[Open multicenter study of the effectiveness and safety of gabitril in epileptic patients with partial seizures]. / Otwarte wieloosrodkowe badanie skutecznosci i bezpieczenstwa stosowania Gabitrilu u chorych z padaczka z napadami czesciowymi.

The paper presents the results obtained by 53 investigators implementing the first Polish multicentre study of the effectiveness and safety of tiagabine (Gabitril). The study included 81 patients with refractory epilepsy with partial seizures. The duration of the study was 16 weeks. For the initial 6 weeks, Gabitril was gradually introduced till a dose of 30 mg/day was achieved. Within the subsequent 10 weeks the treatment effectiveness was observed and monitored, with the provision that the dose could be increased. The final analysis included 62 patients, while in 12 subjects the treatment was discontinued in less than 16 weeks. The results indicate a very beneficial effect of Gabitril on the frequency of seizures in patients with drug-resistant epilepsy. Almost 1 of the analyzed patients were seizure free. The most beneficial effects with respect to seizure number and intensity reduction were noted in subjects with partial complex and partial seizures with secondary generalization. The dynamic character of the decrease in seizure frequency was best observed between the first and third month of therapy. In 2/3 of patients the recommended dose was achieved and maintained. Less than 15% of subjects were excluded from the study, mainly due to lack of therapeutic effects. The number and character of adverse effects observed in the course of the present study did not differ from these noted in long-term Gabitril trials. The drug was demonstrated to exert no effect on vital functions and laboratory parameters. The results confirm the high effectiveness of Gabitril in treatment of patients with partial seizures and a good tolerance of this agent.

[Intravenous valproic acid administration in status epilepticus]. / Dozylne stosowanie kwasu walproinowego w stanie padaczkowym.

Despite progress in controlling status epilepticus (SE), a search is still in progress for a drug--a single agent--that would successfully and safely interrupt this life-threatening situation. Valproate (VPA) has been used in control of SE since the 1970s, yet only in the late 1980s was VPA first administered intravenously, with good results. Twenty adult patients in acute or static SE with generalized tonic-clonic seizures (GTCS) or simple partial motor seizures were administered VPA (Depakine Injectable 400 mg, Sanofi Winthrop) in a bolus dose of 15 mg/kg body weight and then 30 min later as a continuous infusion of 1 mg/kg/h for 24 h. The therapeutic effect was evaluated depending on the type of SE, its aetiology and the time lapse between seizure onset and drug administration. Response latency time (time between drug administration and seizure cessation) was considered as index of therapy success. SE was interrupted in < 30 min in 80% of cases (88.8% of patients with GTCS and 72.7% of those with partial simple motor seizures). A better effect was achieved in patients with static SE and in patients in whom SE lasted < 3 h before treatment. In 60% of patients with interrupted SE, the response latency time was < 20 min. The results indicate high success of VPA in SE control.

Acute hemorrhagic encephalitis (Hurst disease) associated with neuroaxonal dystrophy.

Two cases that fulfil the clinical and neuropathological criteria of acute hemorrhagic encephalitis are described. Histological examination revealed additionally focal changes in the white matter characteristic for neuroaxonal dystrophy. The differences in the clinical course and morphological picture observed in both cases are discussed.

[Open randomized comparative trial of sodium valproate and carbamazepine in adult onset epilepsy]. / Otwarte, randomizowane badanie porównawcze skutecznosci walproinianu sodu i karbamazepiny w padaczce z napadami czesciowymi zlozonymi o poczatku u osób doroslych.

An open randomized comparative study was carried out on the efficacy and tolerance of carbamazepine--Tegretol CR (CBZ) and sodium valproate--Depakine chrono (VPA) in adult patients with newly diagnosed epilepsy with partial complex seizures with or without secondary generalization. The trial included 60 patients aged 18-50 years. Thirty patients were randomized to an initial CBZ dose of 2 x 200 mg daily, and the remaining 30 patients to an initial VPA dose of 2 x 300 mg daily. The follow-up was carried out for 3 years. If clinically necessary, the doses were increased while monitoring blood serum drug levels until the therapeutic effect was achieved or side effects developed. A maximum dose of CBZ was established at 2000 mg/day, and that of VPA at 3000 mg/day. Within the first 6 months of the therapy, 5 patients on CBZ (16.6%) and 2 patients on VPA (6.6%) were excluded from the trial due to poor seizure control or adverse side effects. Between the seventh month and the end of the third year of the study, the number of patients additionally excluded for the above reasons was 5 (16.6%) individuals on CBZ and 6 (20%) patients on VPA. Out of the patients who were followed up for 3 years, 16 (80%) on CBZ and 16 (72.7%) on VPA achieved 12-month remission, while 12 patients on CBZ (60%) and 13 (59%) on VPA achieved a 24-month remission. It can be thus concluded, that the patients administered CBZ achieved the remission faster than the patients on VPA, but after 3-year therapy the effectiveness of the two drugs was comparable. There was no difference in effectiveness between patients with partial complex seizures with and without secondary generalization. The number of patients with adverse effects in both groups was comparable.

[Epilepsy and tremor in the XXY syndrome]. / Padaczka i drzenie w zespole klinefeltera.

Extrapyramidal tremor and epilepsy uncommon in Klinefelter syndrome were found in a 30 year old patient. CT scans revealed partially empty sella and subcortical cerebral atrophy. Chromosomal studies showed the karyotype 47, XXY.