Clinical Side Effects of Phenobarbital, Primidone, Phenytoin, Carbamazepine, and Valproate During Monotherapy in Children

Herranz, J L; Armijo, Juan A.; Arteaga, Rosa

doi:10.1111/j.1528-1157.1988.tb04237.x

Cited by 140 publications

(72 citation statements)

References 69 publications

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“…Age at first risk was defined by any neurologic event deemed to be risk factor for subsequent development for epilepsy (e.g., febrile seizure, meningoencephalitis, traumatic brain injury) or the age at first seizure. The variable of barbiturate administration was included, as these medications have been implicated in worsening mood (36,37).…”

Section: Methodsmentioning

confidence: 99%

Depression in Temporal Lobe Epilepsy Before Epilepsy Surgery

et al. 1999

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Summary:Purpose: This study examined the association of depression with laterality of epilepsy surgery in patients with temporal lobe epilepsy before standard lobectomy.Methods: Forty-nine patients presented for EEG telemetry for localization of epilepsy and eventual temporal lobectomy. Patients underwent routine neuropsychiatric evaluation blinded for epileptic focus, including ratings on depression. Patients were grouped according to right (n = 25, M = 1O/F = 15) and left (n = 24, M = 13/F = 11) temporal lobectomy. Analysis of variance included side of surgery as grouping variable and sex, general depressive, cognitive depressive, and vegetative depressive symptoms as dependent variables. x2 Analyses included categoric variables of sex, handedness, education, neuropathologic findings, and current affective disorders. Tests were performed on variables of age, epilepsy duration, and cognitive function.Results: Right and left temporal epilepsy groups did not differ with regard to sex, handedness, age, duration of epilepsy, education, cognitive function, and neuropathology. Patients with right temporal epilepsy rated higher on general, cognitive, and vegetative depression scores. Women scored higher on general, cognitive, and vegetative depression scores. Current affective disorders were more common in the right temporal epilepsy group.Conclusions: Depression ratings and diagnoses were more prominent in patients with right temporal lobe epilepsy and in women in particular. The strength of this laterality finding lies in the selection of patients, as all underwent epilepsy surgery. The finding on gender difference partly reflects the higher incidence of depression in women and needs further exploration. The laterality finding contrasts with recent findings in epilepsy, stroke, and trauma that associate depression with left hemispheric lesions. However, our results are consistent with findings in electrically hyperactive lesions such as gelastic and dacrystic epilepsy.

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Section: Methodsmentioning

confidence: 99%

Depression in Temporal Lobe Epilepsy Before Epilepsy Surgery

et al. 1999

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“…The incidence of AE during the rapid switchover was not higher than that expected in patients started on CBZ with slow-dose increments (16)(17)(18)(19)(20), despite the fact that they reached a mean CBZ C,, of >9 mg/l, which often has been associated with AE occurrence (16,21). In addition, discontinuation of CBZ because of AE was no different among our patients (7%) than in a CBZ monotherapy trial of newly diagnosed patients (11%) who were started slowly on this drug with target serum concentrations in the midtherapeutic range (22).…”

Section: Discussionmentioning

confidence: 97%

Rapid Switchover to Carbamazepine Using Pharmacokinetic Parameters

et al. 1998

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Summary:Purpose: The standard practice of switching patients to carbamazepine (CBZ) involves initiating a low dose and raising it by small increments until the desired dose is reached, to avoid intolerable adverse effects (AE). In a pilot study, a protocol using single-dose kinetic studies was developed to switch patients to CBZ through rapid-dose increments and to manage concurrent rapid taper of the previous antiepileptic drugs (AEDs) without causing AE. The purpose of this prospective study was (a) to reassess whether a rapid switchover to CBZ could be done with minimal or no AE and without causing an increase in seizures; (b) to determine whether the maintenance dose of CBZ predicted at the time of the singledose kinetic study can yield the desired concentration at steady state (C,,); and (c) to determine the degree to which the calculated maintenance dose of CBZ will need to be adjusted after the previous AED has been discontinued for a four-week period.Methods: Twenty-five patients taking phenytoin (PHT) and/ or phenobarbital (PB) andor primidone (PRM) underwent a rapid switchover to CBZ following a 10 mg/kg single-dose kinetic study (day 1) which allowed calculation of a maintenance dose necessary to yield a mean C,, of 10.2 (&2.2) mgA. On day 2, patients received a CBZ dose equivalent to 10 mgkg + 200 mg; thereafter, they underwent daily dose increments of 200 mg until the calculated maintenance dose was reached. Dose increments were modified in the case of AE. Concurrent tapering of the previous AED was started as of day 1: PHT by 100 mg/day, while PB and PRM were stopped on day 1; PB was restarted before patients were to be discharged from the hospital if a PB serum concentration above 10 mgA was identified at that time. Pharmacokinetic data and occurrence of AE were compared between the two groups at the time of the single-dose kinetic study, at the completion of the switchover to CBZ, and 4 weeks after discontinuation of the previous AED.Results: All patients completed the switchover to CBZ within a mean time period of 6 days (22), reaching a mean maintenance dose of 1,639 mg/day (rt370) which yielded a mean C,, of 11.3 (k3.2) mg/l. The maintenance dose had to be lowered by 20.4% (28.3) in 59% of patients within the four-week period following discontinuation of at least one of the previous AEDs. None of the patients experienced an increase in seizure frequency relative to baseline. Fifteen (60%) patients had no AE; five (20%) experienced AE of mild severity. AE rated as moderately severe (n = 4) or severe (n = 1) occurred in patients with a static encephalopathy (p = 0.02, Fisher's exact test) and among patients 2-55 years (p = 0.017, Fisher's exact test).Conclusions: A rapid switch-over to CBZ from PHT, PB, or PRM can be carried out safely with no, or minimal, AE in young adults, unless they suffer from static encephalopathy.

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“…Side-effects of antiepileptic drugs impair the quality of life in epileptic patients and contribute considerably to diminishing the patients' compliance. The occurrence of such unwanted side-effects, however, is a common observation in the everyday practice of epilepsy-patient care [1], but quantitative data on the prevalence of side-effects in epileptic patient populations are rare [2][3][4]. The same applies to information on the possible correlation between antiepileptic drugs plasma concentrations and the occurrence of such side-effects.…”

Section: Introductionmentioning

confidence: 98%

Side-effects of drugs in epileptic patients

Termond

Theeuwes²,

Schaap

et al. 1990

Pharmaceutisch Weekblad Scientific Edition

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Drug therapy in patients suffering from various forms of epilepsy aims at the administration of such dosages of antiepileptic drugs as to produce significant reduction of seizures without the occurrence of serious side-effects. To assess these side-effects 75 patients (48 males, 27 females) with epilepsy, attending an out-patient clinic were studied prospectively and data were collected regarding diagnosis, drug use and side-effects. Primarily generalized epilepsy and partial complex epilepsy with secondary generalization are the most prevailing categories. 69% (52) Of the patients are treated with monotherapy, with carbamazepine as the drug most frequently prescribed (30/52). Side-effects were scored after examining and questioning the patient with the help of a standard questionnaire. A distinction was made between groups of side-effects, being systemic, anamnestic, dermatological, neurological or miscellaneous. Also, haematological and biochemical changes were looked for. In the monotherapy group 26/52 (50%) of the patients showed side-effects (23 patients with 1, 2 with 2, 1 with 3 side-effects), and in the polytherapy group 15/23 (65%) (8 patients with 1, 7 with 2 side-effects). Adverse drug reactions were hardly related to the plasma concentration category. Between 50-60% of the patients at sub-therapeutic and low-therapeutic plasma levels complained of side-effects. No clear relationship between the clinical efficacy and the side-effects could be established. The clinical custom, among others, to titrate the dose according to the disappearance or appearance of side-effects seems open for discussion.

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Clinical Side Effects of Phenobarbital, Primidone, Phenytoin, Carbamazepine, and Valproate During Monotherapy in Children

Cited by 140 publications

References 69 publications

Depression in Temporal Lobe Epilepsy Before Epilepsy Surgery

Depression in Temporal Lobe Epilepsy Before Epilepsy Surgery

Rapid Switchover to Carbamazepine Using Pharmacokinetic Parameters

Side-effects of drugs in epileptic patients

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