Clobazam in therapy-resistant patients with partial epilepsy: a double-blind placebo-controlled crossover study.

Clobazam was compared with placebo as antiepileptic adjunct medication in 129 therapy-resistant epileptic patients who were mainly suffering from complex partial seizures. The study was performed in five European countries according to a double-blind crossover design lasting 7 months. Two treatment periods of 3 months (1 month adjustment and 2 months maintenance medication) were separated by one medication switch-over month. The difference in seizure reduction between clobazam and placebo was significant (p less than 0.05). Nineteen percent of patients receiving clobazam became seizure-free during the maintenance dose period. In contrast, freedom from seizures was not observed in any placebo patient. Electroencephalogram (EEG) signs, mood ratings, and global impressions also indicated therapeutic effects of clobazam in epilepsy. The most frequent adverse reactions to clobazam were drowsiness and dizziness. However, the sedative effects of clobazam seemed to be less pronounced in comparison with other benzodiazepines. The study gives evidence of the therapeutic value of clobazam as adjunct medication in therapy-resistant partial seizures. The use of clobazam as monotherapy and long-term treatment, as well as the particular seizure response pattern to clobazam, has to be further investigated.

[Psychometric studies in Friedreich's ataxia]. / Investigations psychométriques dans l'ataxie de Friedreich.

The literature contains few reports of investigations on the mental state of subjects with Friedreich's ataxia. Most are based on clinical findings and lead to differing conclusions. For some authors the neurological disease is associated with mental deficits of varying magnitude, for others the mental state of the patients is accompanied by any deficit. The authors discuss five cases and try to supplement clinical findings with a series of psychometric tests in three areas: intellectual efficiency, higher cortical functions and elements of personality. The clinical and psychometric results are summarized in a grid comprising the main psychopathological symptoms attached to cerebral organic suffering (psycho-organic syndrome). Comparison of the results with medical data confirm that, in Friedreich's ataxia, there are no specific disorders characteristic of a psycho-organic syndrome. Lastly, the authors discuss certain hypotheses (concerning methods used, precocious appearance of symptoms and reactions to the disease) which try to explain the divergence of conclusions reached in the literature for this type of study.

[Comparative study of valproic acid and sodium valproate (author's transl)]. / Etude comparative de l'action de l'acide valproïque et du valproate sodique.

The action of valproic acid prescribed instead of sodium valproate in strictly identical conditions was analysed in 11 epileptic children and 24 adults. No change in therapeutic effect was observed in a large proportion of cases. However, blood tests showed an increase in serum levels in most cases. Thus, valproic acid can be of help in cases hitherto treated with sodium valproate, on the same basis as diphenylhydantoin; the acid form sometimes offers an advantage over the use of the sodium salt.

Comparative trial of intravenous lorazepam and clonazepam im status epilepticus.

The primary use of lorazepam, when administered intravenously (IV), has been in the treatment of acute attacks of anxiety and agitation. Recent studies have investigated its efficacy in patients with status epilepticus. The present study compared the efficacy and tolerability of lorazepam and clonazepam in the treatment of status epilepticus. Lorazepam, 4 to 10 mg IV, and/or clonazepam, 1 mg IV, was administered in 61 hospitalized epileptic patients. If needed, the dose of each agent was repeated in 20 minutes. Twenty-two patients were given lorazepam, nine were given clonazepam, and 30 were given both drugs at different times. Improvement in EEG was greater with lorazepam while the clinical symptoms responded more completely to clonazepam. Both drugs were most effective in patients with secondary generalized epilepsy. Drowsiness followed either drug. Psychomotor agitation followed either drug in 12% of patients.

[Electroencephalogram and CAT scan in 393 cases of epilepsy. Consistency between focal EEG changes and focal CAT changes (author's transl)]. / Electroencéphalogramme et tomographie assistée par calculateur dans 393 cas d'épilepsie. Etude des correspondances des localisations EEG et des localisations dédouvertes par la tomographie assistée par calculateur.

A simultaneous study of EEG recordings and CAT scans in 393 epileptics led to the following findings:--in our population, the EEG pattern is normal in 6.8% of the cases and the CAT normal in 64.6%;--focal EEG changes give focal CAT changes in 38.6% and diffuse changes in 4.1% of the cases;--diffuse EEG changes give focal CAT changes in 18% and diffuse changes in 8.8% of the cases;--focal CAT changes give focal EEG changes in 68% and diffuse changes in 28% of the cases;--diffuse CAT changes give focal EEG changes in 27.5% and diffuse changes in 51.8% of the cases;--out of the 393 epileptics, 72 presented distinctly focal changes on simultaneous EEG and CAT records. The changes were on the same side in 80.5% of the cases. The reasons for the lack of consistency in 19.5% of the cases are discussed.