Phenytoin, folic acid and gingival enlargement: Breaking myths.

BACKGROUND: Epilepsy is described as a chronic neurological disorder characterized by recurrent seizures of cerebral origin, presenting with episodes of sensory, motor or autonomic phenomenon with or, without loss of consciousness. A recent meta-analysis of published and unpublished studies puts an overall prevalence rate of epilepsy in India at 5.59 per 1,000 populations. There have been studies that report clinical benefits of the use of folic acid as an adjuvant to the anti-epileptic therapy in the prevention of anti-epileptic drug induced gingival enlargement. However, studies conducted in the past have also reported precipitation of epileptic attacks in patients on folic acid adjuvant therapy due to fall in sera levels of phenytoin due to drug interactions. The study was planned to investigate the association of phenytoin induced gingival enlargement and sera levels of folic acid in epileptic patients on phenytoin therapy so as to justify the use of folic acid as a routine adjuvant to the usual anti-epileptic therapy to prevent this inevitable adverse effect without destabilizing the ongoing regimen leading to the precipitation of seizures in an otherwise stable patient (breakthrough seizures). MATERIALS AND METHODS: A total of 100 patients between the ages 18 and 50 years were clinically diagnosed with epilepsy prior to the start of phenytoin therapy were included based on selection criteria and written informed consents were obtained. Assessment of serum folic acid levels and gingival enlargement was performed prior to the start of and after 1 year of phenytoin therapy. STATISTICAL ANALYSIS USED: The statistical analysis was carried out using t-test and the baseline serum folate levels and the serum folate levels obtained after 1 year of phenytoin therapy were correlated with the respective grades of gingival enlargement using Pearson's coefficient formula. RESULTS: The results of the study confirmed a significant association between low serum folate levels with increasing severity as well as an early onset of phenytoin induced gingival enlargement. CONCLUSIONS: The results of the study suggest a higher incidence of gingival enlargement with an early onset and increased severity in phenytoin treated epileptic patients with a positive correlation with falling serum folic acid levels as the duration of the therapy increases.

Study of psychiatric comorbidities in epilepsy by using the Mini International Neuropsychiatric Interview.

BACKGROUND: Epilepsy is a neurological condition affecting men and women of all age groups and is associated with psychiatric comorbid conditions. There is a paucity of published data available regarding psychiatric comorbid conditions in patients with epilepsy (PWEs) from developing countries. METHODS: We compared the psychiatric comorbid conditions in 80 PWEs, 80 patients with asthma (asthma control (AC) subjects), and 80 healthy controls (normal control (NC) subjects) using the Mini International Neuropsychiatric Interview (MINI) for the diagnosis of Axis I psychiatric disorders. RESULTS: Psychiatric comorbid conditions are more common in PWEs (32.50%) as compared with the AC (17.5%) and NC (7.5%) subjects. Longer duration of seizures, increased frequency of seizures, recent recurrence of seizures, anticonvulsant polypharmacy, poor compliance with medications, and family history of seizures were associated with increased psychiatric comorbidity. CONCLUSION: Patients with epilepsy are more likely to have psychiatric comorbid disorders compared with the other patients with chronic illness or with the healthy controls. It is of immense clinical importance to identify the comorbid psychiatric disorders in PWEs as the treatment of these disorders apart from a good seizure control may significantly improve their quality of life.

A study on gingival enlargement and folic acid levels in phenytoin-treated epileptic patients: Testing hypotheses.

BACKGROUND: There have been studies that report clinical benefits of the use of folic acid as an adjuvant to the antiepileptic therapy in the prevention of antiepileptic drug-induced gingival enlargement. However, studies in the past have also reported precipitation of epileptic attacks in patients on folic acid adjuvant therapy due to fall in sera levels of phenytoin due to drug interactions. The study was planned to investigate the association of phenytoin-induced gingival enlargement and sera levels of folic acid in epileptic patients on phenytoin therapy. The statistical analysis was done using t-test and the baseline serum folate levels and the serum folate levels obtained after 6 months of phenytoin therapy were correlated with the respective grades of gingival enlargement using Pearson's coefficient formula. METHODS: A total of 25 patients aged between 18 and 50 years, clinically diagnosed with epilepsy prior to the start of phenytoin therapy were included based on selection criteria and written informed consents were obtained. Assessment of serum folic acid levels and gingival enlargement was done prior to the start of and after 6 months of phenytoin therapy. RESULTS: The results of the study confirmed a significant association between low serum folate levels with increasing severity as well as an early onset of phenytoin-induced gingival enlargement. CONCLUSIONS: The results of the study suggest a higher incidence of gingival enlargement in phenytoin treated epileptic patients with a positive correlation with falling serum folic acid levels as the duration of the therapy increases.

Production of monoclonal antibodies against Nosema bombycis and their utility for detection of pebrine infection in Bombyx mori L.

Latex agglutination assay based on monoclonal antibodies (MCAs) described in this communication may be useful for detection of Pebrine infection in silkworm. Four murine MCAs were produced against Nosema bombycis spore. In ELISA all 4 MCAs (IgM isotype) reacted with alkali treated Nosema spores and to variable extent with acetone precipitated surface protein. However, MA-310 and MA-542 showed a low degree of cross reactivity with BmNPV. In contrast, MA-503 and MA-515 were devoid of reactivity with BmNPV, B. thuringiensis, S. marcescens, Azotobactor, Rhizobium and normal hemolymph protein in ELISA. Latex beads sensitized with a combination of MA-503 and MA-515 (50 micrograms each per ml of 0.4% latex beads) could detect 1 x 10(5) Nosema spores per test. Sensitization of the latex beads with the cocktail of these two MCAs through protein-A bridge further led to a 10-fold increase in the sensitivity (1 x 10(4) spores/test) of the assay. No agglutination was observed in presence of BmNPV, Rhizobium, Azotobactor, E. coli, B. thuringiensis, S. marcescens and normal hemolymph protein indicating the specificity of the test. The results obtained by latex agglutination assay on hemolymph samples of infected as well as normal larvae collected from field, II instar larvae infected in the laboratory and from infected mother moth revealed 100% correlation with results by microscopic examination.

Protein A linked latex antisera test for detection of infectious flacherie of silkworm, Bombyx mori L. caused by B. mori infectious flacherie virus.

Protein A linked latex antisera (PALLAS) test was used for detection of B. mori infectious flacherie virus (BmIFV) in silkworms. The test was found superior to direct latex agglutination (DLA) test for detection of BmIFV in infected larval and faecal matter extracts and purified preparations. Latex beads sensitized with anti-BmIFV IgG were able to detect up to 75 ng/ml BmIFV in PALLAS test and 300 ng/ml in DLA test. BmIFV was detected in diluted extracts of infected larvae (up to 1:200) and their faecal matter (up to 1:500). BmIFV progressive infection was detected at 12 and 24 hr of post infection in PALLAS and DLA tests, respectively in both larval and faecal matter extracts. PALLAS tests provides a simple, specific and highly sensitive test for detection of infectious flacherie virus.

Evaluation of protein-A linked monoclonal antibody latex agglutination test for diagnosis of nuclear polyhedrosis virus (BmNPV) of silkworm Bombyx mori L.

The symptomology of BmNPV infection in Bombyx mori L depends on the stages of infection. Discernible symptoms develop at later stages of infection, which leads to improper diagnosis and poor crop yield with sericulturists. In the present study development of direct and protein-A linked monoclonal antibody latex (PALMAL) agglutination test for the detection of BmNPV infection in silkworm is described. Latex beads were precoated with protein-A and then sensitised with monoclonal antibody MA-231 (125 micrograms/ml). PALMAL test could detect 1 x 10(5) nuclear polyhedra/test and is ten times more sensitive than the direct agglutination test employing purified polyclonal antibodies. No agglutination was observed in presence of B. thuringiensis, S. marcescens, N. bombycis, group-A streptococci, Staphylococcus aureus, E. coli and normal haemolymph protein indicating the specificity of the test. Fifty haemolymph samples collected from the field were evaluated by PALMAL test. Twenty one samples having infection other than BmNPV, failed to show positive agglutination. Twenty five samples having > or = 5 x 10(6) BmNPV/ml showed positive agglutination. However, 4 samples having < 5 x 10(6) BmNPV/ml failed to show positive agglutination thereby indicating the limit of sensitivity of the assay.