RESUMO
OBJECTIVE: To identify risk factors for subclinical hypothyroidism (SCH) (thyroid-stimulating hormone levels >5 mIU/mL) in patients receiving valproate (VPA) therapy. STUDY DESIGN: During a period of 2 years, consecutive patients with epilepsy receiving VPA and a control group of patients with diseases other than epilepsy attending a tertiary care neurology clinic were screened for SCH. The 2 groups were compared. The association between SCH and specific risk factors was investigated with bivariate and multivariate analyses. RESULTS: Thirty-six of 143 patients receiving VPA (25.2%, mean age +/- SD: 8.5 +/- 6.6 years) and none of the 35 control subjects had SCH (P < .001). Predictors of SCH were younger age (OR: 1.15, cutoff age 3.9 years); duration of treatment between 6 and 24 months versus <6 months (OR: 2.98) and >24 months (OR: 2.66); VPA polytherapy with enzyme-inducing agents (OR: 6.08), or polytherapy with non-enzyme-inducing agents (OR: 3.34) compared with VPA monotherapy. Most (88.2%) patients with duration of therapy >2 years were older than 3.9 years. CONCLUSION: Risk factors for SCH were young age, co-medication with antiepileptic drugs, and duration of therapy between 6 and 24 months. Screening patients with these risk factors may be warranted.
Assuntos
Hipotireoidismo/induzido quimicamente , Hipotireoidismo/epidemiologia , Tireotropina/sangue , Ácido Valproico/efeitos adversos , Adolescente , Distribuição por Idade , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Relação Dose-Resposta a Droga , Epilepsia/diagnóstico , Epilepsia/tratamento farmacológico , Feminino , Seguimentos , Humanos , Hipotireoidismo/diagnóstico , Incidência , Modelos Logísticos , Masculino , Análise Multivariada , Probabilidade , Valores de Referência , Fatores de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Testes de Função Tireóidea , Ácido Valproico/uso terapêuticoRESUMO
Thirty-two children with refractory partial epilepsy received open-label gabapentin as an additional medication to their antiepileptic drug regimen. Gabapentin was given in a dose ranging from 10 to 50 mg/kg per day (mean dose, 26.7 mg/kg daily). All patients had partial seizures with or without secondary generalization. Compared with baseline, 11 patients (34.4%) had a greater than 50% decrease in seizure frequency, and 4 (12.5%) had a 25% to 50% decrease in seizure frequency. Of the seven children who received the medication for 6 months or longer, two were seizure free and four were almost seizure free (having one seizure every few months). Mean gabapentin concentration was 4.8 micrograms/ml, and mean apparent clearance was 372 ml/kg per hour. The major reported side effects were behavioral. These consisted of hyperactivity, irritability, and agitation that occurred in patients with baseline mental retardation with attention deficit. We conclude that gabapentin can be a useful adjunctive medication in the treatment of refractory partial epilepsy in children.
Assuntos
Acetatos/uso terapêutico , Aminas , Anticonvulsivantes/uso terapêutico , Ácidos Cicloexanocarboxílicos , Epilepsias Parciais/tratamento farmacológico , Ácido gama-Aminobutírico , Acetatos/efeitos adversos , Adolescente , Anticonvulsivantes/efeitos adversos , Criança , Comportamento Infantil/efeitos dos fármacos , Pré-Escolar , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Eletroencefalografia/efeitos dos fármacos , Epilepsias Parciais/diagnóstico , Feminino , Gabapentina , Humanos , Lactente , Masculino , Resultado do TratamentoRESUMO
Thirty children (2 to 17 years of age) with refractory partial seizures received open-label felbamate as an add-on medication to their background antiepileptic drugs. The dose was increased up to a maximum of 45 mg/kg. Compared with baseline seizure activity, there was a 53% decrease in seizure frequency during felbamate therapy; 50% of the patients had more than a 50% decrease in seizure frequency. Patients older than 10 years of age were more likely to have a favorable response. Age correlated positively with felbamate concentrations and negatively with apparent felbamate clearance. Transient weight loss occurred in 57% of the patients; the weight loss was maximal after 12 weeks of initiation of felbamate, and subsided after the twentieth week of treatment. Anorexia and insomnia were reported in 20% and 16% of the patients, respectively. Adverse effects were generally tolerable; felbamate therapy was discontinued because of side effects in only one patient, because of a rash. We conclude that felbamate can be a useful and well-tolerated medication in the treatment of refractory partial epilepsy in children. However, increased apparent clearance of this drug in younger children should be considered in treatment of this age group.
Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsias Parciais/tratamento farmacológico , Propilenoglicóis/uso terapêutico , Adolescente , Fatores Etários , Anorexia/induzido quimicamente , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/sangue , Anticonvulsivantes/farmacocinética , Criança , Pré-Escolar , Combinação de Medicamentos , Tolerância a Medicamentos , Epilepsia Generalizada/tratamento farmacológico , Felbamato , Feminino , Seguimentos , Humanos , Masculino , Fenilcarbamatos , Propilenoglicóis/administração & dosagem , Propilenoglicóis/efeitos adversos , Propilenoglicóis/sangue , Propilenoglicóis/farmacocinética , Segurança , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Redução de Peso/efeitos dos fármacosRESUMO
Because Kawasaki disease is a disorder characterized by lymphocyte activation and immune complex destruction of endothelial cells, we examined the effect of administration of high doses of intravenously administered immune globulin (IVIG) on a lymphocyte population with affinity for endothelial cells: the natural killer cells. We found that administration of high doses of IVIG resulted in a significant increase in the activity of natural killer cells and in the numbers of circulating CD16+ cells. Furthermore, a study of patients treated with IVIG for seizure disorders suggests that this effect of IVIG on circulating NK cells is not unique to patients with Kawasaki disease. The beneficial effect of IVIG in the treatment of Kawasaki disease may be due to the ability of IVIG to inhibit interaction between natural killer cells and endothelial cells.
Assuntos
Imunoglobulinas Intravenosas/imunologia , Células Matadoras Naturais/imunologia , Citotoxicidade Celular Dependente de Anticorpos , Criança , Epilepsia/imunologia , Humanos , Imunoglobulina G/análise , Imunoglobulinas Intravenosas/administração & dosagem , Síndrome de Linfonodos Mucocutâneos/imunologiaRESUMO
Six children, five girls and one boy, presented with recurrent episodes of swelling, pain, and tenderness of the long bones. On roentgenographic examination all had cortical hyperostosis of the affected areas. Serum phosphate concentration was persistently elevated, and calcium values were normal. Bone biopsy and histologic examination in three patients revealed periosteal new bone formation. The Ellsworth-Howard test was performed on three patients; all had a normal phosphaturic response and an increase in urinary c'AMP to exogenous PTH. The EDTA test, performed on one patient, demonstrated significant phosphaturic response, but a minimal drop in serum phosphate concentration. These findings suggest that the association of cortical hyperostosis and hyperphosphatemia is a distinct clinical entity, and that hyperphosphatemia results from decreased renal excretion of phosphate.