[Treatment of patients with lumbar disc prolapse with ibuprofen. A controlled clinical trial]. / Behandling af patienter med lumbal discusprolaps med ibuprofen. En klinisk kontrolleret undersøgelse.

The justification of employing the anti-inflammatory agent, ibuprofen, in the conservative treatment of lumbar disc prolapse was investigated. Forty-two patients admitted with clinical symptoms compatible with lumbar disc prolapse participated in the investigation. They were allotted double blindly at random to treatment with a placebo or ibuprofen as a supplement to the conservative treatment consisting of rest in bed, traction and mild analgesics. The analgesic effect of treatment in the two groups was assessed with the aid of a visual analogue scale and also the amounts of supplementary analgesics necessary. No significant difference in the pain experienced or employment of supplementary analgesics in the two groups could be registered. This investigation has thus not demonstrated further analgesic effect of ibuprofen administered as a supplement to the conservative treatment otherwise employed for lumbar disc prolapse.

Serum concentration of clonazepam after rectal administration.

The purpose of the present study was to evaluate the absorption of clonazepam administered rectally. 10 adult non-epileptics were given 0.02 mg clonazepam/kg body weight, and blood samples were drawn 0, 2, 5, 7, 10, 15, 30 and 60 min after administration. The concentrations were measured by gas-chromatography. To gain an impression of the serum concentration after intravenous administration, 2 persons were given 1 mg clonazepam and blood samples were drawn and analyzed in the same way as after rectal administration. Peak values occurred 10 to 30 min after rectal administration; the values were between 18 and 57 nmol/l. After intravenous administration, the values were very high within the first 10-15 min; hereafter the concentrations were about the same level as the peak values after rectal administration, indicating that clonazepam is well-absorbed after rectal administration and can be used in the treatment of status epilepticus, possibly in larger doses than those used in this study.

Practical aspects in the treatment of epilepsy.

The different forms of epilepsy require different treatment, and drug choice depends on certain pharmacological and pharmacokinetic principles. Optimal treatment is based on single drug therapy, if possible, and monitoring of plasma antiepileptic drug levels. Such treatment, together with clinical observations and the cooperation of a well-informed patient, will achieve the best seizure control. Nevertheless, seizure recurrence or increased seizure frequency is a possibility. When withdrawal of treatment is indicated, it must be done according to certain principles. The possibility of pregnancy must be considered when choosing antiepileptic drugs for fertile women. Drug kinetics are different during pregnancy, and frequent monitoring and adjustment of the regimen are essential. Special care is necessary during delivery because of a higher risk of complications and apparently increased perinatal mortality. Plasma half-life of antiepileptic drugs may be increased or decreased in newborns. Slow elimination of diazepam contributes a special risk. Breast feeding is safe in most cases, but phenobarbital and diazepam may cause sedation of the infant.