ABSTRACT
A total of 42 patients were submitted to a clinical, behavioural and neuropsychological evaluation with the objective of eventual surgical treatment of epilepsy refractory to the usual clinical therapies. Prolonged video-EEG monitoring, MRI hippocampal volume measurement, lateralization of speech and memory using the amobarbital (Wada) test were used. Of 18 operated cases, 12 were submitted to temporal lobectomy, with a follow-up of 6-30 months; 8 patients had significant improvement in seizures control; 2 patients had partial improvement in seizure frequency and intensity; 2 patients had no improvement in seizure control. One patient underwent right frontal lobectomy with total remission of seizures and 5 had callosotomy with varying degrees of success. There was no mortality. Morbidity included one subdural hematoma, one transient hemiparesis, one episode of mania, one lobar pneumonia and frequent immediately post-operative muscular tension headaches. These early results indicate good results of temporal lobectomy patients investigated through a non-invasive presurgical evaluation.
Subject(s)
Middle Aged , Female , Humans , Child, Preschool , Child , Adult , Adolescent , Electroencephalography/methods , Epilepsy/surgery , Follow-Up Studies , Treatment OutcomeABSTRACT
The intracarotid amobarbital procedure was carried out in 8 male and 7 female candidates to temporal lobectomy, and a female candidate to frontal lesionectomy, aged 18-50 (mean 32.5) years. Language and memory were tested after injection in each hemisphere. Both were measured by the Montreal procedure. In 9 patients language and memory were evaluated with the Seattle procedure too. In 12 patients the left hemisphere was dominant for language; three had bilateral dominance. In 1 patient the Seattle procedure demonstrated the dominant hemisphere by relatively slowness of speech during the drug effect in the left hemisphere. Memory was defined to be in the left hemisphere in 12 patients, in the right in 2, bilateral in 1 and in another lateralization was not possible. In 1 patient memory dominance was determined by the Montreal protocol alone because of lack of cooperation. These early results indicate that the methods may be complementary for determination of language and memory dominance in epilepsy surgery candidates.
Subject(s)
Adult , Middle Aged , Female , Humans , Adolescent , Amobarbital/pharmacology , Epilepsy/surgery , Neuropsychological Tests , Functional Laterality , Language Tests , Memory/drug effectsABSTRACT
Carbamazepina e amiodarona podem frequentemente ser usadas em conjunto, especialmente em países em que as cardiomiopatias säo comuns. Neste estudo doses de carbamazepina (400 mg) foram administradas a pacientes com doenças cardíacas antes e depois de um mês de terapia com amiodarona, 400 mg ao dia. O perfil cinético da carbamazepina, sua fraçäo livre e o nível sérico da amiodarona, foram avaliados nas duas ocasiöes. Näo foram observadas diferenças estatísticamente significantes na cinética da carbamazepina ou mesmo em sua fraçäo livre, antes e depois da introduçäo da amiodarona. A concentraçäo da amiodarona após um mês de terapia foi baixa. Conclui-se que a possível interaçäo no metabolismo hepático näo foi demonstrada devido as baixas concentraçöes de amiodarona, que provavelmente tenham sido suficientes para inibir o metabolismo da carbamazepina
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Amiodarone/administration & dosage , Carbamazepine/pharmacokinetics , Cardiomyopathies/drug therapy , Amiodarone/pharmacokinetics , Carbamazepine/administration & dosage , Drug Interactions , Drug Therapy, Combination , Prospective StudiesABSTRACT
Doses-carga de difenil-hidantoína (1000mg) e carbamazepina (600mg) foram administradas oralmente a respectivamente 10 e 6 pacientes com crises epilépticas secundárias a doença aguda neurológica ou síndrome de abstinência alcoólica. No grupo da difenil-hidantoína a idade variou de 12 a 73 anos e as concentraçöes séricas 2, 4, 6, 8, 12 e 18 horas após a administraçäo foram 7,6, 8,8 8,7, 7,2 e 6,5 micrograma/ml (média). Näo foram anotados efeitos colaterais importantes por um método quantitativo. No grupo da carbamazepina a idade variou de 25 a 56 anos e as concentraçöes séricas nas mesmas horas foram 3,9, 5,3 6,5, 7,5 7,4 e 8,2 micrograma/ml. Efeitos colaterais foram discretos. Näo foi necessária medicaçäo suplementar durante as 24 horas após a administraçäo das doses-carga. Embora ambos os esquemas tenham controlado a situaçäo clínica sem efeitos colaterais relevantes, as concentraçöes séricas foram sub-terapêuticas no caso da difenil-hidantoína. Sugerimos que a dose-carga ideal de difenil-hidantoína é 1500mg. A dose-carga de carbamazepina foi eficaz e produziu níveis séricos terapêuticos. A estabilidade dos níveis séricos durante o período de estudo torna este esquema útil no controle subagudo de crises epilépticas frequentes, no tratamento de manutençäo de estado de mal epiléptico e na síndrome de retirada alcoólica