LECTURES
REVIEWS
ORIGINAL INVESTIGATIONS
Objective: to evaluate the efficacy and tolerability of sustained-release sodium valproate sodium as first-line monotherapy in patients with newly or recently diagnosed focal epilepsy.
Subjects and methods. This was an open-label, prospective, observational study performed in the real treatment setting. It covered 1580 patients (children older than 6 years and adults) with focal epilepsy. The patients received sustained-release sodium valproate in an average daily dose of 1268 mg for 6 months. Therapeutic effectiveness was evaluated from remission rates when the study was completed. Moreover, the proportion of patients who continued to take the drug following 6 months was estimated. The total efficiency of the therapy was evaluated by the Clinical Global Impression Scale (CGI).
Results. At 6 months of the study, 1478 (93.5%) patients continued to take the drug, 1167 (73.9%) of the 1580 patients achieved remission (they were seizure-free). The drug proved to be effective in all types of epileptic seizures of different etiology and different localization of an epileptic focus. In complex partial seizures and secondary generalized seizures, the efficiency of sustained-release sodium valproate was somewhat higher than that in simple partial seizures [71.1% (477/672), 74% (853/1153), and 68.4% (476/697), respectively]. During treatment, 67.9% (1072/1580) of the patients showed an evident and significant improvement without side effects. The drug was well tolerated. Drug-induced side effects were observed in 139 (8.8 %) of the 1580 patients; these were mild and moderate and led to drug discontinuation in only 10 (0.6%) of the 1580patients. The most adverse events were weight gain in 1.8% (29/1580) of the patients, alopecia in 1.8% (28/1580), and tremor in 1.5% (25/1580).
Conclusion. The study indicates that the use of sustained-release sodium valproate is an effective and well tolerable first-line drug for the treatment of focal epilepsy in children and adults.
Objective: to obtain additional Russian data on the efficacy of Depakine Chronosphere as first-line monotherapy in the treatment of epilepsy in children without epileptic encephalopathy.
Subjects and methods. This was a short-term open-label, prospective observational study performed in the real treatment setting. The observation of patients lasted at least 2 months. The study included 297 patients aged 2 months to 17 years with varying epilepsy other than epileptic encephalopathies. The patients received Depakine Chronosphere in an average daily dose of 26.9±8.2 mg/kg. The efficacy of the drug was objectively evaluated from the change in the number of attacks; in addition, a physician and a patient or his/her parents made a subjective assessment of therapeutic effectiveness. The safety of therapy was judged from the reports made by the patients ' parents on adverse events recorded during the observation period.
Results. More than 90% responded to Depakine Chronosphere well (epileptic seizures ceased or reduced in number). Epileptic seizures completely disappeared in 48.8% of the patients. The drug proved to be effective in different (both partial and generalized) forms of epilepsy. Depakine Chronosphere was well tolerated in this study. No adverse events were seen in 7.41% of the patients and permitted the drug to be discontinued in as low as 0.34%. The physicians and the patients' parents unanimously evaluated therapeutic efficiency as very good and good in more than 90% of cases.
Criminal clozapine (azaleptin, leponex) intoxications are notified very frequently (as high as 99.7% of all criminal intoxications) and have virtually supplanted earlier predominant clofelin poisoning.
Objective: to identify the characteristic clinical features of acute clozapine intoxications to make their differential diagnosis with the similar acute states that are most frequently encountered at the prehospital stage.
Subjects and methods. A total of 4757 patients diagnosed as having criminal clozapine intoxication, followed at the Toxicology Unit, Prof. A.A. Ostroumov City Clinical Hospital Thirty-Three, in 2003 to 2009, were examined and their case histories were analyzed. There were 4474 (94.05%) men and 283 (5.95%) women. The patients aged less than 21 years were 10.6%; those of 21 to 60 and over 60 years of age were 88.7 and 0.7%, respectively. None of them had been followed by a psychiatrist and had systematically taken any psychotropic drugs. Most (54%) of the victims were the capital's guests. Clinical and laboratory studies were used to examine the patients. The pattern and situational features of the intoxication were revealed; the leading clinical syndrome and its degree were established. The group patients' conditions were rated on admission, by applying the integral APACHE-2 scale; the Glasgow coma scale was used to determine the degree of impaired consciousness. The patients' status was analyzed by clinico-anamnestic and clinicopsychopathological studies, as well as by a neuropsychological test after abolishing sopor and coma and then on days 3 and 5 of inpatient treatment.
Results. The interval between intoxication to the arrival of an emergency team (ET) was 30 min to 5 hrs (mean 1.43+0.68 hrs). During this period, the level of consciousness reduced with on-going agent absorption, changing from torpor to sopor or coma. ET sent 98.3% of the patients to hospital for the diagnoses of alcoholic intoxication, alcoholic surrogate, opiate, or clofelin poisoning, closed brain injury, or coma of unknown etiology. On admission, the patients' condition was rated as severe in 98.5% and moderate in 1.5%. Stage I intoxication was present in 17 (0.35%) patients; Stage IIA in 4579 (96.25%), IIB in 75 (1.57%), III in 1 (0.02%), and IV in 85 (1.86%). The patients were found to have peculiar mnestic disorders. Intensive care comprised complex detoxification, infusion therapy, and vitamin therapy; respiratory support was also made in the absence of respiratory disorders. Prominent in the therapy was the use of the antidote intravenous aminostigmine and galantamine bromide in a dose of 2-3 mg. During therapy, there was consciousness recovery for an average of 1.22+0.68 hours with psychomotor excitement developing within 40-90 min and giving way to the significant asthenic syndrome that preserved within 16-30 other hours. Three patients died; 2 of them were patients with Stage IIB with comorbidities.
Conclusion. Criminal clozapine intoxications are distinguished by the fact that they generally occur in the street (97.75%) or public area; the intoxication victims are socially preserved patients; moreover, their money and valuables practically always disappear. In addition, the intoxications are characterized by the rapid development of severe disorders of consciousness, a short-term toxicogenic phase, and a rarity of severe in-hospital complications (from 1.2% in Stage IIA to 3.5% in Stage IIB; no bronchopulmonary complications in Stages I and IV). Fatal outcomes in criminal intoxications are recorded in 00.11% of cases whereas those are in 10-18%. The specific features of the course of criminal clozapine intoxications seem to lie in the combined effects of clozapine and ethanol on the central nervous system and their synchronous metabolism.
Objective: to study personality characteristics, behavioral style, and modes of relations with their people in patients with somatized disorder.
Subjects and methods. Eighty-six patients diagnosed as having somatized disorder were examined using Leary's interpersonal diagnosis system.
Results. The author revealed the following personality characteristics and behavioral styles: a depressed need for authoritarianism, dominance, autonomy, aggressiveness, a display of qualities, such as superfriendliness, benevolence, submissiveness, dependency, and suspiciousness. These characteristics give an insight into the development of somatization in patients with somatized disorder.
Objective: to study baseline autonomic tone and autonomic responsiveness in patients with neuroreflectory syncopal states (NSS) during a passive orthotest in orthostatic and clinostatic phases.
Subjects and methods. A study group comprised 40 patients with NSS, a comparative group included 57 patients with panic attacks (PA); a control group consisted of 22 subjects without the above conditions. Cardiac rhythm variability was estimated applying a Neuron-spectrum device.
Results. During the orthotest, the patients with NSS showed inadequate activity of the sympathetic nervous system as compared with the patients with PA and the control group. At the same time, the clinostatic test revealed that the indicators restored to the normal values in patients with NSS, unlike in those with PA.
PHARMACOTHERAPY
The paper gives the characteristics and causes of pain syndromes and an algorithm for the treatment of chronic pain. It is stated that treating patients with chronic neocancer pain requires that its clinical features be kept in mind; moreover, treatment should be itself safe and effective. Drugs must be used for a long period, by strictly following the schedule in individual doses.
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