ABSTRACT
PURPOSE: To assess the multiple-dose pharmacokinetics of levetiracetam and its major metabolite ucb L057 in children with partial-onset seizures and determine whether it is affected by adjunctive carbamazepine or valproate. To correlate levetiracetam concentrations in plasma and saliva and to assess its safety and clinical response. METHODS: Design was an open-label, multicenter study. Twenty-one children (4-12 years old) with epilepsy taking carbamazepine (13) or valproate (8) received adjunctive levetiracetam. Levetiracetam was initiated at 20 mg/(kg day) and titrated at 2-week intervals to 40 and then 60 mg/(kg day). Twelve-hour pharmacokinetics were determined at the end of each 2-week period. Efficacy was estimated from the partial seizure frequency per week and Global Evaluation Scale. RESULTS: Levetiracetam was rapidly absorbed following oral dosing, with median t(max) of 0.5 h. Dose proportional increases were observed for C(max) and AUC((0-12)) over the dose range; t(1/2) was 4.9 h. Pharmacokinetics of levetiracetam and ucb L057 were not markedly different with concomitant carbamazepine or valproate; clearance was only 7-13% faster and AUC was decreased by only 15-24% in those on carbamazepine compared to valproate. Levetiracetam did not affect trough carbamazepine or valproate. Concentration in saliva and plasma were strongly correlated. Seizure frequency declined by 50% or more in 43% of subjects in the intent-to-treat population (n=21) and in 56% of those with seizures at baseline (n=16). Marked or moderate improvement occurred in 80% and 75% of patients based on Global Evaluation Scale ratings by investigators and parents/guardians, respectively. Levetiracetam was well tolerated. CONCLUSION: Levetiracetam exhibits simple pharmacokinetics in children, with rapid absorption and dose-proportional kinetics. Small but not clinically relevant differences were observed between subjects receiving carbamazepine and valproate, suggesting significant dose adjustment is usually not necessary. This substantiates prior assessments that levetiracetam clearance is higher in children than adults, necessitating a higher dose in children on a mg/kg basis, and suggests it is useful add-on therapy for children with partial-onset seizures regardless of baseline therapy.
Subject(s)
Anticonvulsants/pharmacokinetics , Epilepsies, Partial/drug therapy , Piracetam/analogs & derivatives , Anticonvulsants/administration & dosage , Anticonvulsants/adverse effects , Carbamazepine/therapeutic use , Child , Child, Preschool , Drug Therapy, Combination , Humans , Levetiracetam , Piracetam/administration & dosage , Piracetam/adverse effects , Piracetam/pharmacokinetics , Saliva/chemistry , Valproic Acid/therapeutic useABSTRACT
El trastorno por déficit de atención con hiperactividad es la entidad más frecuente en la consulta pediátrica neuropsiquiátrica. Numerosos estudios sustentan el origen biológico de esta enfermedad. Es un padecimiento crónico que se caracteriza por una tríada de síntomas consistente en inatención, hiperactividad e impulsividad, que afectan el funcionamiento académico, social y laboral de quien lo padece. El diagnóstico se establece de forma clínica; existe una elevada comorbilidad con otras psicopatologías. El abordaje terapéutico debe contemplar tanto la intervención farmacológica como la estrategia principal, siendo los estimulantes la primera línea de elección. Las intervenciones psicosociales son complementarias.
Attention deficit hyperactivity disorder it is the most frequent causes of pediatric neuro psychiatric consultation. Numerous studies sustain the biological origin of this illness. It is a chronic suffering that is characterized by a consistent triad of symptoms in attention deficit, hyperactivity and impulsiveness that affect the academic, social and physical activities of those who suffer it. The diagnosis is clinical and there is strong comorbidity with other psychiatric disorders. The main therapeutic approach is with the stimulants the first line drugs. The psychosocial intervention is complementary.
ABSTRACT
La migraña es un trastorno bastante frecuente en las mujeres, se presenta hasta en 18 por ciento, con mayor prevalencia entre los 20 y 50 años y los cambios hormonales la influencian a lo largo del ciclo reproductivo de la vida. Cuando durante el embarazo se presenta o se recrudece el médico tratante se preocupa acerca de la repercusión que la terapéutica misma pueda tener en el embarazo o bien en el producto. Objetivo. Hacer una breve revisión acerca de la definición, clasificación y teorías que hay para explicar la migraña, el efecto que tiene en el embarazo y finalmente presentar lineamientos de tratamiento tanto en el embarazo como en el periodo de lactancia. Existen dos teorías para explicar el origen de la migraña: la vascular y la neurogénica. Existe la observación de que el embarazo cambia los patrones de la migraña.
Subject(s)
Migraine Disorders , Pregnancy , Lactation , Vascular HeadachesSubject(s)
Humans , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/therapy , Drug Therapy , Father-Child Relations/ethnology , Methylphenidate/administration & dosage , Methylphenidate/therapeutic use , Methylphenidate/pharmacokinetics , Child Behavior Disorders/physiopathology , Child Behavior Disorders/psychology , Child Behavior Disorders/therapy , Growth/drug effects , Antidepressive Agents/therapeutic use , Antihypertensive Agents , Antipsychotic AgentsABSTRACT
El trastorno de déficit de atención e hiperactividad es un problema frecuente que interfiere en la relación de un escolar con su ambiente. En este trabajo se presenta una breve revisión histórica de dicho concepto, así como sus diferentes manifestaciones clínicas y la etiología más frecuente, como el carácter hereditario y la lesión del lóbulo frontal. Se resalta la dificultad de establecer un diagnóstico basado en pruebas de laboratorio, y finalmente se presentan las posibilidades de tratamiento: estimulantes, antidepresivos o antipsicóticos, entre otros; además, se incluye una detallada explicación de la historia natural de este padecimiento
