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Fong ISH, Yiu CH, Abelev MD, Allaf S, Begley DA, Bugeja BA, Khor KE, Rimington J, Penm J. Supply of opioids and information provided to patients after surgery in an Australian hospital: A cross-sectional study. Anaesth Intensive Care 2023; 51:340-347. [PMID: 37688434 PMCID: PMC10493037 DOI: 10.1177/0310057x231163890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Opioids are commonly prescribed to manage pain after surgery. However, excessive supply on discharge can increase patients' risk of persistent opioid use and contribute to the reservoir of unused opioids in the community that may be misused. This study aimed to evaluate the use of opioids in Australian surgical patients after discharge and patient satisfaction with the provision of opioid information after discharge. This prospective cohort study was conducted at a tertiary referral and teaching hospital. Surgical patients were called 7-28 days after discharge to identify their opioid use and the information that they received after discharge. In total, 66 patients responded. Most patients underwent orthopaedic surgery (45.5%; 30/66). The median days of opioids supplied on discharge was 5 (IQR 3-5). In total, 40.9% (27/66) of patients had >50% of their opioids remaining. Patients undergoing orthopaedic surgery were less likely to have >50% of their opioids remaining (P = 0.045), whilst patients undergoing urological or renal surgeries were significantly more likely (P = 0.009). Most patients recalled receiving information about their opioids (89.4%; 59/66). However, the majority (51.5%; 34/66) did not recall receiving any information about the signs of opioid toxicity and interactions between opioids and alcohol. In conclusion, around 40% of patients had more than half of their opioid supply remaining after they ceased taking their opioid. Although most patients recalled receiving information about their opioids, more than half did not recall receiving any information about the signs of opioid toxicity or interactions between opioids and alcohol.
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Affiliation(s)
- Ian SH Fong
- Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
| | - Chin Hang Yiu
- School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Camperdown, Australia
| | - Matthew D Abelev
- School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Camperdown, Australia
| | - Sara Allaf
- School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Camperdown, Australia
| | - David A Begley
- Department of Pain Management. Prince of Wales Hospital, Randwick, Australia
| | - Bernadette A Bugeja
- Department of Pain Management. Prince of Wales Hospital, Randwick, Australia
| | - Kok Eng Khor
- Department of Pain Management. Prince of Wales Hospital, Randwick, Australia
| | - Joanne Rimington
- District Pharmacy Services, South Eastern Sydney Local Health District, Randwick, Australia
| | - Jonathan Penm
- Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
- School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Camperdown, Australia
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Yiu CH, Gnjidic D, Patanwala A, Fong I, Begley D, Khor KE, Rimington J, Bugeja B, Penm J. Opioid-related adverse drug events in surgical patients: risk factors and association with clinical outcomes. Expert Opin Drug Saf 2022; 21:1211-1223. [PMID: 35234566 DOI: 10.1080/14740338.2022.2049230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Opioid analgesics are commonly used to treat acute post-operative pain. The primary objective of this study was to identify the risk factors for opioid related adverse drug events (ORADEs) in surgical patients and the association between ORADEs and clinical outcomes. RESEARCH DESIGN AND METHODS : A retrospective cohort study was conducted using data from July 2016 to April 2020. ORADEs were defined using International Classification of Diseases 10th Revision Australian Modification codes. Multivariate logistic regression was performed to identify risk factors for ORADEs. To investigate the association between ORADEs and clinical outcomes, propensity score matching was performed. RESULTS Among 17,886 surgical patients who received opioid analgesics during hospital stay, 1,814 patients (10.2%) experienced ORADEs. Risk factors for general ORADEs included advanced age, comorbidities, concurrent use of benzodiazepines or gabapentionoids and a higher opioid daily dose. Patients who experienced ORADEs were associated with longer length of stay (LOS, Rate Ratio 3.00, 95% CI 2.97-3.04) but similar 28-day readmission rate (Odds Ratio 0.89, 95% CI 0.71-1.11). CONCLUSIONS Risk factors for general ORADEs were advanced age, specific comorbidities, use of benzodiazepines or gabapentionoids and higher opioid dose. Routine use of opioids with gabapentionoids should be avoided and only used after careful consideration.
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Affiliation(s)
- Chin Hang Yiu
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Science Rd, Camperdown, New South Wales, Australia
| | - Danijela Gnjidic
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Science Rd, Camperdown, New South Wales, Australia
| | - Asad Patanwala
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Science Rd, Camperdown, New South Wales, Australia.,Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, New South Wales, Australia
| | - Ian Fong
- Prince of Wales Hospital, 320-346 Barker St, Randwick, New South Wales, Australia
| | - David Begley
- Prince of Wales Hospital, 320-346 Barker St, Randwick, New South Wales, Australia
| | - Kok Eng Khor
- Prince of Wales Hospital, 320-346 Barker St, Randwick, New South Wales, Australia
| | - Joanne Rimington
- South East Sydney Local Health District, Randwick, New South Wales, Australia
| | - Bernadette Bugeja
- South East Sydney Local Health District, Randwick, New South Wales, Australia
| | - Jonathan Penm
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Science Rd, Camperdown, New South Wales, Australia.,Prince of Wales Hospital, 320-346 Barker St, Randwick, New South Wales, Australia
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Yiu CH, Vitharana N, Gnjidic D, Patanwala AE, Fong I, Rimington J, Begley D, Bugeja B, Penm J. Patient risk factors for opioid‐related adverse drug events in hospitalized patients: A systematic review. Pharmacotherapy 2022; 42:194-215. [DOI: 10.1002/phar.2666] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Chin Hang Yiu
- Faculty of Medicine and Health Sydney Pharmacy School The University of Sydney Camperdown New South Wales Australia
| | - Nilru Vitharana
- Department of Anaesthesia The Children’s Hospital at Westmead Westmead New South Wales Australia
| | - Danijela Gnjidic
- Faculty of Medicine and Health Sydney Pharmacy School The University of Sydney Camperdown New South Wales Australia
| | - Asad E. Patanwala
- Faculty of Medicine and Health Sydney Pharmacy School The University of Sydney Camperdown New South Wales Australia
- Department of Pharmacy Royal Prince Alfred Hospital Camperdown New South Wales Australia
| | - Ian Fong
- Department of Pharmacy Prince of Wales Hospital Randwick New South Wales Australia
| | - Joanne Rimington
- District Pharmacy Services South Eastern Sydney Local Health District Randwick New South Wales Australia
| | - David Begley
- Department of Pain Management Prince of Wales Hospital Randwick New South Wales Australia
| | - Bernadette Bugeja
- Department of Pain Management Prince of Wales Hospital Randwick New South Wales Australia
| | - Jonathan Penm
- Faculty of Medicine and Health Sydney Pharmacy School The University of Sydney Camperdown New South Wales Australia
- Department of Pharmacy Prince of Wales Hospital Randwick New South Wales Australia
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Kreuzer P, Lanske D, Magass C, Merschmeyer M, Meyer A, Papacz P, Pieta H, Reithler H, Schmitz SA, Sonnenschein L, Steggemann J, Teyssier D, Bontenackels M, Davids M, Duda M, Flügge G, Geenen H, Giffels M, Haj Ahmad W, Heydhausen D, Kress T, Kuessel Y, Linn A, Nowack A, Perchalla L, Pooth O, Rennefeld J, Sauerland P, Stahl A, Thomas M, Tornier D, Zoeller MH, Martin MA, Behrenhoff W, Behrens U, Bergholz M, Bethani A, Borras K, Cakir A, Campbell A, Castro E, Dammann D, Eckerlin G, Eckstein D, Flossdorf A, Flucke G, Geiser A, Hauk J, Jung H, Kasemann M, Katkov I, Katsas P, Kleinwort C, Kluge H, Knutsson A, Krämer M, Krücker D, Kuznetsova E, Lange W, Lohmann W, Mankel R, Marienfeld M, Melzer-Pellmann IA, Meyer AB, Mnich J, Mussgiller A, Olzem J, Pitzl D, Raspereza A, Raval A, Rosin M, Schmidt R, Schoerner-Sadenius T, Sen N, Spiridonov A, Stein M, Tomaszewska J, Walsh R, Wissing C, Autermann C, Blobel V, Bobrovskyi S, Draeger J, Enderle H, Gebbert U, Kaschube K, Kaussen G, Klanner R, Lange J, Mura B, Naumann-Emme S, Nowak F, Pietsch N, Sander C, Schettler H, Schleper P, Schröder M, Schum T, Schwandt J, Stadie H, Steinbrück G, Thomsen J, Barth C, Bauer J, Buege V, Chwalek T, De Boer W, Dierlamm A, Dirkes G, Feindt M, Gruschke J, Hackstein C, Hartmann F, Heinrich M, Held H, Hoffmann KH, Honc S, Komaragiri JR, Kuhr T, Martschei D, Mueller S, Müller T, Niegel M, Oberst O, Oehler A, Ott J, Peiffer T, Quast G, Rabbertz K, Ratnikov F, Ratnikova N, Renz M, Saout C, Scheurer A, Schieferdecker P, Schilling FP, Schott G, Simonis HJ, Stober FM, Troendle D, Wagner-Kuhr J, Weiler T, Zeise M, Zhukov V, Ziebarth EB, Daskalakis G, Geralis T, Kesisoglou S, Kyriakis A, Loukas D, Manolakos I, Markou A, Markou C, Mavrommatis C, Ntomari E, Petrakou E, Gouskos L, Mertzimekis TJ, Panagiotou A, Stiliaris E, Evangelou I, Foudas C, Kokkas P, Manthos N, Papadopoulos I, Patras V, Triantis FA, Aranyi A, Bencze G, Boldizsar L, Hajdu C, Hidas P, Horvath D, Kapusi A, Krajczar K, Sikler F, Veres GI, 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MA, Krofcheck D, Tam J, Yiu CH, Butler PH, Doesburg R, Silverwood H, Ahmad M, Ahmed I, Asghar MI, Hoorani HR, Khan WA, Khurshid T, Qazi S, Brona G, Cwiok M, Dominik W, Doroba K, Kalinowski A, Konecki M, Krolikowski J, Frueboes T, Gokieli R, Górski M, Kazana M, Nawrocki K, Romanowska-Rybinska K, Szleper M, Wrochna G, Zalewski P, Almeida N, Bargassa P, David A, Faccioli P, Parracho PGF, Gallinaro M, Musella P, Nayak A, Ribeiro PQ, Seixas J, Varela J, Belotelov I, Bunin P, Golutvin I, Kamenev A, Karjavin V, Konoplyanikov V, Kozlov G, Lanev A, Moisenz P, Palichik V, Perelygin V, Shmatov S, Smirnov V, Volodko A, Zarubin A, Golovtsov V, Ivanov Y, Kim V, Levchenko P, Murzin V, Oreshkin V, Smirnov I, Sulimov V, Uvarov L, Vavilov S, Vorobyev A, Vorobyev A, Andreev Y, Dermenev A, Gninenko S, Golubev N, Kirsanov M, Krasnikov N, Matveev V, Pashenkov A, Toropin A, Troitsky S, Epshteyn V, Gavrilov V, Kaftanov V, Kossov M, Krokhotin A, Lychkovskaya N, Popov V, Safronov G, Semenov S, Stolin V, Vlasov 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I, Savin A, Smith WH, Swanson J, Weinberg M. Measurement of the inclusive jet cross section in pp collisions at √s = 7 TeV. Phys Rev Lett 2011; 107:132001. [PMID: 22026843 DOI: 10.1103/physrevlett.107.132001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Indexed: 05/31/2023]
Abstract
The inclusive jet cross section is measured in pp collisions with a center-of-mass energy of 7 TeV at the Large Hadron Collider using the CMS experiment. The data sample corresponds to an integrated luminosity of 34 pb(-1). The measurement is made for jet transverse momenta in the range 18-1100 GeV and for absolute values of rapidity less than 3. The measured cross section extends to the highest values of jet p(T) ever observed and, within the experimental and theoretical uncertainties, is generally in agreement with next-to-leading-order perturbative QCD predictions.
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Betts RR, Callner J, Cavanaugh R, Dragoiu C, Gauthier L, Gerber CE, Hamdan S, Hofman DJ, Khalatyan S, Kunde GJ, Lacroix F, Malek M, O'Brien C, Silvestre C, Smoron A, Strom D, Varelas N, Akgun U, Albayrak EA, Bilki B, Clarida W, Duru F, Lae CK, McCliment E, Merlo JP, Mermerkaya H, Mestvirishvili A, Moeller A, Nachtman J, Newsom CR, Norbeck E, Olson J, Onel Y, Ozok F, Sen S, Wetzel J, Yetkin T, Yi K, Barnett BA, Blumenfeld B, Bonato A, Eskew C, Fehling D, Giurgiu G, Gritsan AV, Guo ZJ, Hu G, Maksimovic P, Rappoccio S, Swartz M, Tran NV, Whitbeck A, Baringer P, Bean A, Benelli G, Grachov O, Kenny Iii RP, Murray M, Noonan D, Sanders S, Wood JS, Zhukova V, Barfuss AF, Bolton T, Chakaberia I, Ivanov A, Khalil S, Makouski M, Maravin Y, Shrestha S, Svintradze I, Wan Z, Gronberg J, Lange D, Wright D, Baden A, Boutemeur M, Eno SC, Ferencek D, Gomez JA, Hadley NJ, Kellogg RG, Kirn M, Lu Y, Mignerey AC, Rossato K, Rumerio P, Santanastasio F, Skuja A, Temple J, Tonjes MB, Tonwar SC, Twedt E, Alver B, Bauer G, Bendavid J, Busza W, Butz E, Cali IA, Chan M, Dutta V, Everaerts P, Gomez Ceballos G, Goncharov M, Hahn KA, Harris P, Kim Y, Klute M, Lee YJ, Li W, Loizides C, Luckey PD, Ma T, Nahn S, Paus C, Ralph D, Roland C, Roland G, Rudolph M, Stephans GSF, Stöckli F, Sumorok K, Sung K, Wenger EA, Xie S, Yang M, Yilmaz Y, Yoon AS, Zanetti M, Cooper SI, Cushman P, Dahmes B, De Benedetti A, Dudero PR, Franzoni G, Haupt J, Klapoetke K, Kubota Y, Mans J, Rekovic V, Rusack R, Sasseville M, Singovsky A, Cremaldi LM, Godang R, Kroeger R, Perera L, Rahmat R, Sanders DA, Summers D, Bloom K, Bose S, Butt J, Claes DR, Dominguez A, Eads M, Keller J, Kelly T, Kravchenko I, Lazo-Flores J, Malbouisson H, Malik S, Snow GR, Baur U, Godshalk A, Iashvili I, Jain S, Kharchilava A, Kumar A, Shipkowski SP, Smith K, Alverson G, Barberis E, Baumgartel D, Boeriu O, Chasco M, Reucroft S, Swain J, Trocino D, Wood D, Zhang J, Anastassov A, Kubik A, Odell N, Ofierzynski RA, Pollack B, Pozdnyakov A, Schmitt M, Stoynev S, Velasco M, Won S, Antonelli L, Berry D, Hildreth M, Jessop C, Karmgard DJ, Kolb J, Kolberg T, Lannon K, Luo W, Lynch S, Marinelli N, Morse DM, Pearson T, Ruchti R, Slaunwhite J, Valls N, Wayne M, Ziegler J, Bylsma B, Durkin LS, Gu J, Hill C, Killewald P, Kotov K, Ling TY, Rodenburg M, Williams G, Adam N, Berry E, Elmer P, Gerbaudo D, Halyo V, Hebda P, Hunt A, Jones J, Laird E, Lopes Pegna D, Marlow D, Medvedeva T, Mooney M, Olsen J, Piroué P, Quan X, Saka H, Stickland D, Tully C, Werner JS, Zuranski A, Acosta JG, Huang XT, Lopez A, Mendez H, Oliveros S, Ramirez Vargas JE, Zatserklyaniy A, Alagoz E, Barnes VE, Bolla G, Borrello L, Bortoletto D, Everett A, Garfinkel AF, Gutay L, Hu Z, Jones M, Koybasi O, Kress M, Laasanen AT, Leonardo N, Liu C, Maroussov V, Merkel P, Miller DH, Neumeister N, Shipsey I, Silvers D, Svyatkovskiy A, Yoo HD, Zablocki J, Zheng Y, Jindal P, Parashar N, Boulahouache C, Cuplov V, Ecklund KM, Geurts FJM, Padley BP, Redjimi R, Roberts J, Zabel J, Betchart B, Bodek A, Chung YS, Covarelli R, de Barbaro P, Demina R, Eshaq Y, Flacher H, Garcia-Bellido A, Goldenzweig P, Gotra Y, Han J, Harel A, Miner DC, Orbaker D, Petrillo G, Vishnevskiy D, Zielinski M, Bhatti A, Ciesielski R, Demortier L, Goulianos K, Lungu G, Malik S, Mesropian C, Yan M, Atramentov O, Barker A, Duggan D, Gershtein Y, Gray R, Halkiadakis E, Hidas D, Hits D, Lath A, Panwalkar S, Patel R, Richards A, Rose K, Schnetzer S, Somalwar S, Stone R, Thomas S, Cerizza G, Hollingsworth M, Spanier S, Yang ZC, York A, Eusebi R, Gilmore J, Gurrola A, Kamon T, Khotilovich V, Montalvo R, Osipenkov I, Pakhotin Y, Pivarski J, Safonov A, Sengupta S, Tatarinov A, Toback D, Weinberger M, Akchurin N, Bardak C, Damgov J, Jeong C, Kovitanggoon K, Lee SW, Mane P, Roh Y, Sill A, Volobouev I, Wigmans R, Yazgan E, Appelt E, Brownson E, Engh D, Florez C, Gabella W, Issah M, Johns W, Kurt P, Maguire C, Melo A, Sheldon P, Snook B, Tuo S, Velkovska J, Arenton MW, Balazs M, Boutle S, Cox B, Francis B, Hirosky R, Ledovskoy A, Lin C, Neu C, Yohay R, Gollapinni S, Harr R, Karchin PE, Lamichhane P, Mattson M, Milstène C, Sakharov A, Anderson M, Bachtis M, Bellinger JN, Carlsmith D, Dasu S, Efron J, Flood K, Gray L, Grogg KS, Grothe M, Hall-Wilton R, Herndon M, Klabbers P, Klukas J, Lanaro A, Lazaridis C, Leonard J, Loveless R, Mohapatra A, Palmonari F, Reeder D, Ross I, Savin A, Smith WH, Swanson J, Weinberg M. Measurement of the polarization of W bosons with large transverse momenta in W + jets events at the LHC. Phys Rev Lett 2011; 107:021802. [PMID: 21797595 DOI: 10.1103/physrevlett.107.021802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Indexed: 05/31/2023]
Abstract
A first measurement of the polarization of W bosons with large transverse momenta in pp collisions is presented. The measurement is based on 36 pb⁻¹ of data recorded at √s = 7 TeV by the CMS detector at the LHC. The left-handed, right-handed, and longitudinal polarization fractions (f(L), f(R), and f₀, respectively) of W bosons with transverse momenta larger than 50 GeV are determined by using decays to both electrons and muons. The muon final state yields the most precise measurement: (f(L) - f(R))⁻ = 0.240 ± 0.036(stat) ± 0.031(syst) and f₀⁻ = 0.183 ± 0.087(stat) ± 0.123(syst) for negatively charged W bosons and (f(L) - f(R))⁺ = 0.310 ± 0.036(stat) ± 0.017(syst) and f₀⁺ = 0.171 ± 0.085(stat) ± 0.099(syst) for positively charged W bosons. This establishes, for the first time, that W bosons produced in pp collisions with large transverse momenta are predominantly left-handed, as expected in the standard model.
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Choi SW, Benzie IFF, Lam CSY, Chat SWS, Lam J, Yiu CH, Kwan JJ, Tang YH, Yeung GSP, Yeung VTF, Woo GC, Hannigan BM, Strain JJ. Inter-relationships between DNA damage, ascorbic acid and glycaemic control in Type 2 diabetes mellitus. Diabet Med 2005; 22:1347-53. [PMID: 16176195 DOI: 10.1111/j.1464-5491.2005.01647.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIMS The onset of complications in Type 2 diabetes mellitus (DM) patients cannot be predicted in individuals. Evidence suggests a link between complications and hyperglycaemia, oxidative stress and antioxidants, but causality is unclear. This study investigated baseline (entry) fasting plasma ascorbic acid, lymphocytic DNA damage and glycaemic control in Type 2 DM as part of a long-term study, the aim of which is to explore a biomarker profiling approach to identify and improve outcome in high-risk subjects. METHODS A cross-sectional study, in which DNA damage, glycated haemoglobin (HbA(1c)), fasting plasma glucose (FPG) and ascorbic acid (AA) were measured on fasting blood samples collected from 427 Type 2 DM subjects. RESULTS DNA damage was significantly (P < 0.0001) and directly correlated to both FPG (r = 0.540) and HbA(1c) (r = 0.282), and was significantly (P < 0.0001), independently and inversely correlated to plasma AA (r = -0.449). In those subjects with both poor glycaemic control and low AA (< 48 microm, the overall mean value for the study group), DNA damage was significantly (P < 0.005) higher compared with those subjects with a similar degree of hyperglycaemia but with AA above the mean. CONCLUSIONS The novel finding of a significant inverse relationship between plasma AA and DNA damage in Type 2 DM indicates that poorly controlled diabetic subjects might benefit from increased dietary vitamin C. The data also have important implications for biomarker profiling to identify those subjects who might benefit most from intensive therapy. Longer-term follow-up is underway.
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Affiliation(s)
- S W Choi
- Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Lin YY, Shih YH, Hsieh JC, Yu HY, Yiu CH, Wong TT, Yeh TC, Kwan SY, Ho LT, Yen DJ, Wu ZA, Chang MS. Magnetoencephalographic yield of interictal spikes in temporal lobe epilepsy. Comparison with scalp EEG recordings. Neuroimage 2003; 19:1115-26. [PMID: 12880837 DOI: 10.1016/s1053-8119(03)00181-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
To compare magnetoencephalography (MEG) with scalp electroencephalography (EEG) in the detection of interictal spikes in temporal lobe epilepsy (TLE), we simultaneously recorded MEG and scalp EEG with a whole-scalp neuromagnetometer in 46 TLE patients. We visually searched interictal spikes on MEG and EEG channels and classified them into three types according to their presentation on MEG alone (M-spikes), EEG alone (E-spikes), or concomitantly on both modalities (M/E-spikes). The M-spikes and M/E-spikes were localized with MEG equivalent current dipole modeling. We analyzed the relative contribution of MEG and EEG in the overall yield of spike detection and also compared M-spikes with M/E-spikes in terms of dipole locations and strengths. During the 30- to 40-min MEG recordings, interictal spikes were obtained in 36 (78.3%) of the 46 patients. Among the 36 patients, most spikes were M/E-spikes (68.3%), some were M-spikes (22.1%), and some were E-spikes (9.7%). In comparison with EEG, MEG gave better spike yield in patients with lateral TLE. Sources of M/E- and M-spikes were situated in the same anatomical regions, whereas the average dipole strength was larger for M/E- than M-spikes. In conclusion, some interictal spikes appeared selectively on either MEG or EEG channels in TLE patients although more spikes were simultaneously identified on both modalities. Thus, simultaneous MEG and EEG recordings help to enhance spike detection. Identification of M-spikes would offer important localization of irritative foci, especially in patients with lateral TLE.
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Affiliation(s)
- Y Y Lin
- Integrated Brain Research Unit, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei 112, Taiwan.
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Chang LB, Lirng JF, Teng MM, Chang CY, Yen DJ, Yiu CH. Sequential MRI studies of a patient with complex partial status--a case report. Kaohsiung J Med Sci 2001; 17:633-7. [PMID: 12168499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Complex partial status (CPS), the status epilepticus of complex partial seizure, is rarely seen in clinical practice. The clinical presentations of CPS are characterized by confusion, slowness in response, together with stereotypic or complex automatisms and occasional secondary generalization. The electroencephalographic findings of CPS reveal characteristic focal epileptiform activities of mesial temporal region. Magnetic resonance image (MRI) is the imaging method of choice for studying epilepsy, particularly when focus is in the temporal lobe. We report a 49-year-old female with diagnosis of viral encephalitis and clinical presentation of CPS. We present the sequential brain MRI findings at acute, subacute and chronic stages of this patient.
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Affiliation(s)
- L B Chang
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shin-Pai Road, Shin-Pai, Taipei, Taiwan
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Yu HY, Yiu CH, Yen DJ, Chen C, Guo YC, Kwan SY, Lin YY, Shih YH. Lateralizing value of early head turning and ictal dystonia in temporal lobe seizures: a video-EEG study. Seizure 2001; 10:428-32. [PMID: 11700997 DOI: 10.1053/seiz.2001.0538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
To investigate early head turning, we retrospectively studied videotapes of 262 seizures from 82 patients who were seizure free after temporal lobectomy. Early head movements were arbitrarily classified into non-tonic turning, tonic turning, and absence of turning. Among the 222 seizures which showed early head turning, 168 (75.7%) had non-tonic turning and 54 (24.3%) had tonic turning. The direction of the first head turning was ipsilateral to the epileptogenic foci in 132 (78.6%) seizures with non-tonic turning and in 35 (64.8%) seizures showing tonic head turning. The proportion of seizures with turning towards the ipsilateral side in the presence of tonic and non-tonic head turning were significantly different (P= 0.04). Seventy-four seizures (28.2%) evolved to secondary generalization, more frequently found in seizures with early head turning (P= 0.0015) and especially those showing tonic turning (P< 0.0001). The direction of head turning immediately preceding secondary generalization was contralateral to the lesion side in 53 seizures (82.8%). Dystonic upper limb posturing occurred in 86 seizures (32.8%), exclusively contralateral to the seizure focus, whereas 65 (75.6%) were associated with initial head turning ipsilateral to the focus. In summary, temporal lobe seizures with tonic head turning tends to secondarily generalize and the direction of head turning before secondarily generalized was contralateral to the seizure foci. Earlier in the seizures the direction of non-tonic head turning tends to be towards the epileptogenic hemisphere. In addition, dystonic posturing of the extremities is a significant lateralizing sign to the contralateral hemisphere in temporal lobe seizures.
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Affiliation(s)
- H Y Yu
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taiwan
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Yen DJ, Chen C, Shih YH, Guo YC, Liu LT, Yu HY, Kwan SY, Yiu CH. Antiepileptic drug withdrawal in patients with temporal lobe epilepsy undergoing presurgical video-EEG monitoring. Epilepsia 2001; 42:251-5. [PMID: 11240598 DOI: 10.1046/j.1528-1157.2001.15100.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate antiepileptic drug (AED) withdrawal during video-EEG monitoring in adult patients with temporal lobe epilepsy (TLE). METHODS Between 1995 and 1997, 102 consecutive patients with refractory TLE were admitted to the epilepsy monitoring unit for presurgical evaluation. Patients were monitored with ongoing AEDs being rapidly decreased and discontinued in 4-6 days. The monitoring was continued until sufficient numbers of seizures were recorded. Serum AED levels were checked at admission and after the first complex partial seizure (CPS). RESULTS In all, 89 patients had 429 CPSs (mean, 4.8 per patient), including 156 (36.4%) secondarily generalized. A mean of 153.8 h (16-451 h) was required for completing the monitoring in each patient. Forty-three (48.3%) patients experienced seizure clusters, and eight (9.0%) had generalized seizures that had never occurred or had been absent for years. However, none evolved to status epilepticus. Carbamazepine was the most commonly used AED in 71.9% of patients, followed by valproate and phenytoin. When the first CPS occurred, mean 77.2 h since the beginning of the monitoring, serum levels of these three AEDs were mostly subtherapeutic rather than minimal. CONCLUSIONS Acute AED withdrawal effectively provoked seizures in TLE patients undergoing presurgical video-EEG monitoring. However, nearly 50% of patients had seizure clusters or secondarily generalized seizures. Serum AED levels were mostly subtherapeutic when the first CPS occurred.
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Affiliation(s)
- D J Yen
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan 11217 (ROC).
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Abstract
We report on a 22-year-old assistant cook, presenting with seizures evoked by immersing his right hand into hot water of 40-46 degrees C. His seizure pattern consisted of either simple partial seizures of a tingling sensation arising in the right hand and marching to the right shoulder or a similar attack evolving to a complex partial seizure. Video-EEG monitoring recorded habitual seizures originating from the left centro-temporo-parietal region, compatible with lesions seen on brain magnetic resonance imaging. He responded well to antiepileptic drug treatment and wearing gloves while working in the kitchen. In this patient, hot water of 40-46 degrees C could maximally stimulate skin warm thermoreceptors in the right hand whereby afferent impulses subsequently activated the epileptogenic focus, adjacent to or in the sensory cortex, and elicited seizures.
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Affiliation(s)
- Y C Lee
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, 201 Sec. 2, 2 Shih-pai Road, Shih-pai, Taiwan 11217, Republic of China.
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Abstract
PURPOSE The efficacy and safety of topiramate (TPM) as adjunctive therapy in the treatment of adult Chinese patients with refractory partial epilepsy were investigated in a randomized, double-blind, placebo-controlled study. METHODS A total of 46 patients who had four or more complex partial seizures with or without secondary generalization within an 8-week baseline phase were enrolled. Patients were assigned randomly to receive TPM (n = 23) or placebo (n = 23). TPM or placebo was titrated to target doses of 300 mg/d for 6 weeks and maintained at stabilized levels for another 8 weeks. Concomitant antiepileptic drugs remained at constant previous levels during the trial. RESULTS In all, 41 patients completed the trial (TPM group, n = 20; placebo group, n = 21). The proportion of patients with a > or =50% reduction from baseline in complex partial seizures was 11 of 23 (47.8%) in the TPM group and 3 of 23 (13.0%) in the placebo group (p = 0.01). In addition, patients treated with TPM had significantly better investigator (p = 0.014) and patient (p = 0.0005) global assessment scores than patients in the placebo group. Adverse events were mostly mild and transient, with no significant differences between treatment groups. Two patients with TPM therapy complained of weight loss. Routine blood cell counts and other laboratory results showed no significant changes from baseline in either treatment group. CONCLUSIONS TPM 300 mg/d is effective and well tolerated as treatment for refractory partial epilepsy in adults.
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Affiliation(s)
- D J Yen
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taiwan, Republic of China
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Abstract
We report 3 cases presenting ictal vomiting during partial seizures of temporal lobe origin. Two patients had complex partial seizures accompanying vomiting characteristics. Ictal vomiting occurred early in the course of the seizure when rhythmic discharges involved predominantly the left hemisphere, the language dominance hemisphere. The other patient had ictal vomiting in simple partial seizures which originated from the right temporal lobe or the language nondominant side. All 3 patients underwent anterior temporal lobectomy with promising outcomes. Pathologic diagnosis included hippocampal sclerosis in 2 patients and astrocytoma in 1 patient. In our patients, ictal vomiting does not lateralize temporal lobe epilepsy and is not specific to pathology.
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Affiliation(s)
- C Chen
- Department of Neurology, The Neurological Institute, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Shih YH, Yiu CH, Huang CI. Role of foramen ovale electrodes in presurgical evaluation of intractable complex partial seizures. Zhonghua Yi Xue Za Zhi (Taipei) 1997; 60:155-60. [PMID: 9419952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The value of intracranial electrodes such as depth electrodes and subdural grids for intracranial electroencephalographic (EEG) recording in patients with intractable epilepsies has been well recognized. A new technique, foramen ovale electrode (FOE) implantation, was first introduced by Wieser in 1984 for the lateralization of bilateral mesiotemporal lobe (MTL) onset of seizures. METHODS Since October 1993, a multipolar, three-contact FOE has been used in 12 intractable epileptic patients for presurgical evaluation. The reasons for FOE implantation included bilateral MTL onset of seizures recorded by extracranial EEGs in nine patients, and extracranial EEG abnormalities inconsistent with the results of magnetic resonance imaging (MRI), positron emission tomogram (PET) or Wada test in three patients. Under general anesthesia, the FOEs were implanted according to the technique introduced by Kirschner, using Barters landmarks. RESULTS After long-term telemetry recording with FOE, seven patients revealed clear onset of seizures originating from one side of the MTL and underwent anterior temporal lobectomy (ATL). Two patients had seizures of bilateral MTL onset. However, they received ATL due to predominantly unilateral interictal epileptiform discharges (EDs) and/or MRI and PET abnormalities. Seven (78%) of the nine operated patients became seizure-free after ATL. Three patients were considered not operable because two had multifocal onset of seizures and one had seizures with independent bilateral MTL onset. No serious complication resulted from implantation of FOE in this series. CONCLUSIONS The semi-invasive technique of FOE is reliable for lateralization of bilateral MTL onset of seizures which are often not clearly recorded by extracranial EEGs. This procedure is safe and can be an alternative to invasive implantation of depth electrodes and subdural grids.
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Affiliation(s)
- Y H Shih
- Division of Epilepsy, Veterans General Hospital-Taipei, Taiwan, R.O.C
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Lin YY, Su MS, Yiu CH, Shih YH, Yen DJ, Kwan SY, Wu ZA, Chan SH. Relationship between mesial temporal seizure focus and elevated serum prolactin in temporal lobe epilepsy. Neurology 1997; 49:528-32. [PMID: 9270590 DOI: 10.1212/wnl.49.2.528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We evaluated the relationship between mesial temporal seizure focus and serum prolactin (PRL) in patients before and after they underwent anterior temporal lobectomy (ATL) for medically intractable temporal lobe epilepsy (TLE). These patients had a confirmed unilateral epileptogenic focus in mesial temporal structures, a postictal rise in serum PRL 15 to 20 minutes after onset of complex partial seizures, and were refractory for more than 2 years to antiepileptic drugs. Presurgical interictal serum PRL levels were significantly elevated (16.47 +/- 0.85 ng/mL, n = 62) and declined after ATL to normal values (patients, 9.63 +/- 0.55 ng/mL, n = 54; normal subjects, 8.99 +/- 0.57 ng/mL, n = 52). Serial evaluations indicated that normalization was seen 3 months after surgery (9.42 +/- 1.22 ng/mL, n = 9). The postsurgical reduction in serum PRL was similar in men and women, in patients with epileptogenic focus on either side of mesial temporal structures, and was unaffected by antiepileptic medication. We conclude that PRL is elevated following seizures and that a seizure focus in mesial temporal structures may exert a sustained excitatory influence on PRL release in patients with medically intractable TLE.
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Affiliation(s)
- Y Y Lin
- Department of Neurology, Veterans General Hospital-Taipei, Taiwan, Republic of China
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Yen DJ, Yiu CH, Kwan SY, Lin YY, Su MS. Lamotrigine as add-on therapy in adult patients with refractory epilepsy. Zhonghua Yi Xue Za Zhi (Taipei) 1997; 59:303-7. [PMID: 9248123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lamotrigine (LTG), one of the newly developed antiepileptic drugs, is efficacious in treating both partial and generalized seizure disorders including Lennox-Gastaut syndrome. Its effect as an add-on therapy was evaluated in 41 adult Chinese patients with refractory epilepsy. Five of the patients were Lennox-Gastaut syndrome and 36 patients had partial epilepsy. METHODS We started LTG at 25 mg or 50 mg per day, respectively, depending on whether the patients were simultaneously taking valproate (VPA) or not. Then, LTG was increased in steps to maximal dosage (200 mg or 400 mg per day) within seven weeks and maintained for three months while pre-existing antiepileptic drugs remained unchanged. The efficacy of LTG therapy was assessed by the reduction in the overall seizure frequency. Hematological and biochemical parameters were checked before and after the trial in all patients. RESULTS In all, 38 patients completed the trial. Twenty-two patients (57.9%) had > or = 50% reduction in seizure frequency, including four patients with Lennox-Gastaut syndrome and 18 patients with partial seizures. Among the patients with partial epilepsy, there was no significant difference in the efficacy of LTG whether the seizures were of temporal or extra-temporal origin (p = 0.577). In addition, the efficacy was not determined by the concomitant use of VPA (p = 0.189). Thirteen patients (31.7%) complained of adverse experiences, usually mild and dose-dependent. LTG had to be discontinued in only two patients (4.9%) due to severe side effects. The change in blood cell counts and biochemistry profiles was not significant in any of the patients. CONCLUSIONS We conclude that LTG is an efficacious and safe antiepileptic drug for add-on therapy in adult patients with refractory epilepsy.
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Affiliation(s)
- D J Yen
- Department of Neurology, Veterans General Hospital-Taipei, Taiwan, R.O.C
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Abstract
Subacute sclerosing panencephalitis (SSPE) is a rare infectious central nervous system (CNS) disease with a poor prognosis. We reported on the case of an adolescent girl with SSPE and characteristic periodic electroencephalographic (EEG) complexes. Her neurological deficits including generalized myoclonic seizures improved after intraventricular interferon (IFN) treatment. However, unusual EEG patterns consisting of bisynchronous occipital spikes preceding periodic complexes developed in follow-up EEGs.
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Affiliation(s)
- S L Tung
- Department of Neurology, Veterans General Hospital, Taipei, Taiwan, ROC
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Abstract
To evaluate ictal speech manifestations in complex partial seizures (C PS), we reviewed videotapes of 68 consecutive patients who underwent anterior temporal lobectomy (ATL) for treatment of intractable epilepsy in Taiwan. In all, 261 CPS were collected from their video-EEG (VEEG) recordings. Cerebral speech dominance was determined by intracarotid injection of sodium amobarbital (Wada test) in all cases. Ictal speech manifestations, classified as verbalization or vocalization, occurred in 32 patients (47.1%) with 96 seizures (36.8%). Ictal verbalization occurred in 10 patients (14.7%). Ictal vocalization was observed in 28 patients (41.2%); including 6 patients who also had ictal verbalization. Thirty-six patients (52.9%) had no seizure with ictal speech manifestations. Ictal verbalization had significant lateralization value: 90% of patients with this manifestation had seizure focus in the nondominant temporal lobe (p = 0.049). Seizures of patients with ictal vocalization were not more likely to arise from either temporal lobe. We also observed bilingual patients who exclusively spoke in their mother tongue (Taiwanese) rather than the acquired language (Mandarin) in 72.2% of seizures with verbalization. This finding is significant and contrary to a commonly held notion that the acquired language is used in seizures associated with speech behaviors.
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Affiliation(s)
- D J Yen
- Department of Neurology, The Neurological Institute, Veterans General Hospital-Taipei, Taiwan, R.O.C
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19
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Lin YY, Su MS, Yiu CH, Kwan SY, Tu YF, Guo WY, Wong TT, Chang KP. Startle epilepsy presenting as drop attacks: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1995; 56:270-273. [PMID: 8548670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A case of startle epilepsy, induced by an unexpected touch on the left shoulder of a 3.5 year old boy, was investigated. The startle epilepsy manifested as an atonic drop attack. Neurological examination revealed a mild hemiparesis on the left side. Computed tomography (CT) scanning demonstrated an enhancement over the right parieto-frontal region, suggesting a hemangioma. Interictal electroencephalography (EEG) showed diffuse slowing and asymmetry of background activities with lower amplitude over the right centro-parieto-temporal region. The ictal EEG showed a paroxysmal bilaterally synchronized high amplitude single spike followed by a few slow waves lasting about one second over the bilateral centro-parieto-temporal regions. The seizure resisted anticonvulsant therapy and no significant responses were observed despite the use of combined therapy with valproic acid, phenytoin, primidone and clonazepam.
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Affiliation(s)
- Y Y Lin
- Neurological Institute, Veterans General Hospital-Taipei, Taiwan, R.O.C
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20
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Lin YY, Yiu CH, Kwan SY, Tu YF, Wong TT, Chang KP, Su MS. Hypothalamic hamartoma and gelastic epilepsy: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1995; 55:78-82. [PMID: 7712400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We studied a 6-year-old girl who presented with inappropriate and uncontrollable laughing episodes since age 3. Physical examination revealed a precocious puberty. The luteinizing hormone-releasing hormone (LH-RH) stimulation test showed an increased level of follicle-stimulating hormone (FSH). The interictal electroencephalogram (EEG) was normal. Several laughing fits were documented during video/EEG monitoring. During laughing, the ictal EEG showed a diffuse suppression of background rhythm, prominent over the left mesial temporal region. A mass lesion about 2 x 2 cm in size was found over the suprasellar cistern with a broad base attached to the hypothalamus, which was isodense on a computed tomography (CT) scan, isointense to gray matter on T1-weighted magnetic resonance (MR) imaging and hyperintense on T2-weighted MR imaging. The findings were suggestive of a hypothalamic hamartoma. A variety of anticonvulsants had been used with little or no response to the frequency or duration of the laughing seizures.
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Affiliation(s)
- Y Y Lin
- Section of Neurology, Veterans General Hospital-Taipei, Taiwan, R.O.C
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21
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Abstract
We retrospectively studied 1200 hospitalized acute strokes of all etiologies between July 1990 and August 1992. Ninety-six % of all strokes underwent computed tomography of the head. Fifty-eight percent of the 1200 strokes were brain infarction, 32% brain hemorrhage, 6% subarachnoid hemorrhage and 4% were other stroke subtypes. Thirty (2.5%) of all strokes suffered from early seizures. The incidences of early seizures were 2.8% in brain hemorrhage, 2.3% in brain infarction, 2.7% in subarachnoid hemorrhage and 2% in other stroke subtypes. Early seizures were documented in 6% of the patients with carotid territory cortical infarctions and 12% of the patients with lobar hemorrhage, whereas only 0.6% of the patients without carotid territory cortical infarctions and 0.6% of the patients without lobar hemorrhage were affected. Sixty-six percent of 30 early seizures were partial seizures, 24% generalized and status epilepticus were seen only in 10%. In conclusion, we found the early seizure incidence was 2.5% in Chinese patients hospitalized with acute strokes. There was no correlation between seizure occurrence and stroke subtypes. Early seizure developed significantly higher in acute stroke patients with lesions of the cortex than those patients without cortical involvement. The partial seizures were the most frequent type occurring in 66% of all acute stroke patients with early seizures.
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Affiliation(s)
- Y K Lo
- Department of Neurology, Taipei-Veterans General Hospital, Taiwan, ROC
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22
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Shih YH, Yiu CH, Su MS, Yen DJ, Ho DM, Liu RS, Chen CC. Temporal lobectomy in adults with intractable epilepsy. J Formos Med Assoc 1994; 93:307-13. [PMID: 7914772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We report on 30 adult patients with intractable complex partial seizure (CPS) of the temporal lobe origin who received anterior temporal lobectomy. The average follow-up period was 41 months. The age of onset was younger and the duration of epilepsy was longer in the non-mass lesion group than in the mass lesion group. Postoperatively, 21 patients (70%) were seizure-free, four patients (13%) had only rare seizures (less than three attacks per year), three patients (10%) achieved a remarkable reduction (more than 50%) of seizure frequency, and two patients (7%) showed no worthwhile improvement. Based on our experience, anterior temporal lobectomy is an effective and safe procedure for adult patients with intractable CPS. For diagnosis, magnetic resonance imaging (MRI) yielded a higher sensitivity rate than computed tomography (CT), especially in the group without mass lesions. Positron emission tomography using 18F-fluorodeoxyglucose (FDG-PET) was superior to single photon emission computed tomography (SPECT) which had a relatively high false localization rate. With high resolution MRI and FDG-PET, localization of the epileptogenic zone was more accurate. A preresection electrocorticogram (ECoG) was used to confirm the epileptogenic focus during the operation. The residual spikes on the postresection ECoG did not necessarily predict a poor seizure control outcome after anterior temporal lobectomy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- Y H Shih
- Department of Neurosurgery, Veterans General Hospital, Taipei, Taiwan R.O.C
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Wang RB, Liu LT, Yiu CH, Chang TY. Carbamazepine drug interactions: the influence of concurrent drug therapy on serum concentrations of carbamazepine and its epoxide metabolite. Zhonghua Yi Xue Za Zhi (Taipei) 1990; 45:222-32. [PMID: 2168269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The influence of concurrent drug therapy (phenytoin, valproate, phenobarbital, primidone) on serum concentrations of total and free carbamazepine (CBZ) and its active metabolite carbamazepine-10, 11-epoxide (CBZ-E) in 135 epileptic patients was studied. Serum CBZ and CBZ-E levels were analyzed by high performance liquid chromatography, whereas serum levels of the anticonvulsants were determined by fluorescence polarization immunoassay. Ultrafiltration was used to separate the free drugs from the protein-bound drugs in serum. Patients were divided into five groups according to the medication they received. Linear regression analyses revealed that concurrent drug therapy affected the metabolic rate of CBZ and CBZ-E in various ways. In patients on CBZ monotherapy, 78.3% of CBZ and 52.4% of CBZ-E were bound to plasma proteins. The total serum CBZ and CBZ-E concentrations significantly correlated with their respective free levels in serum. Compared with the CBZ monotherapy group, patients receiving concurrent drug therapy showed higher CBZ clearance and had elevated CBZ-E/CBZ ratios. Although the decrease in the total CBZ concentration depended on the simultaneous phenytoin and valproate concentrations (p less than 0.05), the serum levels of phenobarbital and primidone appeared to have no significant influence on the CBZ concentration. Since great interindividual variations were found in the serum concentration after a given dose, routine monitoring of the CBZ and CBZ-E serum concentrations is essential in designing a safe and effective therapeutic regimen for epileptic patients, especially for those on polytherapy.
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Affiliation(s)
- R B Wang
- Department of Pharmacy, Veterans General Hospital-Taipei, R.O.C
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