RESUMEN
Plasma antipsychotic concentrations were measured in five patients when their anticonvulsant medications were discontinued. Plasma antipsychotic concentrations increased by two- to five-fold at 4 weeks after cessation. All patients demonstrated either moderate or marked improvement as antipsychotic plasma concentrations increased. Four patients experienced extrapyramidal side effects within 30 days of anticonvulsant discontinuation. Careful monitoring of clinical symptoms, adverse effects, and plasma antipsychotic concentrations is recommended.
Asunto(s)
Anticonvulsivantes/farmacocinética , Antipsicóticos/farmacocinética , Flufenazina/análogos & derivados , Haloperidol/farmacocinética , Esquizofrenia/tratamiento farmacológico , Síndrome de Abstinencia a Sustancias/sangre , Adulto , Anticonvulsivantes/efectos adversos , Anticonvulsivantes/uso terapéutico , Antipsicóticos/efectos adversos , Antipsicóticos/uso terapéutico , Quimioterapia Combinada , Discinesia Inducida por Medicamentos/sangre , Flufenazina/efectos adversos , Flufenazina/farmacocinética , Flufenazina/uso terapéutico , Haloperidol/efectos adversos , Haloperidol/uso terapéutico , Humanos , Discapacidad Intelectual/tratamiento farmacológico , Trastornos Neurocognitivos/tratamiento farmacológico , Esquizofrenia/sangreRESUMEN
Valproate (VPA) serum concentrations (Cp) were followed in six epileptic mentally retarded patients when carbamazepine (CBZ) was discontinued. VPA Cp significantly increased when CBZ was discontinued. A new plateau of VPA Cp was achieved 4 weeks post-CBZ discontinuation. This time factor is analogous to the autoinduction property of CBZ. Careful VPA Cp monitoring is recommended when CBZ or other enzyme inducing agents are discontinued.
Asunto(s)
Carbamazepina/administración & dosificación , Epilepsia/tratamiento farmacológico , Ácido Valproico/administración & dosificación , Adulto , Carbamazepina/sangre , Interacciones Farmacológicas , Epilepsia/sangre , Femenino , Humanos , Masculino , Ácido Valproico/sangreRESUMEN
Serum concentrations of the anticonvulsants phenytoin, phenobarbital, and carbamazepine were compared before and after patients received influenza vaccine. Serum drug concentrations were measured in patients at a state school for the mentally retarded who were receiving continuous anticonvulsant therapy with only one of the study drugs and taking no other medication regularly. Patients with hepatic or renal disease or other medical problems were excluded. All study patients had steady-state serum concentrations of the anticonvulsants before they were vaccinated with Influenza Virus Vaccine, USP, Types A and B, Whole Virus. Trough serum concentrations of anticonvulsants were measured by enzyme-mediated immunoassay technique immediately before vaccination and on days 7, 14, and 28. Data were excluded for patients who required dosage adjustments because of toxicity or seizures. On day 7, mean serum concentrations of phenytoin (15.16 +/- 5.52 micrograms/mL, n = 8) and phenobarbital (17.25 +/- 6.77 micrograms/mL, n = 27) were significantly higher than at baseline. Mean carbamazepine concentrations on day 7 (6.89 +/- 2.18 micrograms/mL, n = 20) were not significantly greater than baseline; however, there was a significant increase from day 7 to day 14. In patients who are receiving phenytoin, phenobarbital, or other drugs metabolized by the cytochrome P-450 system, serum concentrations of these drugs may increase as a result of influenza vaccination, and dosage adjustments may be necessary.
Asunto(s)
Anticonvulsivantes/administración & dosificación , Epilepsia/tratamiento farmacológico , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Vacunación , Adolescente , Adulto , Anticonvulsivantes/sangre , Carbamazepina/administración & dosificación , Femenino , Humanos , Discapacidad Intelectual/complicaciones , Masculino , Persona de Mediana Edad , Fenobarbital/administración & dosificación , Fenitoína/administración & dosificaciónRESUMEN
Seven terminal deletions and four interstitial deletions of 6q have been reported. We present the clinical and cytogenetic findings of these cases and of two new patients with different interstitial deletions of 6q. Although there are too few cases of interstitial deletions to identify one or more clinical syndromes associated with monosomies of the more proximal regions of 6q, a terminal 6q deletion syndrome is proposed. Its major components are microcephaly with mental retardation, strabismus, apparently low-set malformed ears, a broad nasal bridge, micrognathia, apparently short neck, congenital heart defect, abnormal palmar creases, and various hand abnormalities.
Asunto(s)
Deleción Cromosómica , Cromosomas Humanos 6-12 y X , Anomalías Múltiples/genética , Adolescente , Preescolar , Dermatoglifia , Femenino , Humanos , Discapacidad Intelectual/genética , Masculino , SíndromeRESUMEN
Most of the children who fail in school come from educationally high-risk groups which are identifiable in the preschool years. Early recognition allows for constructive planning and in some cases the interposition of specific therapy (Table 1). Aall physicians should be aware of the relationships between these high-rish categories and future educational failure. The physician needs to accept responsibility for properly ensuring that the child will experience a wholesome, enriching experience in the school years. If the above measures were applied widely, a substantial reduction in the incidence of school failure among American children would be realized.