ABSTRACT
Focal-onset seizures are among the most common forms of seizures in children and adolescents and can be caused by a wide diversity of acquired or genetic etiologies. Despite the increasing array of antiseizure drugs available, treatment of focal-onset seizures in this population remains problematic, with as many as one-third of children having seizures refractory to medications. This review discusses contemporary concepts in focal seizure classification and pathophysiology and describes the antiseizure medications most commonly chosen for this age group. As antiseizure drug efficacy is comparable in children and adults, here we focus on pharmacokinetic aspects, drug-drug interactions, and side effect profiles. Finally, we provide some suggestions for choosing the optimal medication for the appropriate patient.
Subject(s)
Anticonvulsants/therapeutic use , Seizures/drug therapy , Adolescent , Adult , Anticonvulsants/adverse effects , Anticonvulsants/pharmacokinetics , Child , Drug Interactions , Humans , Seizures/classification , Seizures/physiopathology , Treatment FailureABSTRACT
BACKGROUND: The ketogenic diet has long been shown to be an effective therapy for children with medication-refractory seizures. Most complications of the ketogenic diet include short-lived gastrointestinal disturbances, acidosis, and dyslipidemia. Hepatic dysfunction and pancreatitis are among the less common but more serious complications of the ketogenic diet. Many patients on the ketogenic diet receive adjunct treatment with an anticonvulsant drug, and valproate is frequently used. METHODS AND RESULTS: We describe a child who developed hepatic dysfunction in association with the combined use of valproate and the ketogenic diet. After stopping the valproate and then restarting the ketogenic diet, her liver enzymes normalized, and she was able to achieve markedly improved seizure control and quality of life. CONCLUSIONS: Although caution should be advised when using both treatments simultaneously, the development of hepatic dysfunction should not preclude continuation of the ketogenic diet, as the hepatotoxic effects may be completely reversed once the valproate is stopped.
Subject(s)
Anticonvulsants/adverse effects , Diet, Ketogenic/adverse effects , Liver Diseases/etiology , Valproic Acid/adverse effects , Anticonvulsants/therapeutic use , Combined Modality Therapy/adverse effects , Drug Resistant Epilepsy/enzymology , Drug Resistant Epilepsy/therapy , Female , Follow-Up Studies , Humans , Infant , Lennox Gastaut Syndrome/enzymology , Lennox Gastaut Syndrome/therapy , Liver Diseases/enzymology , Retreatment , Treatment Outcome , Valproic Acid/therapeutic useABSTRACT
OBJECTIVE: To examine whether language moderates associations between three communication variables: media use, information scanning (attending to and remembering information) and seeking (actively looking for information), and three HPV outcomes: knowledge, vaccine awareness and vaccine initiation among Hispanics. PARTICIPANTS: Hispanic mothers of females aged 8-22 years (N=288) were surveyed. METHODS: Univariate and multivariate logistic regressions investigated associations between communication variables and HPV outcomes. To examine moderation by language, we compared main effects and interaction models using the likelihood ratio test. RESULTS: For English- and Spanish-speakers, Internet use was associated with more HPV knowledge and vaccine awareness, but not initiation. Scanning and seeking were associated with more knowledge, vaccine awareness, and initiation. Language moderated effects of scanning and seeking only on vaccine awareness. Spanish speakers who scanned for information were more likely to be aware of the vaccine than those who did not (80% vs 26%); Spanish speakers who sought information were also more likely to be aware (95% vs 55%). For English speakers, vaccine awareness did not differ between those who scanned and sought and those who did not. CONCLUSIONS: Effects of information scanning and seeking on HPV vaccine awareness were much greater for Spanish than for English speakers. Providers, therefore, should not assume that Spanish-speaking mothers are already aware of the vaccine. Our findings call attention to heterogeneity within Hispanics which could be particularly important when examining health communication and cancer prevention behaviors.
