ABSTRACT
To investigate the effects of carbamazepine (CBZ) on the plasma concentrations of valproic acid (VPA) and its toxic metabolite 2-propyl-4-pentenoic acid (4-ene VPA) in epileptic patients, the plasma concentrations of VPA and 4-ene VPA were determined, and the effect of CBZ on pharmacokinetics of VPA was evaluated. All patients had been divided into two groups (VPA group, n = 87; and VPA+CBZ group, n = 19). As compared to VPA group, the combination of CBZ significantly (P < 0.01) decreased the trough concentration of VPA [VPA group, (69.5 +/- 28.8) microg x mL(-1); VPA+CBZ group, (46.3 +/- 25.6) microg x mL(-1)] and does-adjusted VPA trough concentration [VPA group, (4.89 +/- 2.21) microg x mL(-1) x mg(-1) x kg(-1); VPA+CBZ group, (3.14 +/- 1.74) microg x mL(-1) x mg(-1) x kg(-1)]. However, the addition of CBZ did not influence the concentration of 4-ene VPA. The present study revealed that coadministration of CBZ can reduce VPA plasma concentration and may impact VPA clinical effect, therefore therapeutic drug mornitoring of VPA should be used when combined use of CBZ and VPA.
ABSTRACT
Objective To investigate the reproductive endocrine status of women with epilepsy at childbearing age and to systematically analyze the clinical features of reproductive endocrine disorders,especially polycystic ovarian syndrome (PCOS),to facilitate early detection and timely intervention.Methods In this study,scoring of anthropometry and physical signs,menstrul assessment,examination of sex hormone and pelvic ultrasound in women with epilepsy at childbearing age were performed,and the data such as overweight,central obesity,oligo/amenorrhea,luteinizing hormone (LH)/follicule-stimulating hormone (FSH),hyperandrogenism and polycystic ovary (PCO) were collected. The characteristics of their reproductive endocrine hormone disorders were analyzed statistically. Results The age of these patients was (22. 5 ± 7.0 ) years,and women younger than 30 years old and at their peak fertility accounted for 84. 89%. The prevalence rate of PCOS in women with epilepsy at childbearing age (12. 75% ) was significantly higher than that of ordinary women at childbearing age (7.2%) in China.Highly specific indicators for PCOS were hyperandrogenism (100%),LH/FSH ＞ 2 (93%) and oligo/amenorrhea (90%),whilst the highly sensitive indicators for PCOS were PCO (92%), oligo/amenorrhea (85%) and hyperandrogenism (54%). This study revealed statistically significant difference in LH,LH/FSH and testosterone (T) between PCOS group (LH: (10.24 ± 6.92) IU/L; LH/FSH;(2.20 ± 1.16);T: ( 1.07 ± 0. 35) ng/ml) and non-PCOS group ( LH: (4. 16 ± 2.62 ) IU/L; LH/FSH:( 0. 87 ± 0. 56 );T: (0. 46 ±0. 25) ng/ml,t = -3. 899,-4. 240 and -4. 918 respectively,all P ＜0. 01 ). Conclusions Hormone indices are objective indicators for the diagnosis of PCOS. In clinical practice,attention should be paid to height,weight,abodominal circumference,menstrul history and ultrasound examination of the ovary in women with epilepsy.When reproductive endocrine hormone disorders are suspected from clinical features,the sex hormones (T,LH,and FSH ) should be checked to allow timely detection and early interventions.
ABSTRACT
[Objective]This study was designed to identify the risk factors related with reproductive endocrinology disorder in Chinese women of child-bearing age with epilepsy.[Methods]The clinical data of 102 women with epilepsy were collected.The patient were grouped according to seven aspects(seizure onset age,seizure type,seizure frequency,duration of epilepsy,AED type,age of start AED therapy and duration of therapy)and the contribution of these factors in development of PCOS and its components were analyzed.[Results]The incidence of hyperandrogenemia in the patients with an early onset age(≤14 years old)was higher than the ones with an onset age＞14 years old.Onset age≤14 was the risk factor of hyperandrogenemia in logistic regression analysis.The incidence of a/oligomenorrhea,polycystic ovaries,hyperandrogenemia and PCOS in the valproate-treated women were 40.63%,50.00%,15.65%,and 34.38%,respectively,which were higher than the no-therapy group and nonvalproate treated group.Valproate therapy was the risk factor of PCOS and its components.[Conclusion]Valproate therapy was the risk factor of PCOS and its components in Chinese women of child-bearing age with epilepsy.Onset age≤14 was the risk factor of hyperandrogenemia.
ABSTRACT
Objective To assess the clinical efficacy and safety of topiramate in adult and children patients with epilepsy. Methods Open-label experience with topiramate as adjunctive, added-on to monotherapy and monotherapy were analyzed.The efficacy was assessed by comparing the average frequency per month for 3 months after topiramate added to the maintenance period of the baseline therapy. Results Topiramate was proven to be a valuable new antiepileptic drug either in monotherapy (86%) or in added-on therapy (70%) on partial onset epilepsy, West syndrome and Lennox-Gastaut syndrome, and showed no tolerance.The topiramate dosage in patients with monotherapy [(85.87?29.19)mg/d in adult] is lower than in those using added-on therapy [(161.11?58.18)mg/d] significantly, and the most common adverse events were CNS-related, but few patients had discontinued the therapy.Conclusions The topiramate used for monotherapy or added-on therapy should be regarded as an effective and widespread antiepileptic drug, without tolerance and severe adverse actions.