Epilepsy Medication Delivers Relief from Shingles Pain
A new report concludes that the anti-convulsant medicine gabapentin is effective in providing relief from post herpetic neuralgia (PHN), a chronic pain condition that occurs in 10-15% of patients with shingles. Note: gabapentin is currently used for the prevention of seizures associated with epilepsy. Researchers at the University of California-San Francisco the Rehabilitation Institute of Chicago, and Oregon Health Sciences University studied the effects of gabapentin in 229 PHN-affected patients to collect data; participants were randomized to treatment with either the drug or a placebo for eight weeks. It was found that patients treated with gabapentin reported an average drop in pain levels from about 6.3 to 4.2 on a 10-point scale, while those given a placebo showed almost no change. Authors say the mechanism of gabapentin's pain-relieving effects is not clearly understood, but that it may be due to an effect on a certain type of calcium channel in spinal nerves that conduct pain-related messages. The study is in The Journal of the American Medical Association (December 2, 1998).
Med Briefs (INC inc.) 12/9/98
A new study concludes that the drug gamma vinyl-GABA (GVG), which is approved in Europe for the treatment of epilepsy-associated seizures, may be an effective treatment for nicotine addiction. Researchers at Brookhaven National Laboratory in Upton, New York, treated mice with GVG about 2.5hours prior to giving the animals nicotine to collect data. The study found that GVG treatment blocked nicotine-induced dopamine production increases in the brain; (dopamine is plays a key role in activating "pleasure centers" in the brain and is thought to contribute to nicotine addiction). Authors further note that GVG-treated animals spent significantly less time searching for nicotine in areas at which they were used to receiving it, compared to non-treated animals. The study is in the journal Synapse (1998;31:76-86).
Med Briefs (INC inc.) 12/9/98
A new study suggests that a type of epilepsy known as mesial temporal lobe(MTL) epilepsy is more common that previously thought. Note: MTL epilepsy does not respond well to medical therapy, but can be cured in most cases by surgery. Researchers at the University of California-Los Angeles studied2,200patients referred to an epilepsy center in Paris to collect data; magnetic resonance imaging (MRI) was used in all patients to identify seizure-related brain abnormalities. The study found that 282 patients showed evidence of abnormalities in the hippocampus regions of the brain, an indicator of MTL epilepsy, and that these patients showed the worst response levels of seizure-controlling medication. Authors say the findings suggest that all epilepsy patients who respond poorly to treatment with commonly- used anti-epilepsy drugs should undergo high resolution MRI evaluation to look for hippocampal abnormalities. The study is in the journal Neurology (November, 1998).
Med Briefs (INC inc.) 12/7/98
a new study concludes that the drug gabapentin (Neurontin), from Parke-Davis Pharmaceutical Research, is an effective treatment for diabetic peripheral neuropathy (DPN). Notes: DPN is pain associated with damaged or diseased nerves; Neurontin is currently used to prevent epileptic seizures. Researchers at the University of Wisconsin at Madison randomized 165patients with DPN to receive either a placebo or gabapentin for eight weeks to collect data. The study found that the average daily pain score, as recorded by patients, was significantly lower at the end of the study among those in the gabapentin group, compared to those in the placebo group; treatment with the drug was also associated with significant improvements in mood and quality of life. Authors note, however, that patients taking gabapentin reported higher levels of dizziness, sleepiness and confusion than did those who received the placebo. The study is in The Journal of the American Medical Association(1998;280:1831-1836).
Med Briefs (INC inc.) 12/4/98
A new study concludes that a high-fat, low-protein, and low-cholesterol diet can help control seizures in children. Researchers at the Johns Hopkins Medical Institutions, Baltimore, Maryland, placed 51 children, aged 1-8,who had histories of at least 10 seizures per week on diets in which the ratio of fat grams to grams of protein plus carbohydrates was 4:1 to collect data. The study found, after six months, that 55% of children on the diet had at least a 50% reduction in seizures; after one year, 40% of those on the diet had 50% or greater reductions in seizures. Authors say the 4:1 diet causes the body to use fats as the primary source of energy instead of glucose (ketosis), and that this conduction appears to prevent seizures for reasons that remain unknown. The study is in the Archives of Neurology (1998;55:1403-1404).
Med Briefs (INC inc.) 11/20/98
A recent report discusses the option of brain surgery to relieve epilepsy symptoms in children whose condition does not respond to medication therapy. Researchers at the Pediatric Epilepsy Program at the Cleveland Clinic Foundation in Cleveland, Ohio, analyzed data concerning 136 children who underwent brain surgery between 1990 and 1996 to reach their conclusions; patients were divided into two age groups: 3 months to 12 years and 13-20 years. It was found that 68% of the younger group and 69% of the older were completely free of seizures one year following their surgery; 11% and 20% of the two groups, respectively, suffered only rare seizures after one year. Authors note that the lowest success rates occurred in children whose seizures originated in areas outside of the temporal lobes and in those whose brains had developed abnormally. The report suggests that children whose severe epilepsy does not respond to medication should be considered candidates for surgical relief. The report is in the Annals of Neurology (November, 1998).
Med Briefs (INC inc.) 11/15/98
A recent study concludes that the drug lamotrigine can be used alone to treat epilepsy with fewer adverse effects than those associated with many standard anti-epilepsy drug therapies. Note: Glaxo Wellcome's lamotrigine is currently approved for use in the U.S. only in combination with other epilepsy medications. Researchers at the University of Alabama at Birmingham conducted a seven-month study of 156 patients, ages 13-73, with partial epilepsy to collect data; patients were randomized to receive either lamotrigine or another drug that can be used alone to treat the condition. The study found that 56% of lamotrigine-treated patients completed the study (did not show a worsening of symptoms, compared to their status when on standard multi-drug therapy), compared to 20% of those treated with the alternative drug. Authors note that, of participants who did not complete the study, those treated with lamotrigine remained involved for an average of 168 days, compared to 57days for those taking the other drug. The study notes that the rate of side-effects was significantly lower in the lamotrigine group, including a complete absence of excessive sleepiness, which is a common side-effect of other anti-epilepsy drug therapies. The study is in the journal Neurology (October, 1998).
Med Briefs (INC inc.) 10/28/98
Researchers have reported findings which suggest that naturally occurring opioid-like peptides in the brain can terminate epileptic seizures. Researchers at London's Institute of Neurology say the findings are the first to show evidence of a brain process important to "switching off seizures." Five patients who suffered from a rare seizure disorder known as reading epilepsy and six volunteers with no history of neurological disease were studied to collect data. It was found that opioid-receptor binding in the brain region called the left parieto-temporo-occipital cortex increased in the healthy volunteers when they read string of symbols or a scientific paper, while opioid-receptor binding in the patients with reading epilepsy decreased when they read the same materials. Authors say the novel use of positron emission tomography (PET) scans to study the opioid-receptor binding could have implications for use, not only in the study of seizures, but for "future anatomical localization of neurotransmitters and circuitry involved in cognitive processing." The findings are in The Lancet (1998;352:952-955).
Med Briefs (INC inc.) 10/25/98
A recent study sought to examine if the assessment of patients soon after their first having experienced a seizure could aid in the diagnosis of specific epilepsy syndromes. Australian researchers conducted electroencephalography (EEG) and magnetic resonance imaging (MRI) tests on 300 consecutive patients, ages 5-83, who had suffered their first seizures, to collect data; EEGs were conducted within 24 hours of a seizure. The study found that, while clinical assessment alone resulted in a diagnosis of either generalized or partial epilepsy in 47% of patients, the addition of EEG and MRI evaluations resulted in the diagnosis of generalized epilepsy in 23% of patients and partial epilepsy in 58% of patients. Authors say the findings suggest that the prompt evaluation of seizure patients using MRI and EEG can help clarify appropriate drug treatments, thereby reducing the risk of seizure recurrence. The study is in The Lancet (September 24, 1998).
Med Briefs (INC inc.) 10/4/98
A new study concludes that the drug lorazepam (Ativan) appears to be a more effective treatment for generalized convulsive status epilepticus than phenytoin (Dilantin). Status epilepticus is a seizure-related condition that occurs in many epileptics who do not take their medications and that is also often experienced as the first presentation of epilepsy. Researchers at the University of Medicine and Dentistry of New Jersey report that trials in about 400 patients found that lorazepam was more effective than phenytoin in inducing the cessation of all clinical and electrical evidence of seizure activity within 20 minutes, with no recurrence during the next 40 minutes. Authors further note that studies in 175 patients who experienced subtle seizures while in a coma found lorazepam and phenytoin to be equally effective. Also tested were the drugs diazepam (Valium) followed by phenytoin, and phenobarbital; lorazepam was not found to be more effective than either of these treatments, but was considered easier to administer. The study is in The New England Journal of Medicine (1998;339:792-798).
Med Briefs (INC inc.) 9/18/98
A recent report suggests that determining an individual patient's "coping style" and matching the medical information concerning a planned procedure given to that patient to the coping style can reduce patient stress and anxiety and may improve recovery time. Researchers at The Canberra Hospital in Garran, Australia, studied the cases of 80 adults scheduled to undergo colonoscopy screening for colon cancer to collect data; patients were classified thought interviews as either information seekers or information avoiders according to their stated desires for information concerning the procedure. The study found that patients reported higher levels of satisfaction with the procedure when the information they were given prior to the procedure matched the information demands of their coping style. Authors suggest that the use of standard patient questionnaires could be useful in efficiently determining the coping style of patients, allowing physicians to use the information to lower stress and anxiety in patients. The report is in the journal Gastrointestinal Endoscopy (1998;48:119-127).
Med Briefs (INC inc.) 8/30/98
The U.S. Food and Drug Administration has granted marketing approval to Lamictal (R) (lamotrigine) Tablets for the treatment of the severe form of epilepsy known as Lennox-Gastaut syndrome (LGS). LGS is characterized as one of the most severe and difficult- to-treat forms of epilepsy. Lamictal, from Glaxo Wellcome Inc., has been available since 1994 in the U.S. for the treatment of partial seizures in adults with epilepsy. The drug's new indication covers its use as an add-on treatment for generalized seizures associated with LGS in both children and adults. Trial results submitted in support of the drug's application for the indication are reported to have shown its use to result in reduced frequency of all major seizure types, drop attacks, and tonic-clonic seizures. Data taken from a Glaxo Wellcome release (August 27, 1998).
Med Briefs (INC inc.) 8/30/98
A recent survey shows that the majority of physicians in managed care programs feel that the managed care has had detrimental effects on the quality of medical care and on the physician-patient relationship. Researcher sat Allegheny University of the Health Sciences in Philadelphia, Pennsylvania, surveyed more than 500 doctors to collect data and found that more than half said the quality of healthcare is adversely affected by limitations in location of diagnostic tests, length of hospital stay, and choice of specialists, and that about two-thirds of respondents said managed care has undermined the physician-patient relationship. Authors say the most common reasons behind the respondents' opinions were that managed care presents conflicts that make it more difficult to place the patients' interests first, such as physician/HMO financial incentives for productivity, and the hostile view of physicians as "gatekeepers" who must approve managed care coverage for tests, hospital stays, and referrals for visits to specialists. The findings are in the Archives of Internal Medicine (1998;158:1626-1632).
Med Briefs (INC inc.) 8/16/98
Reports say the U.S. District Court in Washington, DC, has handed down a ruling overturning the U.S. Food and Drug Administration's policy prohibiting companies from distributing information to physicians on "off-label" use of drugs or devices. Off-label use is use of a drug or device for purposes other than those for which it has been approved by the FDA. The ruling is the result of a 1994 lawsuit filed by the Washington Legal Foundation, which claimed that the FDA policy violated the First Amendment rights of companies. Note: physicians have always been able to obtain information on off-label use by request, but companies have been prohibited from providing such information unsolicited. The FDA has reportedly not decided whether or not it will appeal the decision. Data taken from a Reuters news report (August 6, 1998).
Med Briefs (INC inc.) 8/10/98
A new report suggests that the drug gamma vinyl-GABA (GVG), which is used to control epileptic seizures, may be useful in the treatment of cocaine addiction. Researchers at the U.S. Department of Energy's Brookhaven National Laboratory conducted tests of the drug by monitoring its action in the brains of cocaine-addicted baboons. It was found that baboons treated with GVG showed decreased amounts of dopamine in neural synapses in response to cocaine (increased synaptic dopamine is thought to be responsible for the "high" resulting from cocaine use), and that treated baboons expressed fewer addictive behaviors. Authors further note that GVG treatment was not associated with decreases in healthy behaviors such as learning, food-seeking, or physical movement, which are also linked to dopamine levels and that trials in human cocaine addicts are expected to begin later this year. GVG is not currently approved for use in epileptics in the U.S., but is marketed for seizure control in Europe and Canada under the name Vigabatrin. The report is in the journal Synapse (1998;30:119-129).
Med Briefs (INC inc.) 8/10/98
Researchers have reported the identification of a genetic mutation that appears to play a role in some forms of hereditary epilepsy. Australian, American, and German researchers analyzed DNA from members of families affected by "generalized epilepsy with febrile seizures plus," which is characterized by the continuation of seizures in children past the age of six. The report says mutations in a gene known as SCN1B were found to be prevalent in the study population; SNC1B is partially responsible for the production of certain segments of sodium channels in brain neurons. Authors say abnormalities resulting from malformed sodium channels could lead to the erratic neuron firing that characterized epilepsy. The report is in the journal Nature Genetics (1998;19:340-347).
Med Briefs (INC inc.) 7/31/98
A new study concludes that epilepsy does not appear to affect female fertility, contrary to previous reports. Researchers at the National University Hospital in Reykjavik, Iceland, used national data to determine the number of live births among 209 epilepsy patients and 418 age-matched controls. The study found that all people studies had an average of 2.0 children, with no difference associated with epilepsy. Authors note, however, that patients with one form of epilepsy known as remote symptomatic epilepsy, which is characterized by mental retardation and cerebral palsy, was associated with reduced fertility. The study is in the journal Neurology (1998;51:71-73).
Med Briefs (INC inc.) 7/28/98
A new report concludes that suppressing ovulation through drug therapy can help to alleviate some disorders linked previously to hormonal changes during the menstrual cycle.- researchers at Ontario's Queen's University say study has shown that treatment with drugs from the gonadotropin-releasing hormone agonist class, which suppress the function of the ovaries, can decrease the severity of symptoms associated with epilepsy, asthma, rheumatoid arthritis, and irritable bowel syndrome, reduce the frequency of migraine headaches, and improve blood sugar control in diabetics.- authors further suggest that treatment with gonadotropin-releasing hormone agonists can be used to help determine if a particular condition is menstrual-related. - the report is in the Archives of Internal Medicine (1998;158:1405-1412).
Med Briefs (INC inc.) 7/13/98
A new study concludes that a new form of diazepam gel suppositories are safe and effective for use at home to treat acute repetitive epileptic seizures.- researchers at the National Institute of Neurological Disorders and Stroke in Bethesda, Maryland, tested the rectally-administered gel form of diazepam in 45 children and adults with acute repetitive seizures; another 46 similar patients were treated with placebos for comparison purposes. - found that participants treated with the diazepam gel experienced significantly fewer seizures than did participants who received a placebo, further, none of the diazepam-treated patients required emergency medical care, compared to 13% of placebo-treated patients.- authors note that the gel suppositories were administered by a trained caregiver (parent or spouse) and that adults were given three suppositories at seizure onset and two more suppositories at four hour intervals; children were treated with one dose at seizure onset and one more dose four hours later.- authors say the findings suggest that the diazepam gel suppositories can be safely and effectively used to treat this patients population without the risk associated with orally- or sublingually-administered medications.- the study is in The New England Journal of Medicine(1998;338:1869-1875).
Med Briefs (INC inc.) 6/25/98
A recent study suggests the existence of a link between the anti-seizure drug lamotrigine (Lamictal from Glaxo Wellcome) and aggressive behavior in epileptic patients with developmental problems. Researchers at Epilepsy Research & Services in Chatswood, Australia, say studies in 19 patients, ages 17-54, resulted in five patients being taken off therapy with the drug within 47 days after starting treatment due to aggressive behavior; three other study participants experienced aggression-related side-effects, but responded to either adjunct therapy for the aggression or reduced drug doses. Authors say it is not yet clear why the drug produces aggression in some developmentally challenged patients, but note that previous studies have suggested that this patient population may have increased sensitivity to drug-related side-effects. The study is in the journal Epilepsia (1998;39:280-82).
Med Briefs (INC inc.) 5/15/98
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