A Comparison of the Effectiveness of Primidone Versus Carbamazepine in Epileptic Outpatients

Rodin, Ervin Y.; Rim, Choon Soo; Kitano, Hideki; Lewis, Ronald; Rennick, Phillip M.

doi:10.1097/00005053-197607000-00006

Cited by 50 publications

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“…About 50% of our women had idiopathic epilepsies, and 53% had generalized seizures. This is in keeping with the common belief that complex partial seizures and temporal lobe epilepsy are associated with more interictal depression than is generalized epilepsy (13)(14)(15)24,(32)(33)(34)(35)(36)(37)(38)(39)(40).…”

Section: Discussionsupporting

confidence: 84%

Depression and Altered Quality of Life in Women with Epilepsy of Childbearing Age

2003

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Summary:Purpose: To calculate the prevalence of depression in a referral population of women of childbearing age, to define the factors associated with depression, and to assess health-related quality of life (HRQOL) in the same population.Methods: The 642 consecutive women with epilepsy aged 18-55 years were enrolled by 40 neurologists over an 8-month period and asked to give details on selected demographic and clinical features regarding the disease, any associated clinical condition, and any drug treatment. Depression was diagnosed by using the Hamilton depression scale and HRQOL was measured through the SF-36 form. Demographic, clinical, and therapeutic risk factors for depression were searched for within the study population.Results: Depression (any severity) was present at interview in 242 women, giving a prevalence rate of 37.7% [95% confidence interval (CI), 33.9-41.6]. Mild depression was reported by 18.5% of women, moderate depression by 8.6%, major depression by 10.3%, and severe depression by 0.3%. Factors found to be independently associated with depression (any severity) included treatment of associated conditions [relative risk (RR), 1.5; 95% CI, 1.2-1.8), concurrent disability (RR, 1.3; 95% CI, 1.0-1.6), seizures in the preceding 6 months (RR, 1.4; 95% CI, 1.1-1.7), and being unemployed or a housewife (RR, 1.3; 95% CI, 1.0-1.5). Factors associated with moderate to severe depression included treatment for associated conditions (RR, 2.0; 95% CI, 1.4-2.7), seizures in the preceding 6 months (RR, 1.7; 95% CI, 1.2-2.5), and being unemployed or a housewife (RR, 1.6; 95% CI, 1.1-2.2). Compared with normal women of similar age, patients with epilepsy tended to present lower scores for each HRQOL domain (mostly Role Physical, General Health, Social Functioning, and Role Emotional). However, when the analysis was limited to nondepressed women with epilepsy, any difference disappeared.Conclusions: Women with epilepsy of childbearing age are at high risk of depression. Factors associated with depression include lack of occupation, the presence of an underlying disabling condition (with treatment), and the severity of epilepsy. Compared with the general population, depressed women have greater impairment of HRQOL with epilepsy, which reflects the physical, social, and emotional implications of the disease. Key Words: Depression-Epilepsy-HRQOL.The association between epilepsy and depression is well known. The prevalence of interictal depression in patients with epilepsy has been shown to range between 9 and 55%, depending on the sample population and the methods of assessment (1). By contrast, the prevalence of depression in the general population is thought to be 1-3% in men and 2-9% in women (2). A history of depression is significantly more frequent in patients with epilepsy than in nonepilepsy controls (3), and major depression is a risk factor for seizures (4). Several factors have been implicated in the development of depression in patients with epilepsy, including genetic susceptibility, etiology, seizu...

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Section: Discussionsupporting

confidence: 84%

Depression and Altered Quality of Life in Women with Epilepsy of Childbearing Age

2003

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“…Several studies have found depression to be more common in patients with TLE (27,32,36,58,(71)(72)(73)(74). Others, however have not confirmed the excess psychiatric morbidity in these patients with TLE (29, 75,76 (81) assessed 30 patients with TLE, 25 with non-temporal lobe focal epilepsy, and 19 with multifocal onset/generalized epilepsy, referred to a teaching hospital epilepsy investigation unit.…”

Section: Seizure Typementioning

confidence: 99%

Depression in Epilepsy: Etiology, Phenomenology, and Treatment

1999

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Summary: A history of depression or depressive symptomatology has been reported in up to two-thirds of patients with medically intractable epilepsy, whereas community studies have demonstrated affective disorder only in a quarter of these patients. Depression has been reported peri-and interictally. However, differentiation may be difficult in patients with frequent seizures. Most authors have found no correlation between depression and epilepsy variables. However, complex partial seizures, especially of temporal lobe origin, appear to be etiologic factors, particularly in men with left-sided foci. Depression is also more common in patients treated with polytherapy especially with barbiturates, phenytoin, and vigabatrin. Depression has also been described de novo after temporal lobectomy. Psychosocial factors also play a part, but underlying risk factors (e.g., genetic, endocrine and metabolic) may explain the increased rates of depression in people with epilepsy compared to those with other neurologic and chronic medical conditions. The depression appears to be endogenous. Patients tend to exhibit fewer neurotic traits and more psychotic symptoms such as paranoia, delusions, and persecutory auditory hallucinations. Treatment approaches include psychotherapy, rationalization of antiepileptic drug medication, antidepressant treatment, and ECT. The tricyclic and related antidepressants appear to be epileptogenic, especially in people at high risk (personal or family history of seizures, abnormal pretreatment EEG, brain damage, alcohol or substance abuse/withdrawal and concurrent use of CNS-active medication). Seizures tend to occur early in treatment or after dose increments, especially if rapidly titrated. There is little evidence that the newer antidepressants, e.g., selective serotonin reuptake inhibitors, moclobemide, venlafaxine, or nefazodone are more epileptogenic than placebo.

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“…The addition of adverse effects is a pharmacodynamic interaction, quite distinct from the pharmacokinetic interactions that take place in the liver and Drug Sa fety 1996 May; 14 (5) alter the concentrations of the drugs in question. The most common of these have been discussed at length: induction of hepatic metabolism, inhibition of metabolism, and alteration of drug binding to serum albumin.…”

Section: Discussionmentioning

confidence: 99%

“…All riQhts reserved.clinically very important for some agents, Drugs that are either very rapidly or very extensively absorbed will develop large peak serum concentrations shortly after administration, leading to the transient evolution of distressing symptoms even when the steady-state trough concentration is relatively low and the patient is otherwise asymptomatic. This is particularly common for carbamazeDrug Safety 1996 May; 14(5) …”

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confidence: 99%

Dose-Related Adverse Effects of Anticonvulsants

Troupin

1996

Drug Safety

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The serum concentration at which a given drug has full efficacy in delivering seizure control bears no predictable relationship to the concentration at which adverse effects will appear. In theory, the threshold for adverse effects should be considerably higher than that for efficacy. For each agent this obviously happens most of the time, or the anticonvulsant would not be on the market, but there are also patients in whom this relationship is reversed. The adverse effects of this class of drugs are discussed from three points of view: the adverse effect type, the kinetic factors that so frequently determine the presence of adverse effects, and the specific characteristics of each drug. Some less well recognized adverse effects syndromes that are not strictly dose related are considered. The importance of adverse effects in therapeutic monitoring is then addressed, and some strategies for maximising efficacy without the burden of long term functional impairment or distress are discussed. The usefulness of monotherapy is stressed with due attention to rational choice of second drugs, when necessary, based on mechanisms of antiepileptic action and adverse effects profiles. While most of these symptoms evolve gradually, there are times when acute, drastic, and even life threatening clinical overdose situations present themselves. Special attention is given to these scenarios, drawing on the drug profiles and clinical pharmacokinetics that define these events to propose methods of coping with the problems efficiently and effectively.

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A Comparison of the Effectiveness of Primidone Versus Carbamazepine in Epileptic Outpatients

Cited by 50 publications

References 0 publications

Depression and Altered Quality of Life in Women with Epilepsy of Childbearing Age

Depression and Altered Quality of Life in Women with Epilepsy of Childbearing Age

Depression in Epilepsy: Etiology, Phenomenology, and Treatment

Dose-Related Adverse Effects of Anticonvulsants

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