with the lowest immunoglobulin concentrations did not have more frequent symptoms of respiratory disease than those with higher immunoglobulin concentrations.

Adolescent↗
PubMed1981

The influence of carbamazepine on thyroid hormones and thyroxine binding globulin in hypothyroid patients substituted with thyroxine.

Carbamazepine (CBZ) decreases the serum concentration of thyroid hormones. It is proposed that CBZ increases the extra-thyroidal metabolism of thyroid hormones. In order to test this hypothesis CBZ was given to nine hypothyroid patients substituted with thyroxine (T4). A significant decrease in serum concentrations of T4, calculated free T4 (FT4), triiodothyronine (T3), and calculated free T3(FT3) was found after 3 weeks of CBZ medication. The serum concentrations of TSH and the T4:T3 ratios were unaltered, while the serum concentrations of T4-binding globulin (TBG) increased markedly in eight of the nine patients. These findings support the hypothesis of a CBZ induced increase in the extra-thyroidal metabolism of thyroid hormones.

Adult↗
PubMed1981

Influence of carbamazepine on serum thyroxine and triiodothyronine in patients with epilepsy.

Hypothyroidism induced by anti-epileptic drug treatment gave rise to thyroid function test studies in patients treated with carbamazepine (CBZ) only. In 42 patients on long-term CBZ treatment thyroxine (T4), free T4-index (FT4I), and triiodothyronine (T3) concentrations in serum were significantly lower than in controls, while triiodothyronine uptake (T3U) and thyrotropin (TSH) concentrations did not differ between patients and controls. In 12 patients starting on CBZ, means T4, calculated FT4 and thyroxine binding globulin (TBG) were 1-5 months later reduced compared to the initial levels. Thus, CBZ reduced thyroid hormones, TBG and FT4I. A CBZ-induced increase in conversion and metabolism of the thyroid hormones could explain this effect. The normal T3U values and decreased concentrations of TBG make a competitive CBZ binding to TBG less probable. Although the thyroid hormones levels were found lowered in the patients, all remained clinically euthyroid during the study.

Adolescent↗