comparative assessment the efficacy of intravenous infusion of sodium valproate and phenytoin in the treatment of status epilepticus

Status epilepticus [SE] is a type of persistent lasting seizure with high mortality and morbidity. Numerous medications are suggested for the treatment of SE, two of which are sodium valproate and phenytoin. The purpose of this study is to conduct a comparison between the efficiencies of intravenous sodium valproate and phenytoin in the treatment of this type of epilepsy. This is a clinical trial study conducted on SE-suffering patients admitted to the emergency departments of Al-Zahra and Ayatollah Kashani Medical Centers of Isfahan in 2009 and 2010. The patients were randomly assigned into two groups and taken under treatment, separately by intravenous infusion sodium valproate and phenytoin. No significant difference was observed between the two groups [at P = 0.06]. In terms of incidence of the clinical complications, the incidence of clinical complications in the two groups was significantly different [at P = 0.03]. Based on the findings the efficiency of sodium valproate is larger than that of the phenytoin, and thus, the treatment by sodium valproate is preferred over the treatment by phenytoin

Quality of sleep in patients with Parkinson's disease

Parkinson's disease [PD] is a progressive neurodegenerative disorder causing motor and non-motor symptoms. The latter are common and include autonomic dysfunction, cognitive impairment, and sleep difficulties. Many of the non-motor aspects of PD such as sleep disturbance are more common and significantly affect the day-to-day activities of patients and their quality of life. The most important aim of this study was to evaluate the sleep quality in patients with PD. This case-control study was performed on patients with PD referred to the Neurology Clinic of our teaching hospital in 2011. Thirty-four patients with PD and 34 healthy people as control group were enrolled in this study. Sleep quality of patients and control was evaluated by Parkinson's disease sleep scale [PDSS] questionnaire. PDSS is a reliable and valid tool to measure sleep disorders in PD. The mean total PDSS score in patient group was 55.29 [SD = 26.92] indicating moderate to severe sleep disturbances whereas, the mean total score in control group was 20.34 [SD = 10.65]. Difference between the two groups' mean scores was significant [P < 0.05]. Our study demonstrated that patients with PD experienced poorer nocturnal sleep quality than the control group

Antiepileptic drugs: a consideration of clinical and biochemical outcome in patients with epilepsy

The challenge of antiepileptic drugs [AEDs] management is to attain the best compromise between the desire to maximize seizure control and the need to keep side-effects within tolerable limits for the individual patient. To reduce devastation in Iranian epileptic patients, the aim of this study was to explore the overall outcome following AEDs prescription. A cross sectional study of 36 patients located at the epilepsy ward, conducted to Isfahan Neurosciences Research Centre was carried out during the year 2011. Female [n = 17] and male subjects [n = 19] with a mean age of 27 years [range; 7-74 years] were studied. Variables including, sex, age, age of seizure onset, type, and number of AEDs, biochemical and hematological data were recorded in d-Base and statistical analyses were performed using SPSS [version 18] for windows. The main drug to control seizure attack was carbamazepine and valproic-acid. The following tests were the most frequently influenced; alkaline phosphatase [AP], lymphocyte [Lymph], white blood cell [WBC] counts and hemoglobin [Hgb]. There was a significant increase in [AP] [mean; 534.6 u/l; [P = 0.02] in three patients and [Lymph] [55%; [43-84]%; [P = 0.04] in seven patients. WBC was lower than 4400 mm[3] [P = 0.02] in six patients. Hgb was significantly lower in 70.6% of women [11.8; [10-14.2] g/dl; [P = 0.04] and 68.4% of men population [12.3; [9.7-13.8] g/dl; [P = 0.01]. Mean age of epilepsy onset was 15.6 years [range: Birth-74 years]. Analysis of drug prescriptions showed that the incidence of monotherapy and polypharmacy [2 up to six AEDs simultaneously] was 19.4% plus 80.6% respectively. In Iranian epileptic population, effectiveness of treatment should be attributed by the close supervising of AEDs in relation to clinical circumstance, laboratory data, and therapeutic drug monitoring. Any significant change in patients' biochemical and hematological data may require close verifying for the rapid detection of severe anemia, leukopenia, lymphocytosis, osteomalacia, or liver failure

Preliminarily analysis of carbamazepine [CBZ] C[0] in patients visited Isfahan epileptic clinics

Carbamazepine [CBZ] is mostly considered as the first line of effective treatment against simple or complex partial seizure and primary-secondary generalization. To prevent side-effects related to higher amount of CBZ minimum concentration [C[0]] in body fluid or seizure attacks associated to lower amount of CBZ-C[0], the suggested minimum therapeutic concentrations range from 4 to 12 ng/ml [according to previous publications]. The aim of this preliminarily study was to investigate the scope of discrepancy associated to the C[0] of CBZ in patients visited Isfahan Epileptic Clinic. A cross-sectional study of 22 patients located in neurology ward of Isfahan Neurosciences Research Centre [INRC] was carried out between April 1, 2012 and December 31, 2012. Female [n = 9] and male subjects [n = 13] with a mean age of 27.4 years [range; 16-38 years] were studied. Pharmacological [CBZ-C[0]] and demographical variables were recorded and processed in excel. The results of CBZ-C[0] showed wide inter-individual variability. The mean value of CBZ-C[0] was 7.2 ng/ml. In 10 out of 22 patients, CBZ-C[0] were lower than the suggested therapeutic window [4-12 ng/ml]. CBZ-C[0] in nine patients was non-detectable and in one patient was 0.5 ng/ml [45% <4 ng/ml]. In 55% of the patients, CBZ-C[0] ranged from 4.8 to 12 ng/ml. A schedule therapeutic drug monitoring based on measurement of CBZ-C[0] for individual patient could be a practical marker to achieve therapeutic objectives. Further study related to correlating of CBZC[0] to clinical events in Iranian Epileptic population seems to be valuable

Pizotifen in migraine prevention: A comparison with sodium valproate

Background & Objective: Pizotifen is an alternative option for prophylactic treatment of migraine headache. This study aims to compare the effi cacy and safety of pizotifen with sodium valproate; one of the most-widely used drugs in migraine prevention. Methods: This was a single blind, randomized, parallel-group study. After a 4-week baseline evaluation, patients with episodic migraine were randomly assigned to get either sodium valproate or pizotifen for a period of 12 weeks. Patients were asked to fi ll a headache diary through the study. Headache characteristics and the possible side effects were evaluated throughout and at the end of trial. Results: Forty two patients aged 20 to 49 were recruited to the study. With both drugs, the frequency, intensity and duration of headaches were signifi cantly reduced (p < 0.05). Except for headache duration, pizotifen was signifi cantly superior to sodium valproate in the headache parameters assessed. Total reported side effects were initially higher in patients who received pizotifen (37 vs. 22; P= 0.038); however, persistent side effects were lower for pizotifen (6 vs. 10; P= 0.22). Conclusions: The results of this study suggest that pizotifen is a safe and effective drug in migraine prevention.

Isolated third nerve palsy from mild closed head trauma

Head injury is a common occurrence in motor vehicle accidents. There are numerous causes for cranial nerve injury that include head trauma or other lesions. Few studies regarding cranial nerve injury following mild head trauma [GCS: 14 - 15] exist in the literature. [1]The oculomotor nerve is a somatic and visceral motor nerve. When it is completely injured the result is ptosis, pupils that are non-reactive to light and a lack of eye movement. We report the case of a completely isolated oculomotor nerve palsy associated with minor head injury

Comparison of mental health in patients with chronic idiopathic generalized seizure with control group

Seizure is a prevalent neurological disorder. The number of patients diagnosed with this condition is increasing every year. Psychiatric disorders with seizure are highly prevalent, thus diagnosis and effective treatment seizure is great of importance in terms of its impact on the patients' of quality life. It has been demonstrated that attempted and committed suicide occur in seizure patients more than general population. This study assesses the psychological profiles and mental health state of patients with chronic seizure disorders using the Symptom Checklist-90-R [Scl-90 R]. This descriptive-analytical study was carried out on 40 patients with chronic idiopathic seizure disorder and 40 control participants from seizure clinics of Isfahan University of Medical Sciences in 2004. Scl-90-R was used to evaluate the subjects' psychological symptoms. Eighty-two percent of the subjects were male and 18% were female [mean age: 28.1 years]. The average scores of the case and the control groups were 1.65 versus 0.83 in somatization, 1.79 versus 1.39 in obsessive-compulsive symptoms, 1.61 versus 1.24 in interpersonal sensitivity, 2.01 versus 1.56 in depression and 1.82 versus 1.24 in anxiety respectively. The difference between two groups were significant is all domains [P<0.05]. The total score for psychopathology was 16.43 in the case group versus 12.21 in the control group, which also shows a significant difference between the cases and controls. This study demonstrated the undesirable mental health state of patients with chronic seizure disorder compared to controls, particularly in depression, anxiety, obsession-compulsion, somatization and interpersonal sensitivity domains