Journal of intellectual disability research : JIDR
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J Intellect Disabil Res · Dec 1998
ReviewPhenytoin: effective but insidious therapy for epilepsy in people with intellectual disability.
Phenytoin (5,5-diphenylhydantoin), which has been in use for 60 years, is still an important antiepileptic drug. Its primary mechanism of action is modulation of the sustained repetitive firing of neurones by direct inhibition and blockage of voltage-gated sodium channels in the neuronal cell membrane, and by delay of cellular reactivation. The plasma protein binding of phenytoin is normally between 90% and 95%. ⋯ In patients with epilepsy who also have intellectual disability, and are susceptible to balance disturbances and cognitive dysfunction, it is wise to replace phenytoin with another drug, such as carbamazepine or oxcarbazepine. The long-term use of phenytoin is not recommended for patients with loss of locomotion, marked cognitive impairment, or symptoms and signs of cerebellar disease. The prevention of phenytoin intoxication, with the subsequent development of phenytoin-induced encephalopathy, depends on careful observation of the patients and frequent monitoring of plasma levels of phenytoin and other concomitantly administered antiepileptic drugs.
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J Intellect Disabil Res · Dec 1998
ReviewBenzodiazepines in the treatment of epilepsy in people with intellectual disability.
All the benzodiazepines (BZDs) in clinical use have the capacity to promote the binding of the major inhibitory neurotransmitter, gamma-amino-butyric acid (GABA), to sub-types of GABA receptors which exist as multi-subunit ligand-gated chloride channels. Thus, the BZDs facilitate the actions of GABA in the brain. The BZDs in use as antiepileptic drugs are diazepam, clonazepam, clobazam, nitrazepam, and lately, also lorazepam and midazolam as emergency therapy. ⋯ Despite the limitations of BZDs in the prophylactic treatment of epilepsies, these drugs play a prominent role in clinical practice in the emergency management of acute seizures and status epilepticus. Diazepam, clonazepam and lorazepam are all considered first-line agents in the emergency management of acute seizures and status epilepticus. Furthermore, the value of midazolam as an emergency therapy in epilepsy has been increasingly recognized in recent years.
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J Intellect Disabil Res · Jun 1996
Case ReportsHomo-erotomania for a delusional parent: erotomania with Capgras and Fregoli syndromes in a young male with learning difficulties.
A 19-year-old male with learning difficulties exhibited erotomania associated with first-rank symptoms of schizophrenia; the subject responded to neuroleptic medication. The love object was a male neighbour believed by the subject to be his father. This is the first recorded case where erotic desire has been coupled with the delusion that the object is also the parent of the sufferer. We propose a multifactorial aetiology, considering the possibility of complex psychodynamics in the presence of learning difficulties.
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J Intellect Disabil Res · Feb 1992
A study of the homeostatic level of stereotypy and other motor movements of persons with mental handicaps.
Stereotypy is one of the most common behaviours demonstrated by persons with mental handicaps. As such, it has generated a number of theories concerning its origin or maintenance. One of these theories, the homeostatic one, suggests that some persons engage in stereotypies and other motor behaviours in order to maintain a relatively constant level of responding. ⋯ The purpose of this paper was to determine whether some people do engage in constant levels of responding, and it did so by collecting data on stereotypy and other motor movements of 12 persons with retardation. Collected throughout the school day for 5 consecutive days on micro-computers, the data showed (1) that the stereotypic responding of four subjects was extraordinarily consistent, with the most deviant day's total being only 15 or 16% from the mean of the 5 days, (2) that other motor movements were inconsistent for all but one subject, but (3) that total movement (i.e. stereotypy plus other motor movements) was very high and was consistent for most subjects. The data were discussed in terms of assessing baselines for subjects for whom reinforcing adaptive motor movements would seem an appropriate means for reducing stereotypic responding.