Seizure : the journal of the British Epilepsy Association
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Case Reports
Problems with phenytoin administration in neurology/neurosurgery ITU patients receiving enteral feeding.
Our objective was to investigate the relationship between phenytoin bioavailability, enteral feeding and serum albumin levels in patients admitted to neurology/neurosurgery ITU, via case studies of three patients. The research was performed at the Walton centre for Neurology and Neurosurgery NHS Trust, Liverpool, England, and our subjects consisted of three cases admitted to ITU (1 status epilepticus, 1 post-trauma and 1 post-subarachnoid haemorrhage (SAH)). ⋯ We conclude that, in this setting the patient's phenytoin needs to be closely monitored and treated aggressively to maintain therapeutic levels. They should also be followed up during rehabilitation to avoid toxicity.
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Oxcarbazepine (OXC) is indicated for treating partial-onset with or without secondary generalized tonic-clonic seizures, in both adults and children aged over 6 years, as monotherapy or adjuvant therapy. Trials data and extensive clinical experience demonstrate generally good tolerability and antiepileptic efficacy similar to carbamazepine (CBZ), sodium valproate or phenytoin. Since the UK launch of OXC in March 2000, UK collaborators have pooled experience to optimize prescribing recommendations for adults. ⋯ Serum sodium monitoring is unnecessary, however, unless relevant risk factors or pointers exist. Severe haematological dyscrasias have not been reported with OXC. The enzyme inducing interaction of OXC with ethinyloestradiol and levonorgestrel necessitates additional precautions for women using hormonal contraception.
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The aims of this study were to estimate the proportion of patients with epilepsy who made primary care and/or hospital outpatient medical consultations within 1 year; to formulate a model of the explanatory variables that influence whether patients consult or not; and to estimate the frequency of referral to, and waiting time for, hospital outpatient clinics in patients with new-onset seizures. Suggestions are offered for improvement of epilepsy services based on the findings. A questionnaire was distributed to 3455 unselected patients identified at population level from primary care practices in all NHS regions of the UK. ⋯ The elderly are over-represented in this group. Care tends to be polarized between hospital or primary care, falling short of the ideal of shared care. It will be important to address the influences on consultation seeking in epilepsy, particularly for those patients currently under no medical supervision.