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Affiliation(s)
| | - Kasey Smith
- Idaho College of Osteopathic Medicine, Meridian, Idaho
| | - Shahzeb Hassan
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Viki Patel
- Department of Dermatology, Loyola University Medical Center, Maywood, Illinois
| | | | - Scott L. Zahner
- Aesthetic and Clinical Dermatology Associates, Hinsdale, Illinois
- Correspondence to: Scott L. Zahner, MD, MS, Aesthetic and Clinical Dermatology Associates, 908 N Elm, Suite 300, Hinsdale, IL 60521.
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2
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Merrell RT, Simon KC, Martinez N, Vazquez RM, Hadsell B, Epshteyn A, Wilk G, Frigerio R, Maraganore DM. Standardizing Care of Neuro-oncology Patients Using a Customized Electronic Medical Record Toolkit. Mayo Clin Proc Innov Qual Outcomes 2021; 5:625-634. [PMID: 34195554 PMCID: PMC8240171 DOI: 10.1016/j.mayocpiqo.2021.04.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective To develop and implement a customized toolkit within the electronic medical record (EMR) to standardize care of patients with brain tumors. Patients and Methods We built a customized structured clinical documentation support toolkit to capture standardized data at office visits. We detail the process by which this toolkit was conceptualized and developed. Toolkit development was a physician-led process to determine a work flow and necessary elements to support best practices as defined by the neuro-oncology clinical team. Results We have developed in our EMR system a customized work flow for clinical encounters with neuro-oncology patients. In addition to providing a road map for clinical care by our neuro-oncology team, the toolkit is designed to maximize discrete data capture. Several hundred fields of discrete data are captured through the toolkit in the context of our routine office visits. We describe the characteristics of patients seen at our clinic, the adoption of the toolkit, current initiatives supported by the toolkit, and future applications. Conclusion The EMR can be effectively structured to standardize office visits and improve discrete data capture. This toolkit can be leveraged to support quality improvement and practice-based research initiatives at the point of care in a neuro-oncology practice.
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Affiliation(s)
- Ryan T Merrell
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL
| | - Kelly Claire Simon
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL
| | - Nina Martinez
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL.,Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Rosa Maria Vazquez
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL
| | - Bryce Hadsell
- Health Information Technology, NorthShore University HealthSystem, Skokie, IL
| | - Alexander Epshteyn
- Health Information Technology, NorthShore University HealthSystem, Skokie, IL
| | - Gary Wilk
- Health Information Technology, NorthShore University HealthSystem, Skokie, IL
| | - Roberta Frigerio
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL
| | - Demetrius M Maraganore
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL.,Department of Neurology, Tulane University School of Medicine, New Orleans, LA
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3
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Jaafar F, Haddad L, Koleilat N, Sharara-Chami R, Shbarou R. Super refractory status epilepticus secondary to anti-GAD antibody encephalitis successfully treated with aggressive immunotherapy. Epilepsy Behav Rep 2020; 14:100396. [PMID: 33305253 PMCID: PMC7710630 DOI: 10.1016/j.ebr.2020.100396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 11/29/2022] Open
Abstract
Antibodies against glutamic acid decarboxylase are reported in association with a number of neurological conditions including limbic encephalitis. We report a case of anti-GAD-antibody associated encephalitis presenting with super-refractory status epilepticus. We describe the clinical course, management, and the outcome. In addition, we review the presentation and outcomes of reported cases of anti-GAD encephalitis. Similar to the reported cases of anti-GAD encephalitis, our case was refractory to treatment with conventional antiseizure medication. Treatment with intravenous immune globulin (IVIG), high dose corticosteroids, and plasmapheresis had partial response, but escalation of treatment to the use of tocilizumab was associated with significant clinical improvement.
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Key Words
- AED, antiepileptic drug
- Autoimmune encephalitis
- CSF, cerebrospinal fluid
- EEG, electroencephalogram
- GABA, gamma-aminobutyric acid
- GAD, glutamic acid decarboxylase
- Glutamic acid decarboxylase antibodies
- IVIG, intravenous immunoglobulin
- Limbic encephalitis
- MDZ, midazolam
- MP, methylprednisolone
- MRI, magnetic resonance imaging
- NMDA, N-methyl-d-aspartate
- PCR, polymerase chain reaction
- PLEX, plasma exchange
- RNA, ribonucleic acid
- Status epilepticus
- Tocilizumab
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Affiliation(s)
- Fatima Jaafar
- Division of Child Neurology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Laith Haddad
- Division of Child Neurology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadia Koleilat
- Division of Child Neurology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Sharara-Chami
- Division of Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rolla Shbarou
- Division of Child Neurology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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4
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Sato S, Oba T, Ohta H, Tsukahara Y, Kida G, Tsumiyama E, Kusano K, Nishizawa T, Kawabe R, Yamakawa H, Akasaka K, Amano M, Matsushima H. Levetiracetam-induced interstitial lung disease in a patient with advanced lung cancer. Respir Med Case Rep 2020; 31:101241. [PMID: 33024691 PMCID: PMC7528199 DOI: 10.1016/j.rmcr.2020.101241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/27/2020] [Accepted: 09/12/2020] [Indexed: 11/25/2022] Open
Abstract
An 85-year-old woman with antibiotics-resistant pneumonia after surgery for metastatic brain tumor from lung cancer was consulted to our department. Chest CT showed diffuse GGO bilaterally. BALF showed elevated ratios of lymphocytes and CD4/CD8. Tests for bacteria, mycobacteria, and fungi were negative. She improved following levetiracetam discontinuance and systemic corticosteroid administration, and we diagnosed levetiracetam-induced lung injury. Although levetiracetam is widely used, few reports of levetiracetam-induced pneumonia exist. Changes in chest images may occur after levetiracetam administration if patients have multiple risk factors for development of drug-induced interstitial lung disease. Bronchoscopy is useful for differential diagnosis if new lung lesions appear after starting levetiracetam.
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Affiliation(s)
- Shintaro Sato
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Tomohiro Oba
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Hiroki Ohta
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Yuta Tsukahara
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Gen Kida
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Emiri Tsumiyama
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Kenji Kusano
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Tomotaka Nishizawa
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Rie Kawabe
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Hideaki Yamakawa
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Keiichi Akasaka
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Masako Amano
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Hidekazu Matsushima
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
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5
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Affiliation(s)
- Rebecca G Gaffney
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania.,Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.,Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Meera Tarazi
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania.,Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Victoria P Werth
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania.,Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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6
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Mohamed S, Candela C, Riva R, Contin M. Simple and rapid validated HPLC-fluorescence determination of perampanel in the plasma of patients with epilepsy. Pract Lab Med 2017; 10:15-20. [PMID: 29234708 PMCID: PMC5722279 DOI: 10.1016/j.plabm.2017.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 10/26/2022] Open
Abstract
We present a simple and fast high-performance liquid chromatography method with fluorescence detection for the determination of the antiepileptic drug perampanel in human plasma. The chromatographic separation was performed on a Kinetex PFP (100 × 2.6 mm, 4.6 µm) column, using a mobile phase of sodium acetate 0.03 M pH 3.7 and acetonitrile (40/60, v/v), at a flow rate of 0.8 mL/min. Total chromatography time for each run was 5 min. Sample preparation (250 µL) involved only one simple precipitation step by acetonitrile spiked with mirtazapine as internal standard. The method was validated over a concentration range of 20-1000 ng/mL and successfully applied to measure perampanel concentrations in plasma samples obtained from patients with epilepsy. This assay combines the high specificity of fluorescence detection with a very simple and fast sample pretreatment and can offer real advantages over existing methods in terms of simplicity and transferability to a therapeutic drug monitoring setting.
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Key Words
- AED, antiepileptic drug
- AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid
- Antiepileptic drugs
- CBZ, carbamazepine
- Clinical pharmacokinetics
- Epilepsy
- HPLC-F
- HPLC-F, high performance liquid chromatography-fluorescence detector
- IS, internal standard
- LLE, liquid-liquid extraction
- LLOD, lower limit of detection
- LLOQ, lower limit of quantification
- MIR, mirtazapine
- MS/MS, tandem mass spectrometer
- OXC, oxcarbazepine
- PER, perampanel
- PHT, phenytoin
- Perampanel
- QC, quality control
- TDM, therapeutic drug monitoring
- VPA, valproic acid
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Affiliation(s)
- Susan Mohamed
- IRCCS-ISNB Institute of Neurological Sciences of Bologna, Italy
| | - Carmina Candela
- IRCCS-ISNB Institute of Neurological Sciences of Bologna, Italy.,Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy
| | - Roberto Riva
- IRCCS-ISNB Institute of Neurological Sciences of Bologna, Italy.,Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy
| | - Manuela Contin
- IRCCS-ISNB Institute of Neurological Sciences of Bologna, Italy.,Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy
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7
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Argente-Escrig H, Gómez-Ibáñez A, Villanueva V. Efficacy of perampanel in a patient with epilepsia partialis continua. Epilepsy Behav Case Rep 2017; 8:105-107. [PMID: 29062692 PMCID: PMC5645170 DOI: 10.1016/j.ebcr.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/16/2017] [Accepted: 09/20/2017] [Indexed: 11/29/2022]
Abstract
Perampanel is the first-in-class selective and noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antagonist. It is authorized in the U.S. and Europe as an add-on antiepileptic drug for partial-onset seizures, and for primary generalized tonic–clonic seizures. Single reports have also indicated a potential efficacy for myoclonic jerks. Here, we report a patient whose drug-resistant epilepsia partialis continua completely resolved after adding perampanel. She has remained seizure-free in an eighteen-month follow-up period. Epilepsia partialis continua reemerged transiently after perampanel was temporarily discontinued, with no recurrence after its reintroduction. Therefore, this effect was reproducible, and suggests that it might be worth trying perampanel in similar settings.
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Key Words
- AED, antiepileptic drug
- AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid
- Antiepileptic drug
- CZP, clonazepam
- EEG, electroencephalogram
- EPC, epilepsia partialis continua
- Efficacy
- Epilepsia partialis continua
- Focal epilepsy
- LCM, lacosamide
- LEV, levetiracetam
- MRI, magnetic resonance imaging
- Meningioma
- PER, perampanel
- Perampanel
- RCT, randomized clinical trials
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Affiliation(s)
- H Argente-Escrig
- Multidisciplinary Epilepsy Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, 106 Fernando Abril Martorell Ave, 46026, Valencia, Spain
| | - A Gómez-Ibáñez
- Multidisciplinary Epilepsy Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, 106 Fernando Abril Martorell Ave, 46026, Valencia, Spain
| | - V Villanueva
- Multidisciplinary Epilepsy Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, 106 Fernando Abril Martorell Ave, 46026, Valencia, Spain
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8
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Tawfiq RA, Nassar NN, El-Eraky WI, El-Denshary ES. Enhanced efficacy and reduced side effects of diazepam by kava combination. J Adv Res 2013; 5:587-94. [PMID: 25685527 PMCID: PMC4294317 DOI: 10.1016/j.jare.2013.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 07/18/2013] [Accepted: 08/15/2013] [Indexed: 11/29/2022] Open
Abstract
The long term use of antiepileptic drugs possesses many unwanted effects; thus, new safe combinations are urgently mandated. Hence, the present study aimed to investigate the anticonvulsant effect of kava alone or in combination with a synthetic anticonvulsant drug, diazepam (DZ). To this end, female Wistar rats were divided into two subsets, each comprising 6 groups as follows: group (i) received 1% Tween 80 p.o. and served as control, while groups (ii) and (iii) received kava at two dose levels (100 and 200 mg/kg, p.o.). The remaining three groups received (iv) DZ alone (10 mg/kg p.o.) or kava in combination with DZ (v) (5 mg/kg, p.o.) or (vi) (10 mg/kg, p.o.). Results of the present study revealed that kava increased the maximal electroshock seizure threshold (MEST) and enhanced the anticonvulsant effect of diazepam following both acute and chronic treatment. Moreover, neither kava nor its combination with DZ impaired motor co-ordination either acutely or chronically. Furthermore, kava ameliorated both the reduction in locomotor activity as well as changes in liver function tests induced by chronic administration of DZ. Moreover, no elevation was shown in the creatinine concentration vs. control group following chronic administration of kava or DZ either alone or in combination with kava. In conclusion, the present study suggests the possibility of combining a low dose DZ with kava to reduce harmful effects and might be recommended for clinical use in patients chronically treated with this synthetic anticonvulsant drug.
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Key Words
- AED, antiepileptic drug
- ALP, alkaline phosphatase
- ALT, alanine transaminase
- AST, aspartate transaminase
- Anticonvulsant
- BDZ, benzodiazepine
- DZ, diazepam
- Diazepam
- ECT, electroconvulsive treatment
- FDA, Food and Drug Administration
- GABA, γ-aminobutyric acid
- GABAA, γ-aminobutyric acid type A
- Kava
- Locomotor activity
- MEST
- MEST, maximal electroshock threshold
- OTC, over the counter
- WHO, World Health Organization
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Affiliation(s)
- Rasha A Tawfiq
- Egyptian Patent Office, Academy of Scientific Research and Technology, 101 Kasr El-Eini St., Cairo, Egypt
| | - Noha N Nassar
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Kasr El-Eini St., Cairo, Egypt
| | - Wafaa I El-Eraky
- Department of Pharmacology, National Research Center, El-Tahrir St., Giza, Egypt
| | - Ezzeldein S El-Denshary
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Kasr El-Eini St., Cairo, Egypt
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