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Management of Common Illness
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
The goal of antiseizure medication is to provide complete seizure control using the lowest maintenance dose possible:Begin with the first-line drug where available, increasing the dose up to maximum, before changing to an alternative medication.When switching to a new antiseizure medication: after the initial starting dose, gradually titrate up to mid-range of maintenance dose for the new drug. At this point, start tapering down the first drug.Refer for specialist advice if seizures are not controlled after two monotherapies. However, if seizures are very infrequent, and higher doses produce side effects, infrequent seizures may be acceptable on discussion with the patient/family.Consider differential diagnoses and poor drug adherence.If seizure-free for at least 2 years, consider stopping medication by reducing dose gradually over at least 2 months (6 months for phenobarbitone).
Water-Related Deaths by Manner
Published in Kevin L. Erskine, Erica J. Armstrong, Water-Related Death Investigation, 2021
Examination of the brains of individuals with a seizure disorder or epilepsy often reveals no structural abnormality. Nevertheless, the autopsy should include careful examination of the brain for scarring of the hippocampal region (including Ammon’s horn); abnormal architecture of the gray and white matter, including ectopic gray matter (grossly and microscopically); brain cysts; new and old trauma; and tumors.31,33 The finding of any of these may provide an explanation as to the origin of the seizures and confirmation of previous clinical neurological diagnosis. A complete autopsy will also naturally include an examination of the heart since structural and microscopic abnormalities of this organ may give rise to seizure-like activity. Documentation of any external injuries along with documentation of contusion of the tongue (from biting during seizure activity) can provide additional supportive evidence of seizure activity. The toxicological analysis may reveal subtherapeutic levels of antiseizure medication(s), but detection of therapeutic levels does not rule out seizures as a cause of death. Histories of a recent change in antiseizure medication, the addition of other antiseizure medications to the regimen, and increased frequency of seizures prior to death are important to note and can add certainty that the cause of death is most likely due to seizures.
Reproductive Endocrine Disorders
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Clomiphene therapy has not significantly altered total or free serum antiseizure medication levels in the few cases that have been studied, but a well-controlled investigation of possible drug interactions remains to be carried out (37).
Targeting adverse effects of antiseizure medication on offspring: current evidence and new strategies for safety
Published in Expert Review of Neurotherapeutics, 2023
Leihao Sha, Xihao Yong, Zhenhua Shao, Yifei Duan, Qiulei Hong, Jifa Zhang, Yunwu Zhang, Lei Chen
Drugs must pass through biological barriers to exert their pharmacological effects on the target organs. The biological barrier structures related to the safety and efficacy of ASMs during pregnancy/lactation include the BBB, placental barrier, and blood-milk barrier. The BBB is located between blood circulation and brain tissue and is closely related to the effectiveness of drugs[26]; The placental barrier is located between the maternal blood and fetal blood and is the route for drugs to enter the fetus during pregnancy[27]. The blood-milk barrier is located between the mother’s breast tissue and milk and is closely related to the drug content of milk[28]. Transport across barriers is generally measured by the ratio between drug concentrations (protein-bound plus unbound or protein unbound only) on opposite sides of the barrier. An ideal antiseizure medication during pregnancy/lactation should have no or low transport across the placental and blood-milk barriers, while retaining high transport across the BBB to play a therapeutic role. It is possible to develop a new generation of ASMs that can be safely used in perinatal women with epilepsy by modifying the current ASMs to fulfill these requirements.
Intraventricular neurocysticercosis causing obstructing hydrocephalus
Published in Baylor University Medical Center Proceedings, 2022
Alejandro Perez, Gaurav Syngal, Samreen Fathima, Sam Laali, Sadat Shamim
Antiparasitic therapy is warranted for patients with viable and/or degenerating cysts in the brain on neuroimaging. However, definitive therapy for patients with viable cysts causing obstruction consists of neuroendoscopic cyst removal.9,12 The primary antiparasitic regimen for the treatment of neurocysticercosis consists of albendazole and praziquantel plus dexamethasone for 10 days.12 Prior to initiation of antiparasitic therapy, patients who are likely to require prolonged corticosteroids should undergo screening for latent tuberculosis infection as well as screening for strongyloidiasis to avoid a reactivating infection while on steroids.6 Follow-up neuroimaging should be performed every 6 months following completion of antiparasitic therapy until radiographic resolution.6 The optimal duration of antiseizure medication therapy is uncertain; many patients continue to have seizures following antiparasitic treatment.13,14 For our patient, who had only a single intraventricular lesion, antiseizure medication therapy was continued for 6 months until radiographic resolution of active infection.
Antiseizure medication-induced obsessive-compulsive disorder and tic disorder: a pragmatic review
Published in Expert Review of Neurotherapeutics, 2022
Minakshi Doobay, Verinder Sharma, Heidi Eccles
Antiseizure medication is increasingly used for a variety of general medical disorders such as trigeminal neuralgia, neuropathic pain syndromes, migraine, and essential tremor. These drugs are also frequently prescribed to adults and children for various psychiatric illnesses. Valproate and carbamazepine are FDA approved drugs for treatment of mania in adults. Lamotrigine is an FDA approved drug for maintenance treatment of bipolar disorder in adults. In children, antiseizure medication is commonly prescribed for treatment of pediatric bipolar disorder and disruptive behavior disorders [14]. The off-label use has also expanded to include treatment of disorders such as intellectual disability, autism spectrum disorder, conduct disorder, and attention deficit-hyperactivity disorder [15,16].