Koray Arica, MD
Lamotrigine dosages: 200 mg, 100 mg, 50 mg, 25 mg
Lamotrigine packs: 30 pills, 60 pills, 90 pills, 120 pills, 180 pills, 270 pills, 360 pills
Significant tolerance may develop making effects less pronounced in long-term users for the same dose. In a laboratory setting, heroin produced subjective feelings of sedation for up to 5-6 hours and slowed reaction times up to 4 hours, in former narcotic addicts. Euphoria and elation could also play a role on perception of risks and alteration of behaviors. Effects on Driving: the drug manufacturer states that morphine may impair the mental and/or physical abilities needed to perform potentially hazardous activities such as driving a car, and patients must be cautioned accordingly. Driving ability in cancer patients receiving long-term morphine analgesia (mean 209 mg daily) was considered not to be impaired by the sedative effects of morphine to an extent that accidents might occur. There were no significant differences between the morphine treated cancer patients and a control group in vigilance, concentration, motor reactions, or divided attention. In several driving under the influence case reports, where the subjects tested positive for morphine and/or 6acetylmorphine, observations included slow driving, weaving, poor vehicle control, poor coordination, slow response to stimuli, delayed reactions, difficultly in following instructions, and falling asleep at the wheel. Other characteristic indicators may include presence of fresh injection marks, track marks, flaccid muscle tone, droopy eyelids, drowsiness or "on-the-nod", and low raspy slow speech. Mild to moderately impairing if morphine is used as medication on a regular basis for chronic pain. Severely impairing in acute situations if used orally, or as an intravenous medication, or if either drug is taken illicitly. Epidemiological trends in drug abuse; Proceedings of the Community Epidemiology Working Group, Vol 1;June 2000. A case of high opiate tolerance: implications for drug analyses and interpretations. A randomized controlled trial of single doses of morphine, lorazepam and placebo in healthy subjects. Concentration-related effects of morphine on cognition and motor control in human subjects. Pharmacokinetics and pharmacodynamics of sedatives and analgesics in the treatment of agitated critically ill patients. Subjective, psychomotor, and analgesic effects of oral codeine and morphine in healthy volunteers. Subjective, psychomotor, and physiological effects of cumulative doses of opioid mu agonists in healthy volunteers.
Diseases
Tolerance may develop and users may quickly become addicted and use it with increasing frequency and in increasing doses. Abrupt - 63 - discontinuation of use can produce extreme fatigue, mental depression, apathy, long periods of sleep, irritability, and disorientation. Methamphetamine may restore ethanol induced impairment in simple repetitive tasks of short duration, however, there is no restoration of ethanol-induced deficits of balance and steadiness. In general, high doses of amphetamines are likely to increase the impairing effects of alcohol. Chlorpromazine and haloperidol block dopamine and norepinephrine reuptake, thus inhibiting the central stimulant effects of amphetamines. Performance Effects: Laboratory studies have been limited to much lower doses than those used by methamphetamine abusers. Doses of 10-30 mg methamphetamine have shown to improve reaction time, relief fatigue, improve cognitive function testing, increase subjective feelings of alertness, increase time estimation, and increase euphoria. Expected performance effects following higher doses may include agitation, inability to focus attention on divided attention tasks, inattention, restlessness, motor excitation, increased reaction time, and time distortion, depressed reflexes, poor balance and coordination, and inability to follow directions. Effects on Driving: the drug manufacturer states that patients should be informed that methamphetamine and amphetamine may impair the ability to engage in potentially hazardous activities such as driving a motor vehicle. In epidemiology studies drive-offthe-road type accidents, high speed, failing to stop, diminished divided attention, inattentive driving, impatience, and high risk driving have been reported. Significant impairment of driving performance would also be expected during drug withdrawal. In a recent review of 101 driving under the influence cases, where methamphetamine was the only drug detected, blood concentrations ranged from <0. Driving and driver behaviors included speeding, lane travel, erratic driving, accidents, nervousness, rapid and non-stop speech, unintelligible speech, disorientation, agitation, staggering and awkward movements, irrational or violent behavior, and unconsciousness. Impairment was attributed to distraction, disorientation, motor excitation, hyperactive reflexes, general cognitive impairment, or withdrawal, fatigue and hypersomnolence. Other - 64 - characteristic indicators may include restlessness, body tremors, talkativeness, exaggerated reflexes, anxiety, and track marks or recent injection sites. Drug withdrawal could also lead to the impairment of psychomotor skills required for safe driving.
It is prepared by adding baking soda to aqueous cocaine hydrochloride and heating it until the free-base cocaine precipitates into small pellets. The mixture is cooled and filtered, and then the "rocks" are smoked in a crack pipe. Medical and Recreational Uses: Minor use as a topical local anesthetic for ear, nose and throat surgery. Traditionally, the coca leaves are chewed or brewed into a tea for refreshment and to relieve fatigue. Recreationally, cocaine is used to increase alertness, relieve fatigue, feel stronger and more decisive, and is abused for its intense euphoric effects. Potency, Purity and Dose: In ear, nose and throat surgery cocaine is commercially supplied as the hydrochloride salt in a 40 or 100 mg/mL solution. Depending on the demographic region, street purity of cocaine hydrochloride can range from 20-95%, while that of crack cocaine is 20-80%. Repeated doses are frequently taken to avoid the dysphoric crash that often follows the initial intense euphoric effects. Cocaine is frequently used in combination with other drugs; injected with heroin ("speedball") or taken with alcohol to reduce irritability; smoked with phencyclidine ("tick"); and smoked in marijuana blunts ("turbo"). Recreationally, coca leaves can be chewed, however, cocaine abusers typically smoke "crack" in a glass pipe or inject the hydrochloride salt intravenously. Cocaine hydrochloride can be smoked to some effect but this is very inefficient as the powder tends to burn rather than vaporize. Cocaine prevents the reuptake of dopamine by blocking the dopamine transporter which leads to increased extracellular dopamine, resulting in chronic stimulation of postsynaptic dopamine receptors. As a local anesthetic, cocaine reversibly blocks the initiation and conduction of the nerve impulse.
Presented at the 56th Annual Meeting of the American Epilepsy Society; December 11, 2002; Seattle, Washington. Myoclonus in epilepsy patients with anticonvulsive add-on therapy with pregabalin. Pregabalin-induced generalized myoclonic status epilepticus in patients with chronic pain. Pregabalin-induced cortical negative myoclonus in a patient with neuropathic pain. Erectile dysfunction associated with pregabalin add-on treatment in patients with partial seizures: five case reports. Evaluation of cognitive and psychomotor profile of pregabalin compared to alprazolam in normal volunteers. Presented at the 56th Annual Meeting of the American Epilepsy Society; December 11, 2002; Seattle, Washington. Gabapentin (Neurontin) and S--3isobutylgaba represent a novel class of selective antihyperalgesic agents. Identification of the 2- -1 subunit of voltage-dependent calcium channels as a molecular target for pain mediating the analgesic actions of pregabalin. Lamotrigine has also demonstrated efficacy in the electrically induced electroencephalogram after discharge model (24). Lamotrigine blockade of sodium channels activated from depolarized membrane potentials occurs at lower concentrations than those required to elicit blockade from hyperpolarized membrane, and occurs at clinically achievable concentrations (6). Recently, a potential binding site within the Na channel pore has been identified (8). In addition to sodium channels, lamotrigine produces dose-dependent inhibition of high voltage-activated Ca currents, possibly through inhibition of presynaptic N- and P/Q-type Ca channels (9,10). Despite its apparent clinical activity in human absence seizures, lamotrigine does not appear to inhibit lowvoltage currents mediated by T-type Ca channels. Although these actions are mechanistically similar to those of phenytoin, important differences do exist between these agents.
Kif (Marijuana). Lamotrigine.
Source: http://www.rxlist.com/script/main/art.asp?articlekey=96910
Number or duration of seizures over given period requiring physician notification. Measures to be taken if number, duration, or severity of seizures observed is excessive. Ready access to intensive care unit and anesthesia services in the event of status epilepticus. Intracarotid amobarbital (Wada) testing Functional cortical mapping by stimulation of subdural electrodes either extraoperatively or intraoperatively. Evoked potential recording capable of being used safely with intracranial electrodes. Inpatient and outpatient psychological services for assessment and treatment of emotional disorders associated with chronic epilepsy. Physical, occupational, and speech therapy for evaluation and treatment of multiply handicapped individuals. Sufficient physical, occupational, and speech therapy for managing complications of surgeries performed at the center. A neurologist or neurosurgeon with special expertise in epilepsy should serve as program director. At least one of these individuals should be board certified in clinical neurophysiology by either the American Board of Clinical Neurophysiology or the American Board of Psychiatry and Neurology additional qualifications in clinical neurophysiology. At least one of these individuals should have experience in the indications for and the adjustment of the vagus nerve stimulator. At least one board certified fellowship-trained neurosurgeon with special interest in epilepsy, experience in c. Emergency or elective neurosurgery, including biopsy and removal of incidental lesions and treatment of cerebral complications of epileptic seizures.
Seizures, specifically neonatal ones, are often the first identified feature of this syndrome though patients with later onset and mild epilepsy have been described. Affected individuals without the classic clinical features have been identified and a screening for lumbar puncture should be considered in those with refractory epilepsy (62). Early initiation of the ketogenic diet is effective in the treatment of seizures as well as overall disease progression, as it provides an alternative cerebral energy source (63). The condition appears to be phenotypically milder clinically with less striking hypoglycorrhachia (66). Other Disorders Fructose 1,6-bisphosphatase deficiency, a rare, potentially lifethreatening disorder of gluconeogenesis, presents within the Chapter 32: Epilepsy in the Setting of Inherited Metabolic and Mitochondrial Disorders 389 Treatment varies and includes preventing worsening during metabolic or physiologic stresses, avoiding mitochondrial toxins and poisons, use of select cofactors and supplements, and providing symptomatic care. The E1 enzyme is itself a complex structure, a heterotetramer of two and two -subunits. Pyruvate dehydrogenase deficiency has a wide variety of clinical presentations, ranging from acute lactic acidosis in infancy with severe neurologic impairment in affected males, to a slowly progressive neurodegenerative disorder in some males and more commonly females. Structural abnormalities, such as agenesis of the corpus callosum, are often present on neuroimaging (72). A variety of different seizures, including focal and generalized seizures, have been described (81). Disorders of Amino and Organic Acids Metabolism Amino and organic acids predominantly form from the catabolism of proteins and carbohydrates. Any enzymatic defect in these metabolic pathways leads to an accumulation of potentially acidic compounds, and partial inhibition of the citric acid and urea cycles. Acidosis and hyperammonemia ensues leading to encephalopathy and at times, seizures. These disorders, when most severe (a severe enzyme deficiency), typically present in the newborn period, especially after an infant is exposed to a protein or carbohydrate challenge in the diet. For some, this means after feeding in the 1st day, while for others it is after the introduction of solid foods. Regardless of the type of amino or organic acid disorder, the acute presentation is often the same.
The information in this monograph relates to the individual isoflavones, and the reader is referred back to the herb (and vice versa) where appropriate. It is very difficult to confidently predict whether a herb that contains one of the isoflavones mentioned will interact in the same way. The levels of the isoflavone in the particular herb can vary a great deal between specimens, related species, extracts and brands, and it is important to take this into account when viewing the interactions described below. Types, sources and related compounds Isoflavones are plant-derived polyphenolic compounds that are a distinct group of flavonoids, page 186. Most occur as simple isoflavones, but there are other derivatives such as the coumestans, the pterocarpans and the rotenoids, some of which also have oestrogenic properties. The isoflavones are found in small amounts in many legumes, seeds, grains and vegetables, but soya, page 356, is by far the most concentrated dietary source; it contains principally genistein and daidzein. There are various other isoflavone-rich supplements, including those derived from alfalfa, page 21 and red clover, page 332 (both of which are rich in biochanin A and formononetin), and kudzu, page 267, which contains puerarin. In addition, some popular herbal medicines, such as astragalus, page 46 and shatavari, page 353 contain isoflavones as well as other types of active constituents. The most important isoflavones are: genistein and daidzein, which are hydrolysed from their glycosides genistin, daidzin and puerarin (daidzein 8-C-glucoside); glycetein and its glycoside glycitin; formononetin, biochanin A, isoformononetin, prunetin, calycosin, ononin, orobol; and others. I used for these possible benefits, it remains to be seen whether they are effective. Isoflavones have weak oestrogenic effects, but under certain conditions (for example, in premenopausal women) they can also act as oestrogen antagonists by preventing the more potent natural compounds, such as estriol, from binding to receptor sites. Isoflavones also inhibit the synthesis and activity of enzymes involved in oestrogen and testosterone metabolism, such as aromatase. Because of their oestrogenic effects, isoflavone supplements have been investigated for treating menopausal symptoms such as hot flushes (hot flashes)1,2 and for prevention of menopausal osteoporosis,3 with generally modest to no benefits when compared with placebo in randomised controlled studies. Isoflavones have also been extensively studied for lipid lowering,4 and there are a few studies on other cardiovascular benefits, and effects on cognitive function. In a 2006 analysis, the American Heart Advisory Committee concluded that the efficacy and safety of soya isoflavones were not established for any indication and, for this reason, they recommended against the use of isoflavone supplements in food or pills. Isoflavone glycosides are probably hydrolysed in the gut wall by intestinal beta-glucosidases to release the aglycones (genistein, daidzein, etc. Gut bacteria also extensively metabolise isoflavones: for example, daidzein may be metabolised to equol, a metabolite with greater oestrogenic activity than daidzein, but also to other compounds that are less oestrogenic.
Despite one study reporting 92% Class I outcomes for posterior quadrant resections (117), patients with multilobar resections generally experience significantly lower rates of seizure freedom (4,113,130). Lower rates are not surprising given the extensive abnormalities seen electrographically, Chapter 83: Focal and Multilobar Resection 945 structurally, and pathologically in most patients. For patients with catastrophic epilepsies and multiple daily seizures, a substantial reduction in seizure frequency or elimination of the most disabling seizure semiology will improve quality of life. However, in children experiencing multiple daily seizures and developmental regression, a significant reduction in the seizure frequency may positively impact cognitive development and quality of life. Under such circumstances, palliative surgery is a reasonable option if complete resection is not possible. Intractable epilepsy in childhood may cause major developmental ramifications, but the importance of early seizure control and early epilepsy surgery is only now being elucidated. The majority of these deficits are anticipated based on the resection location and most commonly include hemiplegia, homonymous hemianopsia, quadrantanopsia, dysphasia, and reduced verbal memory. Subtle cognitive sequelae may be overlooked without detailed neuropsychological testing. Proposed criteria for referral and evaluation of children for epilepsy surgery: recommendations of the Subcommission for Pediatric Epilepsy Surgery. Selection criteria and preoperative investigation of patients with focal epilepsy who lack a localized structural lesion. An analysis of clinical seizure patterns and their localizing value in frontal and temporal lobe epilepsies. Frontal lobe epilepsy: clinical characteristics, surgical outcomes and diagnostic modalities. Clinical manifestations of insular lobe seizures: a stereo-electroencephalographic study. Parietal lobe lesional epilepsy: electroclinical correlation and operative outcome. Occipital lobe epilepsy: clinical characteristics, seizure spread patterns, and results of surgery. Complex partial seizures in children: ictal manifestations and their relation to clinical course. Predictors of outcome of anterior temporal lobectomy for intractable epilepsy: a multivariate study.
For example, target shooting with a lethal weapon likely poses little risk to the shooter or people in close proximity except for that very short period of time when squeezing the trigger. In contrast, such activities as motorbike riding or hang gliding might present a relatively high risk for the person with epilepsy as danger periods encompass the entire time they are involved in the activity. Activities with inherent danger must also be factored into the decision of whether to participate. Finally, other factors, such as medication compliance, medication side effects, age, concomitant medical problems, use of safety equipment, and a prolonged and consistent aura, can all influence the risks faced by a person with epilepsy when engaging in a specific activity. A person with epilepsy must conduct the analysis in the context of a specific situation, with the consideration that a seizurerelated injury might occur during the specific activity. To determine potential risk, a person with epilepsy needs to understand all aspects of the specific activity and must try to predict the potential exposure to injury should a seizure occur during participation. The risk of seizure recurrence will determine, at least in part, how safe it is to participate in a desired activity. Factors that influence seizure recurrence have been reported (3) and may provide important insight into determining the risks associated with a desired activity. Partial seizures are also more likely to recur compared with an initial major motor seizure (4,7). If the etiology of a seizure disorder is head injury, the risk for recurrence may be higher. Structural lesions, such as brain tumors, stroke, abscesses, and penetrating head wounds, all carry an increased risk for recurrent seizures. Seizures caused by alcohol use, on the other hand, are unlikely to recur if abstinence is maintained. This privilege is governed by individual country, state, or territorial governments (11). These crashes resulted in approximately 3 million injuries and more than 42,000 deaths (12).
Gunock, 49 years: There were no differences in the percentage of children presenting with convulsions or unconscious. The anticonvulsant retigabine attenuates nociceptive behaviours in rat models of persistent and neuropathic pain. Clinicians should refer to the full prescribing information and published resources when making medical decisions. It has multiple mechanisms of action, including blocking T-type calcium channels (predictive of efficacy against absence seizures), blocking sodium channels, and weak inhibition of carbonic anhydrase activity.
Campa, 54 years: Congenital unilateral perisylvian syndrome: radiological basis and clinical correlations. Vagus nerve stimulation for 1 year in 269 patients on unchanged antiepileptic drugs. Until more is known, some caution might be warranted if patients take nifedipine (and possibly any calcium- Danshen + Food No interactions found. However, due to the side effects of weight gain and tetratogenicity, it is generally used with caution in young females.
Jaroll, 32 years: Encourage them to talk about their feelings and let them know that it is okay to have them. Female rats in estrus are more sensitive to chemical convulsants than are females in diestrus and males, whereas infusion of a progesterone metabolite increases the seizure threshold more for females in diestrus (108). Remarkably similar results were subsequently reported by Rekate and colleagues at the Barrow Neurological Institute in Phoenix (54). Seizure-related injuries in multihandicapped patients with therapy-resistant epilepsy.
References
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