PURPOSE: To learn the changes of phenobarbital serum level after intravenous administration of loading dose and to determine the optimal time of maintenance therapy to support therapeutic concentration. METHODS: A total of 24 patients, who were admitted to the pediatric ward for treatment of ongoing and recurrent seizure, were enrolled in this study from November, 1994 to August, 1996. None of them had taken other anticonvulsants before and their age varied from 8 days old to 7 years old. Loading dose of 20mg per kg of phenobarbital was administered intravenously, and sequential plasma samples were obtained at 2, 6, and 12 hours after administration. RESULTS: The mean serum concentration of phenobarbital was 23.65 (11.53-36.81) microgram/ml after 2 hours, 22.78 (10.97-35.29) microgram/ml after 6 hours and 20.79 (9.79-33.01) microgram/ml after 12 hours. We divided the patients into 2 groups by the 12-hour levels, group A : therapeutic level (>20 microgram/ml), and group B : subtherapeutic level. The mean 12-hour level in group A was 25.39 (20.13-33.01) microgram/ ml and 16.24 (9.79-19.48) microgram/ml in group B. The mean 2-hour level in group A was 28.30 microgram/ml and 19.00 microgram/ml in group B (P<0.05). The mean decline rate of serum phenobarbital level was 0.34 microgram/ml/hr in group A and 0.29 microgram/ml/hr in group B. And there was no significant difference between the two groups. CONCLUSION: It is usually effective to begin maintenance therapy 12 hours after loading dose, but in cases where 2-hour serum level of phenobarbital is below 20 microgram/ml, it is better to begin maintenance therapy earlier.
Administration, Intravenous* ; Anticonvulsants ; Child ; Humans ; Phenobarbital* ; Plasma ; Seizures

PURPOSE: This study aimed to evaluate the effect of anticonvulsants on serum carnitine levels as well as normal serum carnitine levels. METHODS: We measured the serum carnitine levels in 53 healthy children(34 males, 19 females) and 115 epileptic children(55 males, 60 females) receiving a various antiepileptic drugs. We assessed the effects of antiepileptic drugs on serum carnitine level together with a correlation between serum carnitine level and duration of treatment, and blood level of anticonvulsant. RESULTS: 1.Carnitine levels in healthy children 1)There was a positive correlation between total and free carnitine serum levels and the age of the children. 2)The serum total carnitine levels were increased in age group over 5 years of age and serum free carnitine levels were increased in age group over 1 year of age as compared with those of between 1 month and 12 months age group. 2.Carnitine levels in epileptic children receiving anticonvulsants 1)The serum levels of total and free carnitine were significantly reduced in the patients with valproate monotherapy group, valproate polytherapy group, and polytherapy group without valproate as compared with the control group. 2)The reduction was more significant in the patients of valproate polytherapy group than in those of valproate monotherapy group. 3.There was a significant inverse correlation between the serum carnitine levels and the duration of the valproate treatment but not between serum carnitine levels and the blood level of valproate. 4.Carnitine deficiency was corrected in all cases after oral administration of L-carnitine(50mg/kg/day). CONCLUSIONS: Carnitine deficiency may be suspected in patients taking valproate therapy and regular measurement of carnitine levels appears warranted in these patients. If carnitine deficiency is documented, the patient can be treated by oral carnitine supplementation.
Administration, Oral ; Anticonvulsants* ; Carnitine* ; Child ; Humans ; Male ; Valproic Acid

The first nation-wide, hospital-based survey on the epileptic women with child bearing age had conducted between June 2004 and May 2005, under the supervision of Korean Epilepsy Society. One thousand epileptic women in reproductive age from 46 hospitals and 500 age-matched healthy women were subjected to this study. Besides physiological issues including menstruation, contraception, pregnancy, and lactation, problems in social and individual daily life, concomitant illness, factors associated with antiepileptic drug treatments were also inquired. Compared to healthy group, higher incidence of menstruation irregularity, contraception and artificial abortion were reported in women with epilepsy. The main reason for contraception and artificial abortion in epileptic women was fear about fetal malformations. Almost half of epileptic women were reluctant to breast feeding because of their disease and/or medications. Also, epileptic women answered to have problems in social life, marriage, job recruitment and need proper information about their disease. Epileptic women, especially in reproductive age, confronted many additional troubles and physicians should be aware of these problems in managing those patients. Misconceptions about pregnancy, contraception, lactation should be undeceived by adequate education.
Anticonvulsants ; Breast Feeding ; Child* ; Contraception ; Education ; Epilepsy ; Female ; Humans ; Incidence ; Lactation ; Marriage ; Menstruation ; Organization and Administration ; Pregnancy

Anticonvulsants ; administration & dosage ; therapeutic use ; Drug Prescriptions ; Humans ; Off-Label Use

OBJECTIVETo investigate the effect of intranasal administration of low dosage recombinant human erythropoietin (r-HuEPO) on seizure in rats.

METHODSAfter intranasal or intraperitoneal administration of r-HuEPO, the behavioral and electroencephalographic changes were observed in pentylenetetrazol (PTZ) and maximal electroshock (MES) induced seizure or electrical amygdaloid-kindled seizure of rats.

RESULTIntranasal administration of low dosage r-HuEPO increased the seizure latency, and decreased the seizure grade and duration, and the number of convulsive episodes in PTZ induced seizure, with the most potential dosage of 2.4 IU. Intraperitoneal administration of r-HuEPO (3 000, 4 000 IU/kg) only decreased the seizure duration and number of convulsive episodes. The seizure grade, forelimb or hindlimb extension duration were decreased in MES-induced seizure by intranasal administration of 2.4 IU r-HuEPO. In addition, intranasal administration of 2.4 IU r-HuEPO decreased the seizure grade, generalized seizure duration and afterdischarge in electrical amygdaloid-kindled rats stimulated with generalized seizure threshold.

CONCLUSIONIntranasal administration of low dosage r-HuEPO can inhibit the seizure in rats.

Administration, Intranasal ; Animals ; Anticonvulsants ; administration & dosage ; Epilepsy ; chemically induced ; drug therapy ; Erythropoietin ; administration & dosage ; Humans ; Male ; Pentylenetetrazole ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Recombinant Proteins

BACKGROUND: Anticonvulsant agents have been used and found to be effective for the treatment of neuropathic pain. Even though it is rare, they can have very serious side effects and therefore the search for more selective drugs with fewer side effects is justified. This study was conducted to evaluate the newly introduced anticonvulsants, gabapentin, for various neuropathic pain syndromes in the Korean population. METHODS: According to individual diagnostic group as diabetic neuropathy, postherpetic neuralgia, chronic back pain with radiating pain, there were 20 patients per group. Patients have been stabilized in their analgesic regimen at least four weeks prior to enrollment in the study. An anticonvulsant, if taken, was discontinued for four weeks for wash-out. Pretreatment baseline pain scores (visual analog scale and a pain intensity score) were obtained. Oral administration of gabapentin 300 mg was initiated in all groups and doses were given from 300 mg per day with gradual titration over two weeks 1) to the maximum of 2400 mg per day, 2) to the onset of intolerable side effects, and 3) to the onset of analgesic effect. At two weeks follow-up visit, visual analog scale, pain intensity scores, pain improvement scores judged by family, drug efficacy, tolerability and overall evaluation were assessed. The incidence of side effects, cell blood count and chemistry were also obtained. RESULTS: After two weeks of treatment, the visual analog scale and pain intensity scores improved in all study groups and no patients experienced aggravation. These findings were objectively reflected in pain improvement scores observed by family members. In drug efficacy, tolerability and overall evaluation, the majority of patients scored as good or excellent. There were no reports of serious side effects. Minor side effects were spontaneously subsided even with continuation. CONCLUSIONS: Gabapentin, a newer anticonvulsant, appears to be effective as an adjunctive analgesic for the management of various neuropathic pain syndromes with minimal side effects.
Administration, Oral ; Anticonvulsants ; Back Pain ; Chemistry ; Diabetic Neuropathies ; Follow-Up Studies ; Humans ; Incidence ; Neuralgia* ; Neuralgia, Postherpetic ; Visual Analog Scale

The treatment of pathologic aerophagia has rarely been discussed in the literature. In this retrospective study, the authors investigated the effects of clonazepam on the management of pathologic childhood aerophagia (PCA) with psychological stresses (PS), but not with mental retardation. Data from 22 consecutive PCA patients with PS (aged 2 to 10 yr), who had been followed up for over 1 yr, were reviewed. On the basis of videolaryngoscopic views, the authors observed that the pathology of aerophagia was the result of reflex-induced swallowing with paroxysmal openings of the upper esophageal sphincter due to unknown factors and also observed that these reflex-induced openings were subsided after intravenous low dose benzodiazepine administration. Hence, clonazepam was administered to treat paroxysmal openings in these PCA patients with PS. Remission positivity was defined as symptom-free for a consecutive 1 month within 6 months of treatment. The results of treatment in 22 PCA patients with PS were analyzed. A remission positive state was documented in 14.3% of PCA patients managed by reassurance, and in 66.7% of PCA patients treated with clonazepam (p=0.032). Thus, clonazepam may produce positive results in PCA with PS. Future studies by randomized and placebo-controlled trials are needed to confirm the favorable effect of clonazepam in PCA.
Treatment Outcome ; Stress, Psychological/*complications/*drug therapy ; Retrospective Studies ; Male ; Injections, Intravenous ; Humans ; Female ; Clonazepam/*administration & dosage ; Child, Preschool ; Child ; Anticonvulsants/administration & dosage ; Aerophagy/*complications/*prevention & control

Anticonvulsants ; adverse effects ; Bone and Bones ; drug effects ; metabolism ; Calcium, Dietary ; administration & dosage ; Humans ; Valproic Acid ; adverse effects ; Vitamin D ; administration & dosage

OBJECTIVEA series of 4-aryl substituted semicarbazones of levulinic acid (4-oxo pentanoic acid) was designed and synthesized to meet the structural requirements essential for anticonvulsant activity.

METHODSAll the compounds were evaluated for anticonvulsant activity. Anticonvulsant activity was determined after intraperitoneal (i.p.) administration to mice by maximal electroshock (MES) and subcutaneous metrazol (ScMet) induced seizure methods and minimal motor impairment was determined by rotorod test.

RESULTSA majority of the compounds exhibited significant anticonvulsant activity after intraperitoneal administration. In the present study 4-(4'-fluoro phenyl) levulinic acid semicarbazone emerged as the most active molecule, showing broad spectrum of activity with low neurotoxicity. Unsubstituted levulinic acid semicarbazone was found to be inactive in all the screens.

CONCLUSIONThe results obtained validate the hypothesis that presence of an aryl group near the semicarbazone moiety is essential for anticonvulsant activity. The results also indicate that the hydrophilic-hydrophobic site can accommodate hydrophilic groups.

Animals ; Anticonvulsants ; administration & dosage ; adverse effects ; analysis ; chemistry ; Drug Evaluation, Preclinical ; Injections, Intraperitoneal ; Levulinic Acids ; administration & dosage ; adverse effects ; analysis ; chemistry ; Mice ; Seizures ; drug therapy ; Semicarbazones ; administration & dosage ; adverse effects ; analysis ; chemistry ; Treatment Outcome

OBJECTIVETo study the efficacy of levetiracetam (LEV) combined with short-term clonazepam (CZP) in the treatment of electrical status epilepticus during sleep (ESES) in children with benign childhood epilepsy with centrotemporal spikes (BECCT).

METHODSFifteen children (9 boys and 6 girls) diagnosed with BECCT with ESES, who had continuous spike-and-wave accounting for over 85% of the non-rapid eye movement sleep as monitored by 24-hours ambulatory EEG or 3-hours video EEG, were enrolled. The clinical manifestations and EEG characteristics of patients were retrospectively analyzed. These children received two months of CZP treatment in addition to oral LEV [20-40 mg/(kg·d)]. All patients were followed up for 6-18 months.

RESULTSThe 15 children were orally given LEV in the early stage, but showed no improvement when reexamined by EEG or had seizures during treatment. Then, they received LEV in combination with short-term CZP. Re-examinations at 1 and 6 months after treatment showed that 14 cases had significantly reduced discharge (only little discharge in the Rolandic area) or no discharge, as well as completely controlled seizure; one case had recurrent ESES and two epileptic seizures during follow-up. The recurrent case received the combination therapy again, and re-examinations 1 and 6 months later revealed normal EEG; no seizure occurred in the 8 months of follow-up.

CONCLUSIONSLEV combined with short-term CZP is effective and has few side effects in treating ESES syndrome among children with BECCT.

Anticonvulsants ; administration & dosage ; Child ; Child, Preschool ; Clonazepam ; administration & dosage ; Drug Therapy, Combination ; Electroencephalography ; Epilepsy, Rolandic ; drug therapy ; physiopathology ; Female ; Humans ; Male ; Piracetam ; administration & dosage ; analogs & derivatives ; Retrospective Studies ; Sleep ; physiology ; Status Epilepticus ; drug therapy ; physiopathology