Clinical and experimental neurology
-
Daily salivary anticonvulsant monitoring in epileptic patients with frequent seizures appears a promising, practicable and inexpensive approach which may assist in the management of drug therapy. It offers the possibility of predicting the optimal drug concentration likely to minimise seizure activity in a given patient, and sometimes allows the inference that different anticonvulsant drugs should be tried forthwith. The use of the method is described in one patient who collected daily saliva specimens and recorded any seizure activity over periods of several weeks. ⋯ Saliva was again collected daily over another 3 months. Analysis of the data on this occasion suggested that carbamazepine, in the presence of methylphenobarbitone, may have played little role in seizure prevention, and also predicted the salivary level of phenobarbitone likely to minimise seizures. Unfortunately the patient again could not tolerate the drug doses necessary to attain this phenobarbitone concentration.
-
A revised EEG grading scale in coma has been introduced previously. This scale is based on the internationally accepted 5 grade scale but also contains uncommon patterns such as spindle, alpha and theta pattern comas. By defining 15 separate grades and subgrades it was possible to reduce the number of patterns of uncertain prognostic significance for survival to 4 out of the 15 possible patterns. ⋯ Four suggested scale subdivisions did not occur in the material studied but these subdivisions are more common in traumatic encephalopathies. This study shows that an EEG performed 24 to 36 hours after cardiac arrest provides significant information for the prediction of survival. No specific patterns of microscopic changes in the brain were found to correlate with individual EEG abnormalities in fatal anoxic encephalopathies.