Need For Anticonvulsants Research Articles

Prediction of the Need for Anticonvulsants in the Management of Orofacial Neuropathic Pain Using Machine Learning.

Background and aim Orofacial neuropathic pain is a medical condition caused by a lesion or dysfunction of the nervous system and is one of the most challenging for dental clinicians to diagnose. Anticonvulsants, antidepressants, analgesics, nonsteroidal anti-inflammatory drugs, and other classes of medications are frequently used to treat this condition. Our study aimed to build a machine learning-based classifier to predict the need for anticonvulsant drugs in patients with orofacial neuropathic pain. Materials and methods A machine learning tool that was trained and tested on patients for predicting and detecting algorithms, which would in turn predict the need for anticonvulsants in the treatment of orofacial neuropathic pain, was employed in this study. Results Three machine learning algorithms successfully detected and predicted the need for anticonvulsants to treat patients with orofacial neuropathic pain. All three models showed a high accuracy, that is, 97%, 94%, and 89%, in predicting the need for anticonvulsants. Conclusion Machine learning algorithms can accurately predict the need for anticonvulsant drugs for treating orofacial neuropathic pain. Further research is needed to validate these findings using larger sample sizes and imaging modalities.

Importance of EEG, USG skull and CT/ MRI brain in neonatal seizures

Aim and Objectives: The present study was undertaken to evaluate the importance of EEG, USG skull and CT/MRI brain in the diagnosis and management of neonatal seizures. Methods: Total 75 neonates with clinically identified seizure episodes were enrolled in the study.EEG was done for 73 neonates and USG skull was done for all, whereas CT/MRI brain study was undertaken only if indicated by history, examination or other basic investigations. The findings of these investigations were correlated with various demographic parameters like gestational age, gender and birth weight and clinical parameters like age of onset and type of seizure, etiology of seizure, presence of status epilepticus, need for anticonvulsants and mortality. Results: A greater percentage of neonates with 1 st seizure occurring before 72 hours of life were found to have an abnormal EEG (14.70%), USG (14.28%) and CT/MRI (50%) as compared to later age of onset (5.12% and 5.00% and 34.6% respectively). Multifocal clonic and multiple types of seizures have a greater association with EEG abnormalities as compared to other types. There was a statistically significant association between clonic neonatal seizures and USG as well as CT/ MRI abnormalities.EEG, USG and CT/MRI studies revealed a higher incidence of abnormalities in patients with status epilepticus and found a statistically significant correlation between presence of status epilepticus and CT/MRI abnormalities. Most cases of metabolic convulsions do not require anticonvulsants. Conclusion: Interictal EEG provides a useful non-invasive test to diagnose neonatal seizures due to diffuse brain lesions. USG is a rapid, inexpensive and sufficiently accurate modality in evaluation of neonatal brain pathology and in the diagnosis of various lesions that occur in the first weeks of life. CT/MRI further added to our knowledge in understanding the nature and extent of the underlying intracranial pathology by revealing findings which were not easily picked up on USG skull.

Seizure as the first presentation of diabetes mellitus

Seizure as the first presentation of diabetes mellitus

Clinical Pharmacology Of Malaria

Effective chemotherapy of malaria relies on an accurate diagnosis and an appropriate affordable choice of drugs bearing in mind likely adverse effects, patterns of drug resistance, and the degree of host immunity. Choice of Antimalarial Drug: Treatment of multidrug-resistant Plasmodium falciparum malaria prevalent in our environment relies increasingly on combination chemotherapy using blood schizonticides. Chloroquine and Sulfodoxine/Pyremethamine have been cheap and safe options. However widespread resistance to these drugs (and the problem of chloroquine-related pruritus) means that these agents are often ineffective. Quinine has been relied on for multidrug-resistant malaria. However its marked toxicity potential (e.g. cinchonism and ventricular tachyarrhythmias) means that other drugs such as mefloquine, doxycycline, chlorproguanil-dapsone and proguanil-atovaquone are preferred. Halofantrine is not recommended because of its cardiotoxic potential. Increasing problems with drug resistance have led to current recommendations for the use of artemisinin-based combination therapy such as co-artemether (artemether plus lumefantrine). Plasmodium vivax, P. ovale and P. malariae remain sensitive to chloroquine, and likewise the emergent parasite P. knowlesi. Primaquine is used to eradicate hypnozoites of P. vivax and P. ovale. Treatment of malaria: Prompt treatment is of vital importance, especially in patients who lack innate or acquired immunity. Delaying effective treatment increases morbidity and mortality. Circumstances such as pregnancy and infancy should be taken into account, for example to avoid possible teratogenic effects of mefloquine, artemisinins or halofantrine during the first trimester, and to avoid primaquine and halofantrine while breastfeeding. Supportive treatment is important in severe malaria. Fever is part of the host defence against infection and so should not be entirely suppressed. Careful attention should be paid to fluid balance, to postural hypotension and hypoglycemia (which are exacerbated by quinoline antimalarials), to accompanying bacterial infections, renal impairment and the need for anticonvulsants or blood transfusion. Therapeutic failure may be due to a wrong diagnosis, or an additional cause for the febrile illness apart from malaria. Parasite resistance to antimalarials, poor patient compliance, and the use of fake or substandard drugs are alternative explanations. Key Words: Malaria, Drug treatment of Malaria, Clinical Pharmacology Orient Journal of Medicine Vol.16(2) 2004: 59-69

Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma.

To describe the clinical features that distinguish accidental from abusive head injury in hospitalized children <24 months of age. Prospective study of children <24 months of age hospitalized for head injury between August 1, 2000, and October 31, 2002. During hospitalization, children had computed tomographic scans of the brain, serial neurologic examinations, dilated ophthalmoscopic eye examinations, evaluation by a social worker, and, in some cases, a child abuse specialist. The main outcome measure was the proportion of children in each group with retinal hemorrhages (RHs). Secondary outcome measures were the proportion of children in each group who had vitreous hemorrhage; abnormal mental status on presentation; seizures; scalp hematomas; need for anticonvulsants; and operative procedures such as subdural tap, craniotomy, ventriculostomy, tracheostomy, and gastrostomy. Eighty-seven children were prospectively enrolled. Fifteen children were classified as having abusive head injury, and 72 were classified as having accidental head injury. Five children, all in the accidental head injury group, were excluded from statistical analysis, because they did not have a dilated ophthalmoscopic examination during their hospitalization. Thus 82 children were included in the statistical analysis. There were no significant differences between the 2 groups with respect to mean age, gender, or ethnicity. RHs were more likely to be seen in children with abusive head injury (60% vs 10%) and were more likely to be bilateral (40% vs 1.5%). Pre-RHs were more likely to be seen in children with abusive head injury (30% vs 0%). Premacular RHs and RHs that extended to the periphery of the retina were also more likely to be seen in children with abusive head injury (20% vs 0% and 27% vs 0%, respectively). Of the 7 children with accidental head injury who had RHs, 6 had unilateral RHs. Children with abusive head injury were more likely to have seizures (53% vs 6%) and an abnormal mental status on initial presentation (53% vs 1%). Children with accidental head injury were more likely to have scalp hematomas (6.7% vs 49%). RHs are seen more often in abusive head injury and often are bilateral and involve the preretinal layer. Children with abusive head injury were more likely to have RHs that cover the macula and extend to the periphery of the retina. Unilateral RHs can be seen in children with accidental head injury. Children with abusive head injury were more likely to present with abnormal mental status and seizures, whereas children with accidental head injury were more likely to have scalp hematomas. Such characteristics may be useful to distinguish accidental from abusive head trauma in children <24 months of age.

Determinants of compliance in epileptic outpatients.

The authors have investigated reasons for medication compliance in a population of epileptic patients. The hypothesis that the health care belief model would be predictive of medication-taking behavior was validated. A pilot study was constructed which investigated the comparative responses of compliant and noncompliant epileptic outpatients to questions regarding demographic, clinical history, and attitudinal characteristics. Noncompliant patients were characterized as having a longer duration of epilepsy, more complicated dosage regimens, and more changes in medication. In addition, noncompliant patients both demonstrated more confusion over medication directions and less insight into the need for anticonvulsants and feared addiction to their medication. They had a lower level of satisfaction with their health care and were more frequently subject to the social complications of epilepsy. The authors suggest that a more holistic approach be taken when attempting to reverse noncompliant behavior.

Teratogenic effects of anticonvulsants.

The incidence of malformations in fetal mice exposed to phenytoin depends on drug dosage and the strain of mice. Animal research also suggests that most anticonvulsants are teratogenic in experimental animals when large doses are used, but the effect of valproate sodium on the fetus is poorly known. Cleft lip and palatal defects have been most extensively studied, but defects have also been noted in eyes, heart, and limb buds. Data from humans are less clearer than the animal data, but human maternal exposure to anticonvulsants may increase infant clefting by threefold to tenfold. If a woman at risk for childbearing is given anticonvulsants for the first time, carbamazepine may be given first. Before pregnancy, the true need for anticonvulsants should be reassessed, but abrupt discontinuation of anticonvulsants during pregnancy is not now recommended.