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Biomedical subjects

T R Sunder

Publications and source records attributed to T R Sunder.

11 recordsLinked to original sources
PubMed2003

Lamotrigine as adjunctive therapy in patients with refractory epilepsy and mental retardation.

This study evaluated the effects of lamotrigine as adjunctive therapy for refractory epilepsy in patients with mental retardation. Patients with epilepsy and mental retardation having uncontrolled seizures despite treatment with other antiepileptic drugs were eligible (n=67). The open-label study comprised a Baseline Phase, an Escalation Phase during which lamotrigine was titrated to a target dose, an 8-week Maintenance Phase during which doses of lamotrigine and concomitant antiepileptic drugs were maintained, and a 12-week Optimization Phase during which doses of lamotrigine and other antiepileptic drugs could be adjusted. Almost half (44%) of patients experienced a 50% reduction in seizure frequency during the Maintenance Phase after addition of lamotrigine; 15% of patients became seizure-free. A similar pattern of results was reported for the Optimization Phase. Investigator-rated clinical status was improved relative to baseline in 66 and 74% of patients at the end of the Maintenance and Optimization Phases, respectively. Most patients experienced improvements in seizure frequency, duration, and intensity during the Maintenance Phase (62 to 72%) and the Optimization Phase (65 to 74%). Many patients were rated as having improved social functioning during the Maintenance Phase (42%) and the Optimization Phase (46%). The Aberrant Behavior Checklist score for lethargy and the mean Habilitative Improvement Scale score were improved at the ends of the Maintenance and Optimization Phases relative to baseline (P< or =0.04). One limitation of this study is its open-label design, which limits the ability definitively to attribute the clinical improvements to lamotrigine. Adjunctive lamotrigine in patients with refractory epilepsy and mental retardation appears to decrease seizure frequency and improve behavior while permitting a reduction in dose of concomitant antiepileptic drugs.

Adolescent↗
PubMed1997

Meeting the challenge of epilepsy in persons with multiple handicaps.

Epilepsy occurs in more than 30% of persons with mental retardation and up to 50% of those with multiple handicaps living in institutional settings. Treatment of epilepsy in this population presents many unique challenges. Through careful adherence to basic principles of diagnosis, classification, and antiepileptic drug use, as many as 80% of individuals can be successfully managed with one- or two-drug therapy and enjoy positive outcomes in the areas of community integration and increased independence. Rational polypharmacy with the newer anticonvulsant drugs offers additional opportunity for improving outcomes for these individuals, especially with the use of felbamate and lamotrigine, where broad-spectrum efficacy and positive impact on psychosocial functioning is being demonstrated. Further systematic study of new drugs in this population is clearly warranted.

Adolescent↗
PubMed1992

The persistent vegetative state in children: report of the Child Neurology Society Ethics Committee.

Increasing concern about children in a persistent vegetative state (PVS) prompted a survey of members of the Child Neurology Society regarding aspects of the diagnosis and management of this disorder. Major findings of those responding to this survey (26% response rate) were as follows: (1) 93% believed that a diagnosis of PVS can be made in children, but only 16% believed that this applied to infants younger than 2 months and 70% in the 2-month to 2-year group; (2) a period of 3 to 6 months was believed to be the minimum observation period required before a diagnosis of PVS could be made; (3) 86% believed that the age of the patient would affect the duration of time needed to make the diagnosis of PVS; (4) 78% thought a diagnosis of PVS could be made in children with severe congenital brain malformations; (5) 75% believed that neurodiagnostic studies would be of value and supportive of the clinical diagnosis of PVS; (6) members' opinions as to the average life expectancy (in years) for the following age groups after the patients were considered vegetative were: newborn to 2 months, 4.1; 2 months to 2 years, 5.5; 2 to 7 years, 7.3; and more than 7 years, 7.4; (7) 20% believed that infants and children in a PVS experience pain and suffering; and (8) 75% "never" withhold fluid and nutrition from infants and children in a PVS and 28% "always" give medication for pain and suffering.(ABSTRACT TRUNCATED AT 250 WORDS)

Advisory Committees↗
PubMed1982

Neurological manifestations of angioedema. Report of two cases and review of the literature.

Two children had recurrent neurological symptoms associated with angioedema. Extensive clinical and laboratory investigations failed to reveal a separate cause for the neurological changes. Only 19 prior cases of this association have been reported. Seizures and headaches are the most common symptoms, but a wide variety of focal and generalized deficits may occur. The release of vasoactive substances such as histamine, serotonin, and prostaglandins, which are also putative neurotransmitters, is postulated to be the cause of the cerebral symptoms.

Adolescent↗
PubMed1981

Moyamoya disease in a patient with type I glycogenosis.

A 17-year-old boy with type I glycogen storage disease (GSD-I) and a stroke associated with moyamoya disease is described. This is the first report of this association, and only the second reported case of cerebrovascular disease in patients with GSD-I. The relationship of the primary metabolic error and the vascular injury is explored. This represents yet another disorder associated with moyamoya disease, which is considered to be a secondary phenomenon of vascular occlusion that occurs under a specific set of circumstances in a susceptible age group.

Adolescent↗
PubMed1981

Longitudinal assessment of children with enteroviral meningitis during the first three months of life.

Nine children who had enteroviral meningitis during the first three months of life and nine matched control children were evaluated for possible sequelae of their infection. The mean age of the children with meningitis was 46.67 months at the time of testing and that of the control subjects was 47.33 months. The mean IQ level of 89.67 obtained in the control children. Receptive vocabulary testing suggested that the receptive language functioning of the group with meningitis was significantly less than that of the control group. There was no significant difference in head circumference, no detectable sensorineural hearing loss, and no detected difference in intellectual functioning between the meningitis group and matched control subjects.

Cephalometry↗
PubMed1980

Hyperventilation induced abnormalities in the electroencephalogram of children with Moyamoya disease.

Two cases of Moyamoya disease in children are presented. The EEG of each child demonstrated minimal abnormalities at rest. However, during 3 min of hyperventilation, the record developed rhythmic delta activity which persisted in excess of 5 min after termination of over breathing. This activity did not respond to glucose administration and was maximal in the areas correlating with the clinical symptoms. It appears to represent a physiologic correlate of an abnormal vascular response to hypocapnia. Although admittedly a non-specific response, the persistence of delta activity easily provoked by hyperventilation, the topographic correspondence to the ultimately demonstrated vascular anomaly, and the lack of response to glucose ingestion represent a combination of factors which, in the appropriate clinical setting, are distinctive and of diagnostic value. Currently, invasive arteriography is required for definitive diagnosis of Moyamoya. Improved selection of children for invasive studies may be accomplished by EEG screening.

Adolescent↗
PubMed1979

Moyamoya disease.

Explore the source record for details and available documents.

Adolescent↗
PubMedDate not supplied

Hematologic manifestations of long-term valproate therapy.

Sixty patients receiving long-term valproate (VPA) monotherapy were studied for hematologic side effects. All were patients in a long-term care facility and ranged in age from 2 to 29 years (mean 14.6 years). Twenty developed at least one prominent hematologic abnormality. Thrombocytopenia and macrocytosis were the most common findings. In patients with macrocytosis, platelet counts were inversely related to VPA levels. Serum B12 levels were increased in 51 of the patients. In 12 patients with macrocytosis who were extensively studied, no etiology for the increased MCV could be identified. An increased number of Pelger-Huet-like cells was noted in these 12 patients. None of the patients demonstrated hepatic dysfunction. Hematologic toxicity was never severe enough to discontinue therapy and always responded to small decrements in VPA therapy. VPA was discontinued in only 1 patient, owing to poor seizure control.

Adolescent↗