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Determination of risk factors associated with seizure relapse after antiepileptic drug withdrawal

100%
Vurucu S., Saldir M., Unay B., Akin R.
Open Medicine
|
2010
|
vol. 5
|
issue 2
251-256
EN
There is no consensus regarding the time of antiepileptic drug withdrawal and the relevant risk factors for seizure relapse. In this study, we aimed to determine the seizure relapse rates and the associated risk factors for seizure relapse in childhood epilepsy. Two-hundred sixty-six epileptic patients who discontinued the antiepileptic drug therapy after a seizure-free period of at least two years, were enrolled into the study. The data of the patients regarding sex, febrile convulsion history, family history, age at onset, type of epilepsy, total number of seizures and antiepileptic drugs, seizures during treatment, mental status, first and last electroencephalography, brain imaging findings, etiological factors and seizure relapse in the first two years after antiepileptic drug withdrawal were obtained from the patients’ files. Univariate logistic regression analysis was performed for each variable. The variables which were found to be statistically significant in univariate analysis, were included in multivariate logistic regression analysis. The overall seizure relapse rate after antiepileptic drug withdrawal was 19.2%. There were no significant differences for seizure relapse rate after antiepileptic drug withdrawal between patient groups with respect to sex, family history, type of epilepsy, febrile convulsion history, seizures before treatment, first electroencephalography findings, brain imaging findings and etiology. However, there were statistically significant differences for seizure relapse rate among patient groups concerning age at onset of epilepsy, new seizure during treatment, the total number of antiepileptic drugs, mental status, and last electroencephalography findings. We imply that the clinical status of the patients should be considered before the cessation of drug therapy rather than the etiological factors or laboratory findings.
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The effects of oxcarbazepine treatment on vitamin B12 and folate levels, thyroid functions, sex hormones, and bone mineral density in epileptic patients

88%
Vurucu S., Gulgun M., Yesilkaya E., Unay B., Akin R.
Open Medicine
|
2009
|
vol. 4
|
issue 3
310-314
EN
The aim of this study was to evaluate vitamin B12 and folate levels, thyroid functions, sex hormones and bone mineral density in idiopathic epileptic patients taking oxcarbazepine as monotherapy. Newly diagnosed pediatric patients with idiopathic partial epilepsy taking oxcarbazepine (OXC) as monotherapy were enrolled in this study. The pre-treatment and 6 months post-treatment values of vitamin B12, folate, thyroid functions, sex hormones, and bone mineral density (BMD) were obtained from all patients. A total of 32 patients (22 (68.8%) males and 10 (31.2%) females) were included in this study. The mean age was 7.4 ± 3.2 years (range: 2–14 years). There were no significant differences between the pre-treatment and 6 months post-treatment values of vitamin B12, folate, thyroid functions, sex hormones, and BMD. However, the 6 month post-treatment sex hormone binding globulin (SHBG) values (159.92 ± 48.14 nmol/L) were significantly higher than the pre-treatment values (137.88 ± 43.12 nmol/L) (p=0.009). We found that OCX treatment in children did not have an effect on serum folate and vitamin B12 levels, thyroid functions, sex hormones and BMD but caused increased SHBG. Over time, the increase in serum SHBG levels may lead to diminished bioactivity of sex steroids, and thus to reduced fertility. The further studies are needed to demonstrate the clinical importance of increased SHBG levels.
3
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Metoclopramide induced intermittent opisthotonos in infant

88%
Balamtekin N., Gulgun M., Sarici S., Unay B., Dundaroz M.
Open Medicine
|
2010
|
vol. 5
|
issue 2
224-226
EN
Metoclopramide is widely used as an antiemetic and a prokinetic agent. Both the antiemetic properties and side effects of the drug are the result of dopamine receptor antagonism within the central nervous system. Therapeutic doses of metoclopramide can produce adverse effects. A 5-month-old girl was referred to our emergency department with the pre-diagnosis of afebrile convulsion. In her medical history, she was mistakenly given 2 mg/kg metoclopramide within a 24 h period, after which she became hypertonic and exhibited intermittent opisthotonos. Complete blood count, electrolytes, liver and renal function tests, blood gas analysis, and urinalysis were all within normal limits. Electroencephalogram, brain CT and cerebrospinal fluid examination were normal. Metoclopramide treatment was discontinued and she was treated with biperiden, which led to an improvement in symptoms after 15 minutes and complete remission in 60 minutes. Intermittent opisthotonos may be confused with convulsion in infant and thus lead to an unnecessary hospital admission. Physicians should be aware that metoclopramide is widely used in the pediatric population and children are susceptible to the side effects of metoclopramide and the side effects may present as “intermittent opisthotonos” as observed in our patient.
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