Efficacy and motor complications of original and generic levodopa in Parkinson's disease treatment.

BACKGROUND: In general, a generic drug is considered interchangeable with the original formulated drug. In Parkinson's disease (PD), generic drug use remains debated. This study was aimed to investigate whether the generic drug was as effective as the original in improving the symptoms of PD and the prevalence of motor complications. METHODS: This study was a multicenter cohort study of patients with PD enrolled from three northeast hospitals in Thailand between February 2013 and February 2014. The patients were categorized into original and generic levodopa groups. The clinical characteristics, efficacy, and motor complications were compared between the groups. RESULTS: There were 400 eligible patients. Of these, 327 patients (81.75%) met the study criteria and were classified as the original levodopa group (200 patients, 61.16%) and the generic levodopa group (127 patients, 38.84%). The average age of all patients with PD was 65 years. The duration of PD and the modified Hoehn-Yahr stages were not different between the groups. The total doses of original and generic levodopa-equivalent doses were significantly different (199.97±127.08 versus 305.58±138.27 mg; P-value <0.001) and the actual doses were 198.10±117.92 versus 308.85±139.40 mg (P-value <0.001). Approximately 80% of patients with PD in both groups had good responses (P-value >0.999), but the development of motor complications was significantly greater in the original than in the generic group. CONCLUSION: Generic levodopa was effective in improving the symptoms of PD. The prevalence of motor complications in the original compound group, at a lower dose of levodopa equivalent, was higher than in the generic group.

Factors associated with poor discharge status in patients with status epilepticus at Khon Kaen Hospital.

BACKGROUND: Status epilepticus (SE) is a serious neurological condition and has high a mortality rate. Data on importance of factors associated with poor outcomes in Asian or Thai populations are limited. METHODS: Adult patients diagnosed as SE at Khon Kaen Hospital, Thailand from October 1, 2010 to September 30, 2012 were enrolled. Patients were categorized as good or poor outcomes at discharge. Good outcomes were defined by improvement at discharge and absence of neurological deficits, while poor outcomes were defined by: not being improved at discharge; being discharged against advice; death; or presence of a neurological deficit. Clinical factors were compared between both groups. RESULTS: During the study period, there were 211 patients diagnosed as SE. Of those, 130 patients were male (61.61%). The mean age of all patients was 53.28 years. Acute stroke was the most common cause of SE in 33 patients (15.64%). At discharge, there were 91 patients (43.13%) who had poor outcomes. Only initial plasma glucose levels were significantly associated with poor outcomes with an adjusted odds ratio of 1.012 (95% confidence interval of 1.003 and 1.021). CONCLUSION: Initial plasma glucose is associated with poor discharge status in patients with SE.

Hyperglycemia associated with seizure control in status epilepticus.

BACKGROUND: Status epilepticus (SE) is a serious neurological condition and has a high mortality rate. Factors associated with seizure control measures in nonneurointensive care units (non-NICU) are limited. METHODS: Adult patients diagnosed with SE at Khon Kaen hospital, Thailand from October 1st, 2010 to September 30th, 2012 were enrolled. Patients were categorized as having controlled seizures and having uncontrolled seizures. Controlled seizures were defined as seizures that were aborted without any recurrence, while uncontrolled seizures were defined as unstoppable or recurrent seizures. Clinical factors were analyzed to find factors associated with uncontrolled SE. RESULTS: During the study period, there were 211 patients diagnosed with SE. Of those, 57 patients (27.01%) were in the group with controlled SE. Plasma glucose and serum albumin were two significant factors with adjusted ORs (95% CI) of 1.008 (1.001, 1.027) and 0.166 (0.059, 0.466) that differentiated patients with controlled seizures from patients with uncontrolled seizures. Central nervous system infections and cardiac arrests were also completely associated with the uncontrolled SE in the multivariate logistic analysis. CONCLUSIONS: In the etiology of SE, high plasma glucose and low serum albumin levels were associated with uncontrolled seizures in patients with SE in the non-NICU setting. This article is part of a Special Issue entitled "Status Epilepticus".

Clinical features and predictive factors in neuropsychiatric lupus.

BACKGROUND: Neuropsychiatric lupus (NPL) can present with a wide variety of clinical manifestations secondary to major organ involvement. These are often difficult to diagnose and treat with a high mortality. OBJECTIVE: This study aims to describe the prevalence, clinical features and predictive factors for NPL patients. METHODS: Patients with SLE were retrospectively reviewed for 10 years, between January 1996 [corrected] and August 2005. The prevalence, clinical features and predictive factors for NPL patients were studied. Neuropsychiatric (NP) syndromes were defined using the American College of Rheumatology (ACR) nomenclature and case definitions. RESULTS: 750 patients with SLE were studied; 13 patients were excluded due to incomplete data. The mean age was 35 +/- 11.7 years and 95.2% were female. The mean SLE disease duration was 6.9 +/ 5.6 years. Eleven of the 19 ACR NP syndromes were identified and NP manifestations occurred in 97 patients (13%) with a total of 103 NP events. Central nervous system (CNS) manifestations accounted for 87% (84 patients), while involvement of the peripheral nervous system (PNS) 13% (13 patients). The three most frequent manifestation were seizures (31.1%), followed by psychoses (223%), and cerebrovascular disease (22.3%). CNS involvement was strongly associated with hematologic and gastrointestinal involvements. The mortality rate in patients with NPSLE was 18.8%. CONCLUSION: Seizures, psychoses and cerebrovascular disease were the three most common NP features in SLE patients. CNS involvement was strongly associated with hematologic and gastrointestinal involvement.