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Ethnicity has been shown to be a contributing risk factor regarding antiepileptic drug (AED)-induced severe cutaneous adverse drug reactions (SCARs). To increase the clinical and epidemiologic information in Asians, we investigated the characteristics, outcome, and tolerability toward alternative drugs for AED-induced SCARs.
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These data illustrate the additional value of LPAs in the detection of CBZ allergy while showing that a major part of side effects to CBZ and OCBZ is not immunologically mediated, according to PTs and LPAs.
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A total of 86 patients were seen, of whom five had an underlying disorder that could account for the pain. The study cohort therefore consisted of 81 patients, and based on attack duration these were divided into short (≤2 minutes, n = 61) and long (>2 minutes, n = 20) groups, for further analysis. The features of these patients and a discussion on the differential diagnosis have been presented in part 1 of this report. Employing an accepted stepped pharmacotherapeutic protocol for the management of CTN, significant improvement was more frequent in the short (74%) than in the long attack group (50%, p = 0.05). In the short attack group there were statistically significant associations between a poor treatment response and longer disease duration, the presence of autonomic signs and atypical pain descriptors for pain quality (p < 0.05).
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Continuing experience with oxcarbazepine has shown that the drug tends to be less sedative than carbamazepine and at least as potent as an anticonvulsant but much more likely to cause hyponatraemia. The behaviour of the clearance of oxcarbazepine over a period of 3 months raises the possibility that the drug may not be as active an inducer of drug metabolism as is carbamazepine.
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The center conducted trials of zonisamide, oxcarbazepine, gabapentin, remacemide, tiagabine, vigabatrin, felbamate, and lamotrigine both as add-on trials in refractory seizure disorders and as monotherapy trials in de novo epilepsy. More than 200 patients have been recruited for trials at ERS (with some patients being involved in more than one trial). External review endorsed ERS as a superior environment for such research and as a model for other centers.
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When cimetidine (CIM) is administered together with the anti-epileptic drug carbamazepine (CBZ), a drug interaction may cause a rise in plasma concentrations of CBZ, which can result in CBZ-related toxic symptoms. The aim of this cross-over study was to investigate whether CIM influences the disposition and kinetics of the new anti-epileptic oxcarbazepine (OXC) and its metabolites. In 8 healthy volunteers there was no difference in AUC, Cmax or tmax when OXC was administered either with or without CIM. The results of this study suggest that in the treatment of epilepsy OXC offers an important advantage over the established anti-epileptics, especially when concomitant therapy with CIM is required.
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Oxcarbazepine is a new anticonvulsant, currently undergoing clinical trials. Its spectrum of antiepileptic action, and its chemical structure, resemble those of carbamazepine, though the 2 drugs have no pharmacologically active metabolites in common. In a study of 7 adults with poorly controlled partial epilepsy, progressive substitution of oxcarbazepine for carbamazepine left seizure control unaltered in 4 and improved in 3, whilst 5 became more alert and one was rendered ataxic. Three subjects became hyponatraemic. There were no other adverse effects. Plasma levels of the drug and its pharmacologically active 10-hydroxy derivative were measured sequentially over 4 days after a single drug dose at the outset of therapy in 5 subjects. Calculated pharmacokinetic parameter values for the drug, assuming complete oral bioavailability, were: absorption lag time 2.07 +/- 1.61 h: absorption rate constant 8.328 +/- 8.941 h-1: apparent volume of distribution 3.937 +/- 2.222 L kg-1: oral clearance 2.898 +/- 1.439 L kg-1: elimination rate constant 0.609 +/- 0.261 h-1 (half-life 1.26 +/- 0.37 h), while the metabolite had a formation rate constant of 0.593 +/- 0.233 h-1, and an elimination rate constant of 0.082 +/- 0.014 h-1 (half-life 8.74 +/- 1.79 h). Even with a single dose, peak plasma metabolite levels were substantially higher than those of the parent drug. Oxcarbazepine appears to be a promising alternative to carbamazepine as an anticonvulsant, although in view of its rapid elimination it probably serves mainly as a prodrug for its 10-hydroxy metabolite.
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This systematic review supports the extrapolation of efficacy results in adults to predict a similar adjunctive treatment response in 2- to 18-year-old children with POS.
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Cognitive tests and subjective complaints of 30 patients with low-dose TPM monotherapy (50-200 mg/day) were retrospectively compared with those of 30 patients with OXC monotherapy at 1 year of medication. The two groups did not differ with respect to epilepsy-relevant variables, nor on baseline neuropsychological tests.
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This study investigated whether long-term treatment with antiepileptic drugs (AEDs) had negative effects on statural growth and serum calcium levels in children with epilepsy in Taiwan.
This paper demonstrates the necessity of rigorous interpretation of ISR results and close monitoring of all subject sample results.
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A double-blind crossover study was conducted in 10 volunteers. Eight-day treatment with carbamazepine, oxcarbazepine, levetiracetam, or placebo was administered in random order. Drug doses were titrated gradually to the daily target doses on day 7: carbamazepine 800 mg, oxcarbazepine 1200 mg, and levetiracetam 1500 mg. At baseline and at the end of each treatment period, participants underwent cognitive and neurophysiologic assessment. A washout period of 14 days between treatment periods was conducted.