Epileptic patients

Masukawa, LM, Higashima, M, Kim, JH and Spencer, DD (1989) Epileptiform discharges evoked in hippocampal brain slices from epileptic patients. Brain Res. 493 168-174. 

Cunha JM, Carlini EA, Pereira AE, Ramos OL, Pimentel C, di Gagliardi R, Sanvito WL, Lander N and Mechoulam R (1980). Chronic administration of cannabidiol to healthy volunteers and epileptic patients. Pharmacology, 21, 175-185. 

Secobarbital exhibits the same pharmacologic properties as other members of the barbiturate class. Most nonmedical use is with short-acting barbiturates, such as secobarbital. Although there may be considerable tolerance to the sedative and intoxicating effects of the drug, the lethal dose is not much greater in addicted than in normal persons. Tolerance does not develop to the respiratory effect. The combination of alcohol and barbiturates may lead to fatalities because of their combined respiratory depressive effects. Similar outcomes may occur with the benzodiazepines. Severe withdrawal symptoms in epileptic patients may include grand mal seizures and delirium. 

Basaran, N. et al., Humoral and cellular immune parameters in untreated and phenytoin-or carbamazepine-treated epileptic patients, Int. J. Immunopharmacol., 16,1071, 1994. 

Olsen JH, Boice JD Jr, Jensen JP et al (1989) Cancer among epileptic patients exposed to anticonvulsant drugs. J Natl Cancer Inst 81 803-808... 

Phase I. Initial safety trials on a new medicine, usually conducted in normal male volunteers. An attempt is made to establish the dose range tolerated by volunteers for single and for multiple doses. Phase I trials are sometimes conducted in severely ill patients (e.g., in the field of cancer) or in less ill patients when pharmacokinetic issues are addressed (e.g., metabolism of a new antiepileptic medicine in stable epileptic patients whose microsomal liver enzymes have been induced by other antiepileptic medicines). Pharmacokinetic trials are usually considered Phase I trials regardless of when they are conducted during a medicine s development. 

D. A. Svinarov, C. E. Pippenger, Relationships between Carbamazepine-Diol, Carba-mazepine-Epoxide, and Carbamazepine Total and Free Steady-State Concentrations in Epileptic Patients The Influence of Age, Sex, and Comedication , Ther. Drug Monit. 1996,18, 660 - 665. 

As with other quinolones, ciprofloxacin should be used with caution in epileptic patients (since it may precipitate seizures), in children, during pregnancy and breast-feeding (due to risk of arthropathy in weight-bearing joints). 

Withdrawal Abrupt withdrawal in epileptic patients may precipitate status epilepticus. 

In epileptic patients previously receiving valproic acid therapy, initiate divalproex sodium at the same daily dose and dosing schedule. After the patient is stabilized on divalproex tablets, a dosing schedule of 2 or 3 times/day may be elected in selected patients. 

In experiments done many years ago on epileptic patients who were undergoing brain surgery, small brain biopsies were taken at operation. The concentration of anti-convulsant drug was measured in both the brain tissue and in the plasma from simultaneously-withdrawn venous blood. For the drugs phenobarbitone and phenytoin, a linear correlation was observed between plasma and brain concentrations. This suggested that plasma concentrations of anti-convulsants could reflect brain concentrations, and therefore, presumably concentrations at the receptor sites within the brain substance. 

Wilson JT, Wilkinson GR. Delivery of anticonvulsant drug therapy in epileptic patients assessed by plasma level analyses. Neurology 1974 24(7) 614-23. 

Baclofen is a GABA agonist at GABA B receptors and it has a presynaptic inhibitory function by reducing calcium influx. Its indication is increased extensor tone and clonus. Intrathecal administration may control severe spasticity pain. It is used for the treatment of spastic movement, especially in instances of spinal cord injury, spastic diplegia, multiple sclerosis and amyotrophic lateral sclerosis. Its central nervous system effects include drowsiness, somnolence and seizure activity in epileptic patients. 

Most of the contraindications specific to pentazocine stem from its excitatory effects. Other contraindications are similar to those for morphine. Pentazocine is contraindicated in patients with myocardial infarction because it increases heart rate and cardiac load. Similarly, it is contraindicated in epileptic patients because it decreases seizure threshold. In addition, in head trauma patients, it can increase intracranial pressure and brain injury. Pentazocine use in patients with psychoses is contraindicated because of its psychotomimetic side effects. 

An epileptic patient who is taking phenytoin and lamotrigine to control her seizures is in the first month of pregnancy and definitely wants to have the baby. What vitamin supplement would be essential ... 

Grand mal seizures may occur in epileptic patients, especially those receiving the drug by IM administration. 

In epileptic patients there is repetitive detonation of normal brain cells during the depolarisation shift and consists of synchronous and unusually large depolarisation on which action potentials are superimposed. Phenjdoin prevents repetitive detonation of these normal brain cells as it has a stabilizing influence on the neuronal membrane. It is achieved by prolonging the inactive state of voltage sensitive... 

The EEC changes associated with ketamine anaesthesia are quite unlike those seen with other intravenous anaesthetics and consist of fast 3 activity mixed with high-voltage 5 waves. While ketamine-induced myoclonic and seizure-like activity has been seen in normal (non-epileptic) patients, ketamine appears to possess anticonvulsant properties. 

Oxcarbazepine is less potent than carbamazepine, both in animal models of epilepsy and in epileptic patients clinical doses of oxcarbazepine may need to be 50% higher than those of carbamazepine to obtain equivalent seizure control. Some studies report fewer hypersensitivity reactions to oxcarbazepine, and cross-reactivity with carbamazepine does not always occur. Furthermore, the drug appears to induce hepatic enzymes to a lesser extent than carbamazepine, minimizing drug interactions. Although hyponatremia may occur more commonly with oxcarbazepine than with carbamazepine, most adverse effects that occur with oxcarbazepine are similar in character to reactions reported with carbamazepine. 

In previously treated epileptic patients, the administration of a large loading dose of phenytoin may cause some dose-related toxicity such as ataxia. This is usually a relatively minor problem during the acute status episode and is easily alleviated by later adjustment of plasma levels. 

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