Attitudes towards the switching of anti-epileptic medications in pharmacies: the patients' perspective.

Purpose: A survey of epilepsy patients' experiences of and attitudes towards the pharmacy switching of anti-epileptic medications. Methods: A structured questionnaire was administered to a group of epilepsy patients treated at the Institute of Psychiatry and Neurology and the Medical University of Silesia, Poland. Two hundred and eleven patients (mean [± SD] age: 41.0 ± 15.6 years) were recruited; 60.6% were women. 68.2% had been treated for over 10 years. Results: Most individuals (63%) claimed that they had never bought a generic substitute medication. Among the patients who declared that a switch had been proposed to them at a pharmacy (~40%), only 68.7% received any explanation at all from a pharmacist. Some reported positive emotions mostly related to a lower price of the new drug but also to the explanations received. Most respondents who accepted the pharmacy switch (67.4%) did not notice any significant changes in the efficacy or tolerability of treatment, while the remaining subjects reported an increase in seizure frequency (23.2%) and deterioration in treatment tolerance (9%). Conclusions: Around 40% of Polish epilepsy patients have been confronted with a proposal to switch their anti-epileptic medications at a pharmacy. More of them report negative attitudes towards the pharmacist's proposal than do not. It is possible that one of the major reasons for this is the insufficient information provided by pharmacists. It remains to be established whether the reported decrease in seizure control could be accounted for by a low concentration of the anti-epileptic drug in the blood after the switch.

Autoimmune meningitis and encephalitis in adult-onset still disease - Case report.

INTRODUCTION: Adult-onset Still disease (AOSD) is a rare systemic inflammatory disease of unknown cause. Its symptoms usually include persistent fever, fugitive salmon-colored rash, arthritis, sore throat (not specific), but it may also lead to internal organs' involvement, which presents with enlargement of the liver and spleen, swollen lymph nodes, carditis or pleuritis - potentially life-threatening complications. In rare cases, AOSD can cause aseptic meningitis or/and encephalitis. CASE PRESENTATION: We report a case of 31-year-old male patient, who was referred to neurological department for extending diagnostics of frontal lobes lesions with involvement of adjacent meninges. Abnormalities have been revealed in brain MRI, which was performed due to persistent headaches, visual disturbances, fever, fatigue and cognitive decline. Wide differential diagnosis was performed including laboratory findings, contrast enhanced MRI, MR spectroscopy, flow cytometry and finally brain biopsy to exclude neoplastic or infectious origin. Final diagnosis of autoimmune meningoencephalitis in adult-onset Still disease has been made. CONCLUSION: Adult-onset Still disease is a rare cause of inflammatory changes in central nervous system, which if diagnosed, may be treated successfully with steroids (commonly available agent), intravenous immunoglobulins or more specific immunomodulating regiments.

Frequent difficulties in the treatment of restless legs syndrome - case report and literature review.

Restless legs syndrome (RLS) is one of the most common sleep disorders. The purpose of this paper is a case description of the patient suffering from RLS, concurrent with numerous clinical problems. In our patient, during long-term therapy with a dopamine agonist (ropinirole), the phenomenon of the augmentation, defined as an increase in the severity of the RLS symptoms, was observed. The quality of life of the patient was significantly deteriorated. Due to the augmentation of RLS symptoms the dopaminergic drug was gradually withdrawn, and the gabapentin as a second-line drug for the treatment of RLS was introduced. Because of the large increase of both insomnia and RLS symptoms during the reduction of ropinirole dose, clonazepam was temporarily introduced. In addition, in the neurological assessment of the distal parts of the lower limb sensory disturbances of vibration were found. The neurographic study confirmed axonal neuropathy of the sural nerves, which explained an incomplete response to dopaminergic medications. However, gabapentin treatment in the dose recommended in neuropathies was impossible due to bothersome side effects. Another important issue in the treatment of the patient were depressive symptoms and the fact that the majority of used antidepressants (mirtazapine, mianserin, tricyclic antidepressants) increase the severity of RLS. Among antidepressants recommended for the treatment of depression in patients with RLS (such as bupropion, moclobemide, reboxetine, tianeptine and agomelatine) only agomelatine exhibits promoting sleep properties. Because of the concomitant insomnia, this drug was applied in our patient.