Epilepsia
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Review
Pharmacokinetics and clinical use of benzodiazepines in the management of status epilepticus.
Benzodiazepines are potent and effective drugs for the management of acute seizures and status epilepticus. Lorazepam, diazepam, and clonazepam have been the most widely studied of the benzodiazepines in the treatment of status epilepticus. In 47 studies of these drugs involving 1,455 patients, lasting control of status epilepticus was achieved in 79% of the patients. ⋯ This allows the orderly administration of an antiepileptic drug for long-term seizure control after status epilepticus has been controlled. For this reason, lorazepam is preferable for the initial management of status epilepticus. Continuous intravenous infusion of diazepam has been used successfully in the management of some patients with status epilepticus refractory to initial treatment.
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"Hot water epilepsy" (HWE), precipitated by a bath or shower in hot water, has been described infrequently in the literature. We report 279 cases of HWE that were seen between 1980 to 1983 in Bangalore, South India. ⋯ Although prognosis seems favorable 25.4% of our patients developed nonreflex epilepsy within 1-3 years. They were managed with antiepileptic drugs and the use of lukewarm water for bathing.
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Comparative Study
Observations on the effect of morphine on thalamocortical excitability in the cat.
The acute effects of morphine on the thalamocortical augmenting response in the cat were evaluated. The thalamocortical augmenting response was elicited by delivering pairs of pulses to the ventrolateral thalamus and recording from ipsilateral sensorimotor cortex. A biphasic, dose-related, naloxone-attenuable effect on the augmenting response elicited by pulse pairs was observed. Although the clinical significance of those morphine-induced changes is currently uncertain, they can be correlated with the convulsant and anticonvulsant effects of different doses of morphine.
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Review Comparative Study
Cognitive dysfunction associated with antiepileptic drug therapy.
Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. ⋯ A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.
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No documentation is available for myocardial infarction complicating status epilepticus. A 31-year-old man developed an acute inferolateral myocardial infarction during repetitive epileptic seizures. A cineangiographic study performed 6 months later revealed normal coronary arteries and an apical aneurysm in the left ventricle. The main pathogenetic mechanisms involved and a therapeutic possibility are discussed.