Carbamazepine monotherapy with maternal serum levels within the reference range does not impair intelligence in prenatally exposed offspring. Exposures to polytherapy and to valproate during pregnancy were associated with significantly reduced verbal intelligence. The independent effects of valproate remain unconfirmed because the results were confounded by low maternal education and polytherapy.

The quality of life for 46 stroke survivors under the age of 65 years in a stroke register was studied 4 years after their first stroke. A questionnaire covering four domains of life (working conditions, activities at home, family relationships, and leisure time activities) was used for investigation of the quality of life. The results showed that in spite of a good recovery in terms of discharge from the hospital, activities of daily living, and return to work, the quality of life of most patients (83%) had not been restored to the prestroke level. Deterioration among the several domains of life ranged from 39% to 80%, the lowest being in the domain of activities at home and the highest in the domain of leisure time activities. Hemispheral localization of the lesion, paresis, coordination disturbances, and especially subjective tendency to depression were highly correlated with a deterioration in the quality of life. Dependence in activities of daily living and an inability to return to work were also associated with the lack of restoration. Our results suggest that much more attention should be paid to the quality of life of stroke patients. (Stroke 1988;19:1101-1107)S troke is a major, chronically disabling neurologic disease that often radically and permanently changes the lives of its victims. Medical treatment and occupational and physical therapy have been used to help stroke patients. Discharge from the hospital and the degree of independence achieved in activities of daily living (ADL) have been the usual criteria 1 -5 used to measure the success of rehabilitation. Although many studies 6 -8 have shown that stroke rehabilitation can help a patient to regain and maintain functional abilities, the efficacy of therapeutic interventions has been questioned. However, little attention has been given to the quality of life following expensive, often long treatment. As Feigenson 9 points out, "unless this factor is considered, any statistics used in analysing the benefits of treatment are incomplete and misleading."Although the concept has been only loosely defined, there is agreement that quality of life refers to a person's subjective well-being and life satisfaction and that it includes mental and physical health, material well-being, interpersonal relationships within and outside the family, work and other activities in the community, personal development and fulfillment, and active recreation.10 -13 Despite the fact that the basic definition of quality of life From the Department of Neurology, University of Helsinki, Helsinki, Finland.Supported by the Finnish Heart Association. Address for correspondence: Marja-Liisa Niemi, MA, Department of Neurology, University of Helsinki, Haartmaninkatu 4, 00290 Helsinki, Finland. Received November 12, 1987; accepted April 26, 1988. seems to apply to most people, there is a need to focus its evaluation directly on the problems created by illness and disability. 911 The aim of our study was to investigate the quality of life in relation to recovery from stroke. Sub...

The recovery from stroke of 154 survivors out of 255 stroke patients was analyzed. The outcomes documented were: discharge from hospital, activities of daily living (ADL) and return to work. A clear improvement in neurological and neuropsychological deficits was seen from the acute stage to three months, and this continued to twelve months, but to a lesser degree. 69% and 78% respectively, of the patients were at home three and twelve months after stroke. Independence in ADL increased from 32% acutely to 62% and 68% by three and twelve months, respectively. Of those gainfully employed prior to stroke, 55% had returned to work after twelve months. As a group, SAH patients seemed to recover better, but, for those that could be age-matched with infarction patients, there was no difference in outcome. Old age, acute stage hemiparesis, impairment of intelligence and memory, visuoperceptual deficits, nonadequate emotional reactions, and living alone all had a major negative influence on outcome. This study suggests that neurological and neuropsychological deficits, as well as emotional reactions, influence the outcomes after stroke, and all should be taken into consideration in prognosis.

Summary:Purpose: Weight gain is an important adverse effect of valproate (VPA) therapy, and it is associated with hyperinsulinemia and hyperandrogenism in women with epilepsy. Leptin is considered a signaling factor regulating body weight and energy metabolism. In human subjects, obesity is in general associated with elevated serum leptin levels, suggesting decreased sensitivity to leptin. The present study aimed at evaluating the role of insulin and leptin in VPA-related obesity.Methods: Body mass index (BMI) was calculated, and serum insulin and leptin levels were measured in 81 patients with epilepsy taking VPA and in 51 healthy control subjects.Results: Forty (49%) of the patients taking VPA and 25 (49%) of the control subjects were obese. The mean insulin levels were higher in VPA-treated patients than in the control subjects despite similar BMI values, when all subjects were included in the comparison. Both obese male and female patients taking VPA had higher serum insulin levels than the respective control subjects with similar BMI values. Serum insulin levels also were higher in lean male and lean female patients compared with the lean control subjects of same sex. Serum leptin levels did not differ between the VPA-treated patients and the control subjects.Conclusions: Both obese and lean patients taking VPA for epilepsy have hyperinsulinemia, suggesting development of insulin resistance. This may be one of the factors leading to weight gain during VPA treatment. However, the results of the present study do not suggest an independent role for leptin in the pathogenesis of VPA-related obesity.

Summary:Purpose: Antiepileptic drugs (AEDs) may affect serum thyroid hormone concentrations. This study aimed to evaluate thyroid function in men taking carbamazepine (CBZ), oxcarbazepine (OCBZ), or valproate (VPA) for epilepsy.Methods: Ninety men with epilepsy (40 taking CBZ, 29 taking OCBZ, and 21 taking VPA monotherapy) and 25 control subjects participated in the study. After clinical examination, a blood sample for hormone, ␥-glutamyl-transferase (GGT) and antibody (ab) assays was obtained.Results: Serum thyroxine (T 4 ) and free thyroxine (FT 4 ) concentrations were low in men taking CBZ or OCBZ. Forty-five percent of men taking CBZ and 24% of men taking OCBZ had serum T 4 and/or FT 4 levels below the reference range. However, no correlations were found between T 4 or FT 4 and GGT concentrations in men taking CBZ or OCBZ. Thirteen percent of men taking CBZ, 17% of men taking OCBZ, and 6% of control men had increased levels of thyroid peroxidase (TPO)-ab and/or thyroglobulin (TG)-ab, but these were not associated with altered serum thyroid hormone concentrations. Serum triiodothyronine and thyrotropin levels in men taking CBZ or OCBZ were normal. In men taking VPA, the concentrations of thyroid hormones, thyrotropin, and antithyroid ab were normal.Conclusions: Serum thyroid hormone concentrations are low in CBZ-or OCBZ-treated men. However, these low levels do not seem to be due to liver enzyme induction or activation of immunologic mechanisms. Therefore, interference with hypothalamic regulation of thyroid function by CBZ and OCBZ seems possible. VPA does not have any significant effects on thyroid function. Key Words: Epilepsy-Thyroid hormonesCarbamazepine-Oxcarbazepine-Valproate.The endocrine effects of carbamazepine (CBZ) have been well documented. A decrease in serum thyroid hormone levels can already be detected in patients 2 months after starting CBZ (1). However, serum thyrotropin concentrations do not change, and the clinical significance of low serum thyroid hormone concentrations is unclear (1-8). The altered thyroid function during CBZ medication has been attributed to induction of the hepatic P-450 enzyme system and the consequent increase in the metabolism of thyroid hormones (9,10).Oxcarbazepine (OCBZ) is a novel antiepileptic drug (AED) that structurally resembles CBZ. However, the metabolic pathway of OCBZ in the liver is different from that of CBZ. OCBZ is mainly reduced, instead of being oxidized. Consequently, OCBZ does not appear to induce the hepatic P-450 enzyme system (11). Therefore, it has been suggested that OCBZ may not have effects on endocrine function equivalent to those of CBZ, and replacing CBZ with OCBZ resulted in deinduction of liver enzyme levels and short-term restoration of normal endocrine function in men with epilepsy (10,12). However, OCBZ may induce the hepatic P-450 enzyme system when given in high doses, and recent studies have shown that high doses of OCBZ may also affect sex hormone metabolism in men with epilepsy (13). Furthermore, OCBZ is well known to decreas...