RESUMEN
INTRODUCTION: Hormonal and metabolic factors related to pregnancy itself are considered to increase the likelihood of seizure recurrence. If so, we should expect a similar evolution of epilepsy in a subsequent pregnancy. We investigated differences in evolution of non-gestational epilepsy in each pregnancy of women suffering from epilepsy. METHODS: A prospective study was conducted in order to compare seizure frequency in two successive pregnancies of more than 36 weeks duration in 12 patients. Improvement/worsening is defined as a change of +/- 50 % in the number of seizures regarding that which occurred within the previous eleven months. RESULTS: Twelve epileptic women were studied during two subsequent pregnancies. Eight of them took the same antiepileptic treatment for both pregnancies and one took no antiepileptic drug. Three worsened in the first pregnancy and two in the second. Seven patients had the same seizure frequency during both pregnancies. The total plasma antiepileptic concentrations tended to decline with the same proportion in both pregnancies if the dose remained unchanged. We observed no differences in mean hormone plasma concentrations for each quarter, within subsequent pregnancies. CONCLUSION: Except for one case with drug-resistant epilepsy, we found that the reason for the discrepancy in the frequency of the seizure between two successive pregnancies in the same patient was a sharp or rapid change in antiepileptic drug dose or non-compliance. In well controlled epileptic women a consistent evolution of epilepsy should be expected in a subsequent pregnancy, if adequate treatment is maintained.
Asunto(s)
Epilepsia/epidemiología , Número de Embarazos , Complicaciones del Embarazo , Adulto , Anticonvulsivantes/uso terapéutico , Epilepsia/clasificación , Epilepsia/tratamiento farmacológico , Femenino , Humanos , Incidencia , Embarazo , Estudios ProspectivosRESUMEN
OBJECTIVE: To determine the correlation between two methods of measurement of total PSA (PSA-T) and free PSA (PSA-F) and the utility of the PSA-F/PSA-T ratio in patients with PSA-T between 4 and 10 ng/ml suspected as having prostate cancer. METHODS: Determinations of both PSA-T and PSA-F were performed using two different techniques in 91 patients suspected as having prostate cancer. Diagnosis was made on the findings of biopsy and the complementary tests. RESULTS: The following correlation was found for the two techniques: R = 0.99 and p < 0.05 for PSA-T, and R = 0.85 and p < 0.05 for PSA-F. For PSA-T values of 4-10 ng/ml and PSA-F greater than 25%, we found two patients with prostate cancer. For a PSA-F/PSA-T ratio less than 9%, all cases had prostate cancer. Three cases with bone metastasis had PSA-T values less than 10 ng/ml. CONCLUSIONS: A PSA-F/PSA-T ratio greater than 25% does not exclude malignancy in patients with a total PSA of 4-10 ng/ml; values less than 9% correspond to prostate cancer. Bone metastasis was found with both methods in patients with total PSA values less than 10 ng/ml.
Asunto(s)
Carcinoma/diagnóstico , Antígeno Prostático Específico/análisis , Hiperplasia Prostática/diagnóstico , Neoplasias de la Próstata/diagnóstico , Biopsia , Diagnóstico Diferencial , Humanos , Masculino , Juego de Reactivos para DiagnósticoRESUMEN
We observed a clinical deterioration of epilepsy observed during pregnancy in 29% of 45 consecutive epileptic women. Increase in frequency of attacks is not related to type of attack, previous frequency, type of epilepsy, age at first appearance, family history or presence of anomalies by computed tomography imaging. No association has been found between recurrence of attacks and maintenance of sub-therapeutic plasma levels of anti-epileptic drugs (AED). In 60% of the patients who deteriorate, there is a temporal relation between increase in attacks and the suspension of or reduction of AED doses. Changes observed during one pregnancy cannot always predict what will happen during subsequent pregnancies.