ABSTRACT
In the vast majority of women with epilepsy, no complications occur during pregnancy. Important for that is early, preconceptional counseling and close surveillance during pregnancy. The aim should be to maintain the best possible seizure control without occurrence of generalized tonic-clonic seizures while using antiepileptic drugs and with the lowest possible risk of malformations. The warnings for the prescription of valproic acid in women of reproductive age were tightened because of the dose-dependent increase in the malformation rate and other risks, especially regarding adverse effects on childhood cognitive development. The pharmacokinetics of antiepileptic drugs in pregnancy require monitoring of serum drug levels and an early dose adjustment. Breastfeeding should be encouraged in women with epilepsy taking antiepileptic drugs as long as infants are closely monitored with respect to possible sedation and poor drinking.
Subject(s)
Abnormalities, Drug-Induced/prevention & control , Anticonvulsants/administration & dosage , Anticonvulsants/adverse effects , Epilepsy/drug therapy , Pregnancy Complications/drug therapy , Abnormalities, Drug-Induced/etiology , Congenital Abnormalities , Dose-Response Relationship, Drug , Drug Monitoring/methods , Epilepsy/diagnosis , Evidence-Based Medicine , Female , Humans , Pregnancy , Pregnancy Complications/diagnosis , Risk Assessment , Treatment OutcomeABSTRACT
BACKGROUND AND PURPOSE: Patients with cerebellar infarction are threatened by infratentorial herniation and impaired circulation of cerebrospinal fluid if mass effect in posterior fossa develops. Clinical assessment is often impaired in patients with disturbances of consciousness. Therefore, computed tomography (CT) examination is essential in the diagnosis of complication and decision for operative treatment. METHODS: Mass effect of cerebellar infarction was quantitatively assessed using a 3-item CT score: width of fourth ventricle, compression of quadrigeminal cistern, and width of lateral ventricle. Retest and interrater reliability was determined. Validity of assessment of mass effect was examined using 185 CT scans from a cerebellar infarction study, and the effect of operative treatment on CT score was determined. RESULTS: The correlation coefficients for retest and interrater reliability were 0.94 and 0.75, respectively. The authors found a significant difference for the CT sum score and all CT items except "compression of the fourth ventricle" between patients with different levels of consciousness. Effect of operative treatment was documented by improvement of CT score. CONCLUSIONS: The proposed CT score is of high interrater and retest reliability, supplements the clinical assessment of the patient, and is able to monitor the efficacy of decompressive treatment.
Subject(s)
Cerebellar Diseases/diagnostic imaging , Cerebral Infarction/diagnostic imaging , Tomography, X-Ray Computed , Cerebellar Diseases/complications , Cerebellar Diseases/surgery , Cerebral Infarction/complications , Cerebral Infarction/surgery , Female , Humans , Male , Middle Aged , Reproducibility of Results , Statistics, NonparametricABSTRACT
From March to August 1993 we performed a comprehensive educational campaign about stroke and acute stroke therapies to shorten admission delay and to recruit more patients for the ECASS trial [8]. We compared the presentation data of all stroke patients admitted in a six month preeducational period with data of a six month posteducational period. The median admission delay was significantly reduced from eight hours in the preeducational to five hours in the posteducational period. The number of patients undergoing thrombolytic treatment increased. The following factors shortened admission delay: age > 70 years, living in cities, stroke onset during daytime, admission by ambulance, stroke in anterior circulation, cardiogenic embolic stroke, severe symptoms.
