Short-term efficacy and safety of valproate sustained-release formulation in newly diagnosed partial epilepsy [VIPe-study]. a multicenter observational open-label study

To evaluate the efficacy and safety of valproate [VPA] sustained-released in monotherapy across all ages in newly-diagnosed epileptic patients with partial seizures [PS] with or without secondary generalization. This was a multicenter, prospective, observational, open-label, non-comparative study involving the Gulf Cooperation Council [GCC] countries except the Kingdom of Saudi Arabia, and was performed between November 2004 and May 2006. Adults and children [6 years or older with newly diagnosed partial epilepsy [PE]] with or without secondary generalization were enrolled. The primary efficacy parameter was 6 month-remission rate [proportion of seizure-free patients in relation to total number of retained patients]. Secondary efficacy parameters included: 6 month-retention rate, investigator's clinical global impression rating, maximal effective dose and safety profile. Seventy-seven patients were enrolled; 56% adults and 44% children, with average duration of epilepsy of 5 months in the pediatric and 17 months in the adult group. Seizures type distribution: PS with secondary generalization [62%], complex PS [53%] and simple PS [14%]. The majority had idiopathic seizures [48%]. Sixty-six patients completed the study [treatment retention rate 80.5%]. At 6 months, 87% of patients became seizure free with VPA sustained-release monotherapy [average dose 22 mg/kg/day]. Adverse drug reactions [hair loss and tremor] were recorded in <20% of patients, mostly affecting adults. In this population, short-term treatment with VPA sustained-release in monotherapy provides good seizure control and is well tolerated

Central nervous system demyelination associated with etanercept in a 51 years old woman

There are few case reports documenting a new onset of demyelinating processes in patients receiving anti-tumour necrosis factor alpha therapy [anti-TNF alpha] for chronic inflammatory arthropathies. Whether anti-TNF alpha therapy induces new onset demyelination or just exacerbates pre-existing latent multiple sclerosis is not fully understood. We are reporting a 51-year-old woman without a prior history of multiple sclerosis, who developed demyelinating brain lesions three months after starting Etanercept. Her symptoms partially resolved on cessation of the drug. Our case was unusual compared to some previous case reports, as the patient's age at presentation was beyond that for idiopathic multiple sclerosis. This may strengthen the hypothesis of a causal relationship between new onset demyelination and Etanercept; however, exacerbation of pre-existing demyelinating process by Etanercept in this patient still cannot be totally excluded. We recommend doing magnetic resonance imaging [MRI] of the brain before starting patients on anti-TNF alpha therapy to exclude latent demyelination. In addition, new onset demyelination following anti-TNF alpha therapy should be reported and studied thoroughly as this may yield a significant advancement in our understanding of the pathogenesis of multiple sclerosis. Long-term follow-up of these cases is also important to determine the long-term prognosis and the rate of relapse of demyelinating process in this group of patients

Schwannoma of the vestibulocochlear nerve presenting as isolated paroxysmal vertigo

We report a patient with a schwannoma of the eighth cranial [vestibulocochlear] nerve who presented with isolated episodes of paroxysmal vertigo and positive Dix-Hallpike maneuver, and without the common features of hearing loss, disequilibrium and tinnitus. There are no previous reports of paroxysmal episodes of vertigo as the sole manifestation of schwannoma of the vestibulocochlear nerve. Hence, recurrent paroxysmal vertigo should therefore prompt the physician to rule out schwannoma of the vestibulocochlear nerve as a potential cause even in the presence of normal hearing tests