The Clinical Importance of Subnormal Folate Levels in Epileptic Patients on Anticonvulsant Therapy

1987 ◽  
Vol 32 (6) ◽  
pp. 171-172 ◽  
Author(s):  
G.R. Nimmo ◽  
M.J. Ryan ◽  
N. Chalmers ◽  
A.W. Patrick

A neurological history was obtained and examination performed on 62 outpatient epileptics on anticonvulsant therapy. Blood counts, folate and B12 assays were performed on all patients and on a control group of 59 adult non-epileptic neurological outpatients. None of the anticonvulsant treated group had clinical peripheral neuropathy; there was one patient with microcytic anaemia and one with normochromic, normocytic anaemia. In 5 of this group the mean corpuscular volume (MCV) was slightly raised but there was no significant overall difference from the control group. In 17 patients serum folate was subnormal and in 7 the red cell folate was subnormal and this was significantly different to the control group (P <0.001). Vitamin B12 levels were normal in all subjects. It is concluded that despite subnormal measured folate levels, there is no increased incidence of clinical peripheral neuropathy or of significant macrocytosis. In view of this, we recommend that folate replacement should not be given to non anaemic asymptomatic patients, with subnormal folate levels, on anticonvulsant therapy.

Author(s):  
Ashraf Albrakati

Tramadol, a broadly in recent years, is an effective analgesic agent for the treatment of moderate to acute pain. Its metabolites are excreted by the kidney which may cause nephrotoxicity. Moringa oleifera leaves are commonly used to provide herbal and plant-derived medicinal products especially in developing nations. The present study was carried out to determine the biochemical and histopathological changes in the kidney of tramadol-treated albino mice and to evaluate the possible protective role of Moringa oleifera leaves against tramadol-induced nephrotoxicity. Twenty adult albino mice were divided into four groups. Control group (group i) received daily intraperitoneal injection of normal saline only, group ii received oral dose of Moringa oleifera leaves extract (20 mg/kg/bw) for three weeks, group iii received daily intraperitoneal dose of tramadol (0.3 mg/kg/bw) for the same period, group iv, received daily oral dose of Moringa oleifera leaves extract, (20 mg/kg/bw) three hours before injecting intraperitoneal dose of tramadol (0.3 mg/kg/bw), for the same period. Blood samples were withdrawn at the end of the experiment for kidney function tests and specimens from the kidney were processed for histological study. No significant differences in the mean values of the kidney function tests were noticed between Moringa oleifera group and control group. However, there was highly significant increase in the mean values of serum, urea and creatinine in tramadol-treated group as compared to the control group. Although tramadol + Moringa oleifera group revealed significant difference in the mean values of urea and creatinine when compared with tramadol-treated group. So, Moringa oleifera leaves extract have been shown to attenuate the renal dysfunction, improve the renal architecture, with nearly normalization of serum urea and creatinine levels which indicate improvement of renal function. In conclusion, in the light of biochemical results and histological findings, co-administration of Moringa oleifera leaves lessened the negative effects of tramadol-induced nephrotoxicity; possibly by its antioxidant action. Further investigation of these promising protective effects of Moringa oleifera leaves against tramadol-induced renal injury may have considerable impact on developing an adjunct therapy aiming to improve the therapeutic index of some nephrotoxic drugs.


2020 ◽  
Vol 8 (1) ◽  
pp. 209-228
Author(s):  
Layla Parast ◽  
Priscillia Hunt ◽  
Beth Ann Griffin ◽  
David Powell

AbstractIn some applications, researchers using the synthetic control method (SCM) to evaluate the effect of a policy may struggle to determine whether they have identified a “good match” between the control group and treated group. In this paper, we demonstrate the utility of the mean and maximum Absolute Standardized Mean Difference (ASMD) as a test of balance between a synthetic control unit and treated unit, and provide guidance on what constitutes a poor fit when using a synthetic control. We explore and compare other potential metrics using a simulation study. We provide an application of our proposed balance metric to the 2013 Los Angeles (LA) Firearm Study [9]. Using Uniform Crime Report data, we apply the SCM to obtain a counterfactual for the LA firearm-related crime rate based on a weighted combination of control units in a donor pool of cities. We use this counterfactual to estimate the effect of the LA Firearm Study intervention and explore the impact of changing the donor pool and pre-intervention duration period on resulting matches and estimated effects. We demonstrate how decision-making about the quality of a synthetic control can be improved by using ASMD. The mean and max ASMD clearly differentiate between poor matches and good matches. Researchers need better guidance on what is a meaningful imbalance between synthetic control and treated groups. In addition to the use of gap plots, the proposed balance metric can provide an objective way of determining fit.


2001 ◽  
Vol 95 (2) ◽  
pp. 179-189 ◽  
Author(s):  
Hans-Peter Richter ◽  
Erich Kast ◽  
Rainer Tomczak ◽  
Werner Besenfelder ◽  
Wilhelm Gaus

Object. Failed-back syndrome is still an unsolved problem. Use of ADCON-L gel, already commercially available, has been proven to reduce postoperative scarring in animal experiments. The authors of two controlled clinical studies have also shown positive results when applying the gel. They did not, however, establish patient-oriented endpoints. The authors report a study of ADCON-L in which they focus on patient-oriented endpoints. Methods. Patients with lumbar disc herniation were randomized to an ADCON-L—treated or control group. Therapeutic success was evaluated using the validated Hannover Questionnaire on Activities of Daily Living (FFbH) 6 months after surgery. The study took place between November 14, 1996, and April 20, 1998, in eight neurosurgical centers in Germany. A total of 398 patients was recruited; 41 patients dropped out during follow up. The mean functional FFbH score (100 points = all activities are possible without problem; 0 points = no activity is possible) was 78.5 points in the ADCON-L—treated group compared with 80 points in the control group. Furthermore, in terms of secondary outcome variables, the ADCON-L group did not have an advantage over the control group. Only the mean magnetic resonance imaging score showed a slight advantage of ADCON-L over the control group. Conclusions. The authors found no positive effect of treatment with ADCON-L gel in patients in whom one-level lumbar microdiscectomy was performed. Because of its rather large sample size and its homogeneity, the study had sufficient power to detect even small differences between the two groups.


2019 ◽  
Vol 10 (1) ◽  
pp. 73-81
Author(s):  
Faezeh Nemati Karimooy ◽  
Alireza Ebrahimzadeh Bideskan ◽  
Abbas Mohammadi Pour ◽  
Seyed Mahmoud Hoseini

AbstractStanozolol is an anabolic-androgenic steroid which is commonly abused by athletes for improved energy, appearance, and physical size. It has been previously shown to cause changes in behaviour and has various physical effects. Studies have previously been conducted on its neurotoxic effect on the central nervous system (CNS), which are typically psychological in nature. This study was performed to investigate the apoptotic effect of stanozolol on different parts of the rat hippocampus. Sixteen male Wistar rats were divided randomly into two groups (experimental and control). The experimental group received subcutaneous injections of stanozolol (5mg/kg/day) for consecutive 28 days, whereas the control group received saline using the same dosing schedule and administration route. After routine procedures, coronal sections of rat brain were stained with Toluidine blue and TUNEL for pre-apoptotic and apoptotic cell detection, respectively. In order to compare groups, the mean number of TUNEL-positive and pre-apoptotic neurons per unit area were calculated and analysed. Histopathological examination revealed that the mean number of pre-apoptotic and apoptotic neurons in the CA1, CA2, CA3 and DG areas of the hippocampus were significantly increased in the stanozolol treated group. In conclusion, stanozolol abuse may induce pre-apoptotic and apoptotic cell formation in different regions of the hippocampus.


Author(s):  
Mirthes Ueda ◽  
Eide Dias Camargo ◽  
Adelaide José Vaz ◽  
Ana Maria Carvalho de Souza ◽  
Regina Maria Figueiredo ◽  
...  

A passive haemagglutination test (PHA) for human neurocysticercosis was standardized and evaluated for the detection of specific antibodies to Cysticercus cellulosae in cerebrospinal fluid (CSF). For the assay, formaldehyde-treated group O Rh-human red cells coated with the cysticerci crude total saline extract (TS) antigen were employed. A total of 115 CSF samples from patients with neurocysticercosis was analysed, of these 94 presented reactivity, corresponding to 81.7% sensitivity, in which confidence limit of 95% probability (CL95%) ranged from 74.5% to 88.9%. Eighty-nine CSF samples derived from individuals of control group presented as nonreactive in 94.4% (CL95% from 89.6% to 99.2%). The positive and negative predictive values were 1.4% and 99.9%, respectively, considering the mean rate of that this assay provide a rapid, highly reproducible, and moderately sensitive mean of detecting specific antibodies in CSF samples.


2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 182-182
Author(s):  
Tsuyoshi Ohno ◽  
Takashi Mine ◽  
Hiroki Yoshioka ◽  
Mikiko Kosaka ◽  
Sadayuki Matsuda ◽  
...  

182 Background: Chemotherapy-induced peripheral neuropathy (CIPN) has become a substantial problem because of specific cytotoxic agents such as nab-paclitaxel, oxaliplatin, and eribulin. In addressing CIPN-related side effects caused by nab-PTX, we previously reported better CTCAE v4.0 grades and superior nab-PTX dose maintenance in breast cancer treatment adopting our 3S approach. Our 3S approach combines compression therapy (stockings and sleeves applied 24 hours from the beginning of nab-PTX administration) with medication therapy (selected prophylactic medications goshajinkigan, lafutidine, and mecobalamin applied over the course of treatment). In revisiting how stocking use restored skin perfusion levels decreased by nab-PTX chemotherapy, we examined whether the skin perfusion increases differ by CIPN grade. Methods: Using a laser Doppler blood flow meter with integrated probe (NL-101 Nahri Nexis Japan), we measured the skin perfusion of the lower limbs before and after stocking use across four groups: three groups of 3S prophylactics-treated nab-PTX patients divided by CIPN grade (Grade 0 [G0, n=12], Grade 1 [G1, n=20], Grades 2 and 3 combined [G2+3, n=12]), and one control group of healthy volunteers (GH, n=50). Results: In the control group (GH), the mean increase in skin perfusion level (mL/min/100g) after wearing stockings was 0.90 (SD= 3.36). For the 3S prophylactic treatment patients, the mean increase was 4.25 (4.98) in the G0 group, 2.11 (4.93) in the G1 group, and 2.69 (2.53) in the G2+3 group. ANOVA analysis indicated a significant difference in skin perfusion increase among the groups (p=0.0493). Analysis between the groups indicated significance in the G0 group increase over the control group increase (p=0.0255). Conclusions: CIPN was previously shown to decrease skin perfusion; in the current study skin perfusion responsiveness to stockings differed significantly between chemotherapy patients and healthy volunteers. Restorative skin perfusion increase is potentially related with alleviating CIPN grade, for which further evaluation is needed.


2014 ◽  
Vol 30 (1) ◽  
pp. 27-34
Author(s):  
Md Khairul Kabir Patwary ◽  
Shakila Sultana ◽  
- Md Salahuddin ◽  
Abu Jafor Md Salahuddin ◽  
Mohammed Sayeed Hassan ◽  
...  

Objective: To evaluate the effect of long term use of carbamazepine on lipid profile in adult epileptic patients Methodology: The study was conducted in the Department of Neurology at BSMMU, Dhaka over a period of 2 years from January 2010 to December 2011. Adult epileptic patients taking carbamazepine as anticonvulsant and attending the Epilepsy Clinic and Neurology OPD of BSMMU, Dhaka were the study population. A total of 107 cases and 107 controls were included in the study. Data were collected by interview of the patients, clinical examination and laboratory investigations using the research instrument Result: The mean age of case and control groups were almost identical (23.3 ± 6.8 vs. 23.8 ± 6.4 years, p = 0.972). The proportion of male and female patients was similar in both the study groups. Of the 107 cases, more than 70% had generalized epilepsy and the rest (29%) focal epilepsy. Of the 107 cases, 8% had family history of epilepsy. The prevalence of raised triglycerides and raised LDL were observed to be significantly higher in the case group than those in the control group (35.5% vs. 23.4%, p = 0.049 and 15% vs. 0.9%, p < 0.001 respectively). The prevalence of low HDL was also significantly higher in the former group than that in the latter group (43.9% vs. 18.7%, p < 0.001). The mean serum triglyceride and LDL were higher and mean HDL was lower in the case group than those in the control group. Over half (51.4%) of the case group exhibited dyslipidemia compared to the control group (27.1%). The risk of developing dyslipidemia in epileptic patients receiving carbamazepine for longer duration was nearly three-fold (95% of CI = 1.6 – 5.0) higher than that in the control group (p < 0.001). There is positive correlation between duration of carbamazepine treatment and lipid profile. Serum total cholesterol and triglycerides bear linear relationship with duration of treatment with carbamazepine (r = 0.201, p = 0.038 and r = 0.223, p = 0.021 respectively). The association of dyslipidemia with sex in epileptic patients receiving carbamazepine for more than 2 years. The proportion of dyslipdemia was considerably higher in the female patients than their male counterparts, although the difference was not statistically significant (55.3% vs. 41.9%, p < 0.211). Conclusion: A conclusion can be made from the above mentioned result that long-term use of carbamazepine in epileptic patients may cause dyslipidemia and the risk of having dyslipidemia in such patients is 3 times greater than the normal healthy population. Bangladesh Journal of Neuroscience 2014; Vol. 30 (1): 27-34


2013 ◽  
Vol 28 (2) ◽  
pp. 74-80
Author(s):  
Hasan Zahidur Rahman ◽  
Md Rafiqul Islam ◽  
Moniruzamman Bhuyian ◽  
Masud Rana ◽  
Rashed Imam ◽  
...  

Background: Stroke is the third commonest cause of death in developed countries and is responsible for the physical disability of a large population. The study was designed to see the association of serum folic acid with ischemic stroke. It was concluded that the low levels of folic acid are associated with ischemic stroke. Aim and objectives: To evaluate the association of serum folic acid level with ischemic stroke and to measure and compare the serum folic acid level among the cases and control subjects. Material and method: This study was a case-control study which was conducted in the Department of Neurology and Department of Biochemistry of BSMMU, Dhaka, between the period of 1st January 2010 and 31st December 2011 for duration of two years. A total number of 60 patients presented with ischemic stroke and 60 control person were enrolled in this study. All patients of both sexes, aged between 20 years and above presented with ischemic stroke, from 0 day to 1 month that was confirmed by CT scan of head/MRI of brain. Blood sample was collected from the cases and the controls and analyzed at the Dept. of Biochemistry, BSMMU for estimation of serum folic acid, serum homocysteine fasting blood sugar. Fasting lipid profile for cases only. Result: The mean ± SD of age of the cases was 58.42 ± 11.47 and among the cases 45 (75.0%) were male and 15 (25.0%) were female. Among the control male and female were 43 (71.7%) and 17 (28.3%) respectively. The mean (±SD) serum folate level of case and control group was 6.26(± 4.06) and 8.07(± 4.70) respectively. Statistically significant differences was observed between case and control group in term of Serum folate (p<0.05). This study showed serum folate level was deficient at the early period of ischemic stroke. Conclusion: Low serum folate concentration is significantly and independently associated with increased risk for ischemic stroke. DOI: http://dx.doi.org/10.3329/bjn.v28i2.17173 Bangladesh Journal of Neuroscience 2012; Vol. 28 (2): 74-80


Author(s):  
Mahsa Doctor Arastoye Marandi ◽  
Maryam Yadegari ◽  
Abbas Shahedi ◽  
Majid Pourentezari ◽  
Morteza Anvari ◽  
...  

Background and Aims: This study aimed to observe the effect of Icariin on histomorphometric changes of testis and prostate induced by Acrylamide. Materials and Methods: Male mice were divided into four groups (n=8): A is the control group and does not get any treatment, B is the sham group and only received drinking water. C group received Acrylamide 10 mg/kg. D group received Acrylamide 15 mg/kg+1.5 mg/kg of Icariin. Histological changes in testis and prostate were examined using stereological methods. Results: Results showed decreases in testis weight of the group treated by (p≤0.01) and the group cured by Acrylamide +Icariin group (p≤0.05). The total volume of testis showed a reduction in the Acrylamide  group compared to other groups (p≤0.05). The total number of spermatogonia and spermatocyte cells in the Acrylamide group showed a decrease in comparison with the other groups (p≤0.05). The total number of spermatid cells in the Acrylamide group indicated a significant reduction in comparison with the control and sham group (p≤0.05). The total number of sertoli cells in the Acrylamide group showed a reduction when the number of leydig cells in the Acrylamide group showed a significant decrease in comparison with the control, sham, and Acrylamide+Icariin groups (p≤0.05). The mean Johnsen score was decreased in the Acrylamide treated group compared to control, sham, and Acrylamide+Icariin groups (p≤0.05). Testosterone concentration in the Acrylamide group showed a reduction in comparison with control, sham, and Acrylamide+Icariin groups (p≤0.05). Conclusion: Results demonstrated that Acrylamide altered the structure of the testis, prostate gland, and spermatogenesis stage, and Icariin treatment improved these histopathological changes.


2015 ◽  
Vol 55 (3) ◽  
pp. 164
Author(s):  
Fathy Pohan ◽  
Aryono Hendarto ◽  
Irawan Mangunatmadja ◽  
Hartono Gunardi

Background Long-term anticonvulsant therapy, especially with enzyme inducers, has been associated with low 25-hydroxyvitamin D [25(OH)D] levels and high prevalence of vitamin D deficiency. However, there have been inconsistent results in studies on the effect of long-term, non-enzyme inducer anticonvulsant use on vitamin D levels.Objective To compare 25(OH)D levels in epileptic children on long-term anticonvulsant therapy and non-epileptic children. We also assessed for factors potentially associated with vitamin D deficiency/insufficiency in epileptic children.Methods This cross-sectional study was conducted at two pediatric neurology outpatient clinics in Jakarta, from March to June 2013. Subjects in the case group were epileptic children, aged 6-11 years who had used valproic acid, carbamazepine, phenobarbital, phenytoin, or oxcarbazepine, as a single or combination therapy, for at least 1 year. Control subjects were non-epileptic, had not consumed anticonvulsants, and were matched for age and gender to the case group. All subjects’ 25(OH)D levels were measured by enzyme immunoassay.Results There were 31 epileptic children and 31 non-epileptic control children. Their mean age was 9.1 (SD 1.8) years. Most subjects in the case group were treated with valproic acid (25/31), administered as a monotherapy (21/31). The mean duration of anticonvulsant consumption was 41.9 (SD 20) months. The mean 25(OH)D level of the epileptic group was 41.1 (SD 16) ng/mL, lower than the control group with a mean difference of 9.7 (95%CI 1.6 to 17.9) ng/mL. No vitamin D deficiency was found in this study. The prevalence of vitamin D insufficiency in the epileptic group was higher than in the control group (12/31 vs. 4/31; P=0.020). No identified risk factors were associated with low 25(OH)D levels in epileptic children.Conclusion Vitamin D levels in epileptic children with long-term anticonvulsant therapy are lower than that of non-epileptic children, but none had vitamin D deficiency.


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