Rapid switchover to carbamazepine using pharmacokinetic parameters.

Abstract:

PURPOSE:The standard practice of switching patients to carbamazepine (CBZ) involves initiating a low dose and raising it by small increments until the desired dose is reached, to avoid intolerable adverse effects (AE). In a pilot study, a protocol using single-dose kinetic studies was developed to switch patients to CBZ through rapid-dose increments and to manage concurrent rapid taper of the previous antiepileptic drugs (AEDs) without causing AE. The purpose of this prospective study was (a) to reassess whether a rapid switchover to CBZ could be done with minimal or no AE and without causing an increase in seizures; (b) to determine whether the maintenance dose of CBZ predicted at the time of the single-dose kinetic study can yield the desired concentration at steady state (Css); and (c) to determine the degree to which the calculated maintenance dose of CBZ will need to be adjusted after the previous AED has been discontinued for a four-week period. METHODS:Twenty-five patients taking phenytoin (PHT) and/ or phenobarbital (PB) and/or primidone (PRM) underwent a rapid switchover to CBZ following a 10 mg/kg single-dose kinetic study (day 1) which allowed calculation of a maintenance dose necessary to yield a mean Css of 10.2 (+/-2.2) mg/l. On day 2, patients received a CBZ dose equivalent to 10 mg/kg + 200 mg; thereafter, they underwent daily dose increments of 200 mg until the calculated maintenance dose was reached. Dose increments were modified in the case of AE. Concurrent tapering of the previous AED was started as of day 1: PHT by 100 mg/day, while PB and PRM were stopped on day 1; PB was restarted before patients were to be discharged from the hospital if a PB serum concentration above 10 mg/l was identified at that time. Pharmacokinetic data and occurrence of AE were compared between the two groups at the time of the single-dose kinetic study, at the completion of the switchover to CBZ, and 4 weeks after discontinuation of the previous AED. RESULTS:All patients completed the switchover to CBZ within a mean time period of 6 days (+/-2), reaching a mean maintenance dose of 1,639 mg/day (+/-370) which yielded a mean Css of 11.3 (+/-3.2) mg/l. The maintenance dose had to be lowered by 20.4% (+/-8.3) in 59% of patients within the four-week period following discontinuation of at least one of the previous AEDs. None of the patients experienced an increase in seizure frequency relative to baseline. Fifteen (60%) patients had no AE; five (20%) experienced AE of mild severity. AE rated as moderately severe (n = 4) or severe (n = 1) occurred in patients with a static encephalopathy (p = 0.02, Fisher's exact test) and among patients > or =55 years (p = 0.017, Fisher's exact test). CONCLUSIONS:A rapid switch-over to CBZ from PHT, PB, or PRM can be carried out safely with no, or minimal, AE in young adults, unless they suffer from static encephalopathy.

journal_name

Epilepsia

journal_title

Epilepsia

authors

Kanner AM,Bourgeois BF,Hasegawa H,Hutson P

doi

10.1111/j.1528-1157.1998.tb01358.x

subject

Has Abstract

pub_date

1998-02-01 00:00:00

pages

194-200

issue

2

eissn

0013-9580

issn

1528-1167

journal_volume

39

pub_type

杂志文章
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    authors: Nishiyama I,Ohtsuka Y,Tsuda T,Inoue H,Kunitomi T,Shiraga H,Kimura T,Fujimoto K

    更新日期:2007-06-01 00:00:00

  • Do children with benign rolandic epilepsy have a higher prevalence of migraine than those with other partial epilepsies or nonepilepsy controls?

    abstract:PURPOSE:Prior studies have given conflicting data concerning the association of benign rolandic epilepsy of childhood (BREC) and migraine but were limited by lack of sensitive, diagnostic criteria for childhood migraine. By using revised International Headache Society (IHS-R) criteria, we compared the prevalence of mig...

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    pub_type: 杂志文章

    doi:10.1111/j.1528-1167.2006.00639.x

    authors: Wirrell EC,Hamiwka LD

    更新日期:2006-10-01 00:00:00

  • Vagus nerve stimulation elevates seizure threshold in the kindling model.

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  • Nonconvulsive status epilepticus: high incidence of complex partial status.

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    authors: Rejdak K,Papuć E,Grieb P,Stelmasiak Z

    更新日期:2009-06-01 00:00:00

  • Elevated cerebrospinal fluid protein in POLG-related epilepsy: Diagnostic and prognostic implications.

    abstract:OBJECTIVE:Epilepsy is common in individuals with mutations in POLG, the gene encoding the catalytic subunit of the mitochondrial DNA polymerase gamma. Early recognition and aggressive seizure management are crucial for patient survival. Disruption of the blood-brain barrier (BBB) is implicated in various neurological d...

    journal_title:Epilepsia

    pub_type: 杂志文章,多中心研究

    doi:10.1111/epi.14459

    authors: Hikmat O,Naess K,Engvall M,Klingenberg C,Rasmussen M,Tallaksen CME,Brodtkorb E,Fiskerstrand T,Isohanni P,Uusimaa J,Darin N,Rahman S,Bindoff LA

    更新日期:2018-08-01 00:00:00

  • Cliniconeuropathologic correlations show astroglial albumin storage as a common factor in epileptogenic vascular lesions.

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    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1167.2012.03405.x

    authors: Raabe A,Schmitz AK,Pernhorst K,Grote A,von der Brelie C,Urbach H,Friedman A,Becker AJ,Elger CE,Niehusmann P

    更新日期:2012-03-01 00:00:00

  • Tonic phase of a generalized convulsive seizure is an independent predictor of postictal generalized EEG suppression.

    abstract:PURPOSE:To determine the incidence, duration, risk factors for, and clinical correlates of postictal generalized electroencephalography (EEG) suppression (PGES), and to further delineate the significance of PGES in the pathogenesis of sudden unexpected death in epilepsy (SUDEP). METHODS:We retrospectively reviewed the...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/epi.12094

    authors: Tao JX,Yung I,Lee A,Rose S,Jacobsen J,Ebersole JS

    更新日期:2013-05-01 00:00:00

  • Transition issues for benign epilepsy with centrotemporal spikes, nonlesional focal epilepsy in otherwise normal children, childhood absence epilepsy, and juvenile myoclonic epilepsy.

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    journal_title:Epilepsia

    pub_type: 杂志文章,评审

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    authors: Camfield CS,Berg A,Stephani U,Wirrell EC

    更新日期:2014-08-01 00:00:00

  • Validating screening tools for depression in epilepsy.

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    pub_type: 杂志文章

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    authors: Fiest KM,Patten SB,Wiebe S,Bulloch AG,Maxwell CJ,Jetté N

    更新日期:2014-10-01 00:00:00

  • Microstructural and functional MRI studies of cognitive impairment in epilepsy.

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    authors: Braakman HM,van der Kruijs SJ,Vaessen MJ,Jansen JF,Debeij-van Hall MH,Vles JS,Aldenkamp AP,Backes WH,Hofman PA

    更新日期:2012-10-01 00:00:00

  • The history of the concept of epileptic encephalopathy.

    abstract::The first description of epileptic encephalopathies dates back to Dr. West who, in 1857, described the syndrome that took his name. In addition to West syndrome, in the last century other epileptic syndromes entered into the chapter of epileptic encephalopathies. Henry Gastaut has the virtue of having created the mode...

    journal_title:Epilepsia

    pub_type: 历史文章,杂志文章,评审

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    authors: Capovilla G,Wolf P,Beccaria F,Avanzini G

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  • Historical aspects of idiopathic generalized epilepsies.

    abstract::Early in these proceedings, the origin of the three terms in the title, "idiopathic generalized epilepsy," is discussed with respect to their significance over time, and typical misunderstandings. In the mid-20th century, a rather chaotic use of a multitude of often loosely defined terms had developed, which increasin...

    journal_title:Epilepsia

    pub_type: 历史文章,杂志文章

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    更新日期:2005-01-01 00:00:00

  • A kindling-like effect induced by repeated exposure to heated water in rats.

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    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.1984.tb04192.x

    authors: Klauenberg BJ,Sparber SB

    更新日期:1984-06-01 00:00:00

  • PACES in epilepsy: Results of a self-management randomized controlled trial.

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    journal_title:Epilepsia

    pub_type: 杂志文章,随机对照试验

    doi:10.1111/epi.13052

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    更新日期:2015-08-01 00:00:00

  • Focal cortical dysplasia type IIb: completeness of cortical, not subcortical, resection is necessary for seizure freedom.

    abstract:PURPOSE:Focal cortical dysplasia type IIb (FCD IIb) lesions are highly epileptogenic and frequently cause pharmacoresistant epilepsy. Complete surgical resection leads to seizure freedom in most cases. However, the term "complete" resection is controversial with regard to the necessity of performing resections of the s...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1167.2011.03158.x

    authors: Wagner J,Urbach H,Niehusmann P,von Lehe M,Elger CE,Wellmer J

    更新日期:2011-08-01 00:00:00

  • Molecular pathways controlling inhibitory receptor expression.

    abstract::Epilepsy is a disease of complex etiology, and multiple molecular mechanisms contribute to its development. Temporal lobe epilepsy (TLE) may result from an initial precipitating event such as hypoxia, head injury, or prolonged seizure (i.e., status epilepticus [SE]), that is followed by a latent period of months to ye...

    journal_title:Epilepsia

    pub_type: 杂志文章,评审

    doi:10.1111/epi.12036

    authors: Grabenstatter HL,Russek SJ,Brooks-Kayal AR

    更新日期:2012-12-01 00:00:00

  • Susceptibility weighted imaging in the diagnostic evaluation of patients with intractable epilepsy.

    abstract:AIM:Dedicated magnetic resonance imaging (MRI) protocol can diagnose epileptogenic abnormalities in patients with intractable epilepsy. However, it is not sufficiently sensitive to detect small calcified lesions that may result from infections, tumors, or vascular malformations. This study aims to study the impact of t...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1167.2008.01882.x

    authors: Saini J,Kesavadas C,Thomas B,Kapilamoorthy TR,Gupta AK,Radhakrishnan A,Radhakrishnan K

    更新日期:2009-06-01 00:00:00

  • Prenatal nicotine and CNS development.

    abstract::The teratological effect of nicotine has been studied during different trimesters of pregnancy. Three groups of pregnant albino Swiss mice were used for each trimester. The daily doses of nicotine base used were equivalent to 10 (900 micrograms/kg), 20 (1,800 micrograms/kg), or 30 (2,700 micrograms/kg) cigarettes. The...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.1985.tb05708.x

    authors: Al-Hachim GM,Mahmoud FA

    更新日期:1985-11-01 00:00:00

  • Nuclear magnetic resonance imaging, a new approach to the investigation of refractory temporal lobe epilepsy.

    abstract::Nuclear magnetic resonance is a noninvasive technique of imaging the brain using signals produced by magnetic fields and radiowaves. Sixteen patients with refractory temporal lobe epilepsy (TLE) had magnetic resonance imaging (MRI) during investigation for possible surgical management. These images plus those of 10 no...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.1985.tb05691.x

    authors: McLachlan RS,Nicholson RL,Black S,Carr T,Blume WT

    更新日期:1985-11-01 00:00:00

  • A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus.

    abstract::The Commission on Classification and Terminology and the Commission on Epidemiology of the International League Against Epilepsy (ILAE) have charged a Task Force to revise concepts, definition, and classification of status epilepticus (SE). The proposed new definition of SE is as follows: Status epilepticus is a condi...

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    pub_type: 历史文章,杂志文章,评审

    doi:10.1111/epi.13121

    authors: Trinka E,Cock H,Hesdorffer D,Rossetti AO,Scheffer IE,Shinnar S,Shorvon S,Lowenstein DH

    更新日期:2015-10-01 00:00:00

  • The epilepsy of Fyodor Mikhailovitch Dostoevsky (1821-1881).

    abstract::Over 100 years ago, on the 27th of January 1881, Fyodor Mikhailovitch Dostoevsky died. Since that time, many biographies, monographs, memoirs, and, to a lesser extent, articles in the medical literature have discussed the fact that Dostoevsky was a patient with epilepsy. An attempt is made here to integrate the detail...

    journal_title:Epilepsia

    pub_type: 传,历史文章,杂志文章

    doi:10.1111/j.1528-1157.1983.tb04628.x

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  • Optimizing the molecular diagnosis of CDKL5 gene-related epileptic encephalopathy in boys.

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    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/epi.12803

    authors: Mei D,Darra F,Barba C,Marini C,Fontana E,Chiti L,Parrini E,Dalla Bernardina B,Guerrini R

    更新日期:2014-11-01 00:00:00

  • Physiological factors in childhood epilepsy.

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    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.1980.tb04090.x

    authors: LeWinn EB

    更新日期:1980-08-01 00:00:00

  • Characteristics of KCNQ2 variants causing either benign neonatal epilepsy or developmental and epileptic encephalopathy.

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    pub_type: 杂志文章

    doi:10.1111/epi.16314

    authors: Goto A,Ishii A,Shibata M,Ihara Y,Cooper EC,Hirose S

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  • Visual field loss associated with vigabatrin: quantification and relation to dosage.

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    pub_type: 杂志文章

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    authors: Hardus P,Verduin WM,Engelsman M,Edelbroek PM,Segers JP,Berendschot TT,Stilma JS

    更新日期:2001-02-01 00:00:00

  • Standards for data acquisition and software-based analysis of in vivo electroencephalography recordings from animals. A TASK1-WG5 report of the AES/ILAE Translational Task Force of the ILAE.

    abstract::Electroencephalography (EEG)-the direct recording of the electrical activity of populations of neurons-is a tremendously important tool for diagnosing, treating, and researching epilepsy. Although standard procedures for recording and analyzing human EEG exist and are broadly accepted, there are no such standards for ...

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    pub_type: 杂志文章,评审

    doi:10.1111/epi.13909

    authors: Moyer JT,Gnatkovsky V,Ono T,Otáhal J,Wagenaar J,Stacey WC,Noebels J,Ikeda A,Staley K,de Curtis M,Litt B,Galanopoulou AS

    更新日期:2017-11-01 00:00:00

  • On seeing the trees and the forest: single-signal and multisignal analysis of periictal intracranial EEG.

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    pub_type: 杂志文章

    doi:10.1111/j.1528-1167.2012.03588.x

    authors: Schindler K,Gast H,Goodfellow M,Rummel C

    更新日期:2012-09-01 00:00:00

  • [11C]flumazenil positron emission tomography visualizes frontal epileptogenic regions.

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    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.1995.tb01066.x

    authors: Savic I,Thorell JO,Roland P

    更新日期:1995-12-01 00:00:00

  • Topiramate and phenytoin pharmacokinetics during repetitive monotherapy and combination therapy to epileptic patients.

    abstract:PURPOSE:To evaluate the potential pharmacokinetic interactions between topiramate (TPM) and phenytoin (PHT) in patients with epilepsy by studying their pharmacokinetics (PK) after monotherapy and concomitant TPM/PHT treatment. METHODS:Twelve patients with epilepsy stabilized on PHT monotherapy were enrolled in this st...

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    pub_type: 杂志文章

    doi:10.1046/j.1528-1157.2002.41701.x

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    更新日期:2002-07-01 00:00:00