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  • 1
    Electronic Resource
    Electronic Resource
    Lack of relationship between sodium valproate-induced adverse effects and the plasma concentration of its metabolite 2-propylpenten-4-oic acid (1987)
    Springer
    European journal of clinical pharmacology 32 (1987), S. 219-222 
    Details
    ISSN: 1432-1041
    Keywords: sodium valproate ; adverse effects ; anti-convulsants ; drug interaction ; hyperammonia ; metabolites ; epilepsy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The concentrations of valproic acid (VPA) and of its metabolites 3-oxo-VPA and 4-en-VPA were measured in the plasma of 12 selected epileptic patients 1,2,3, and 4 h after administration of a loading dose of VPA. Four of the patients, all on polytherapy, had had short-term adverse effects during chronic VPA treatment, and in them there has been abnormal NH3-values after a test doese of VPA. Eight patients (4 on monotherapy and 4 on polytherapy) had been free from adverse effects. No significant difference in the VPA, 3-oxo-VPA and 4-en-VPA concentrations was found between the three groups of patients. Accumulation of 4-en-VPA is not involved in the short-term adverse effects and hyperammonaemia induced by VPA.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00542201
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Adjunctive lamotrigine therapy in patients with refractory seizures: a lifetime cost–utility analysis (1998)
    Springer
    European journal of clinical pharmacology 53 (1998), S. 421-427 
    Details
    ISSN: 1432-1041
    Keywords: Key words Lamotrigine ; Refractory epilepsy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objective: Lamotrigine as add-on treatment (500 mg per day) is effective in patients with refractory epilepsy, but its high cost requires a pharmacoeconomic analysis. We conducted a retrospective lifetime cost–utility study in which clinical data were derived from a recent placebo-controlled clinical trial, cost-of-illness data were drawn from a previous ad-hoc study, and quality-of-life values were obtained by prospectively interviewing a separate group of 81 patients referred to our institution with epilepsy. Results: Our analysis showed that chronic lamotrigine treatment implies an incremental lifetime cost of about $1 600 000 for every 100 patients. Incremental lifetime utility was around 40 quality-adjusted life-years (QALYs) for every 100 patients. On the basis of these data, adjunctive lamotrigine was estimated to cost approximately $41 000 per QALY gained. Sensitivity testing suggested a range of $25 000–$85 000 per QALY gained. Conclusion: Adjunctive lamotrigine (500 mg per day) in refractory epilepsy seems to have a worse pharmacoeconomic profile than many pharmacological treatments commonly used in areas other than epilepsy. Further data are needed to determine if lamotrigine can be equally effective at lower (and less costly) daily doses which could markedly improve its pharmacoeconomic characteristics.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002280050402
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Motor imagery in a locked-in patient: evidence from transcranial magnetic stimulation (1999)
    Springer
    Italian journal of neurological sciences 20 (1999), S. 37-41 
    Details
    ISSN: 1126-5442
    Keywords: Key words Imagery ; Locked-in syndrome ; Transcranial magnetic stimulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Motor evoked potentials (MEPs) to transcranial magnetic stimulation were evaluated in a case of locked-in syndrome due to a large pontine infarction. In this patient, magnetic resonance imaging (MRI) and somatosensory evoked potentials demonstrated a tegmental involvement. One month after the attack, no MEP could be recorded from the right abductor digiti minimi (ADM) or either tibialis anterior muscle. On the contrary, MEPs were obtained from the left ADM, although with a prolonged latency and a reduced amplitude. When the patient was requested to think about the abduction of her paralyzed left little finger, the latency and the elicitability of these responses improved as compared with the relaxed condition. These severe MEP alterations correctly predicted a poor recovery of motor function in the chronic stage. However, although the tegmental involvement raises the question of an insufficient cortical motor arousal, preserved motor imagery suggested a normal cortical motor area activation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100720050008
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  • 4
    Electronic Resource
    Electronic Resource
    Valproate-induced hyperammonaemia in two epileptic identical twins (1985)
    Springer
    Journal of neurology 232 (1985), S. 167-168 
    Details
    ISSN: 1432-1459
    Keywords: Valproic acid ; Hyperammonaemia ; Adverse effects ; Identical twins
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The cases of two epileptic identical twins are described, one of whom had presented an episode of valproate (VPA)-induced stupor associated with very high blood ammonia (NH3) concentrations. Both twins showed a similar marked increase of venous NH3 concentrations after the administration of a single loading dose of VPA (800 mg).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00313894
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  • 5
    Electronic Resource
    Electronic Resource
    Clinical application of the Mullen and Foster method for individualizing phenytoin dosage (1984)
    Springer
    Neurological sciences 5 (1984), S. 195-200 
    Details
    ISSN: 1590-3478
    Keywords: Anticonvulsants ; phenytoin ; pharmacokinetics ; Michaelis-Menten kinetics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Sommario Il metodo di Mullen e Foster è stato applicato al fine di individualizzare la posologia della fenitoina in 24 pazienti epilettici. Le caratteristiche di precisione ed affidabilità del metodo sono state valutate confrontando le concentrazioni plasmatiche previste con quelle misurate sperimentalmente. La differenza percentuale tra valori e misurati della concentrazione plasmatica di fenitoina è risultata inferiore al 15 per cento in 22 casi su 35 (63 per cento), compresa tra il 15 e il 25 per cento in 8 casi su 35 (23 per cento), superiore al 25 per cento in 6 casi su 35 (17 per cento).
    Notes: Abstract The Mullen and Foster method was prospectively applied for individualizing phenytoin dosage in 24 epileptic patients. Accuracy and reliability of the method were assessed by comparing predicted and measured values of plasma phenytoin steady-state concentration. The absolute difference between predicted and measured phenytoin levels was less than 15 percent in 22 of 35 cases (63 percent), between 15 and 25 percent in 8 of 35 cases (23 percent) and more than 25 percent in 6 of 35 cases (17 percent).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02043223
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  • 6
    Electronic Resource
    Electronic Resource
    A new method for analyzing smooth-pursuit eye movements (1991)
    Springer
    Neurological sciences 12 (1991), S. 537-544 
    Details
    ISSN: 1590-3478
    Keywords: Eye movements ; oculography ; smooth ; pursuit eye movements
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Sommario L'utilizzo di procedure di analisi computerizzate per lo studio dei movimenti oculari consente di rilevare fini alterazioni patologiche in una ampia gamma di malattie neurologiche. Descriviamo un nuovo metodo di analisi dei movimenti oculari di inseguimento lento. Il segnale, rilevato da ambedue gli occhi con tecnica elettrooculografica, è amplificato da due amplificatori in DC e, dopo un filtraggio analogico a 50 Hz, viene campionato a 250 Hz e digitalizzato. Il movimento di inseguimento lento è elicitato da una mira luminosa che si muove a velocità costante (da 5 a 100 gradi/sec) da un estremo all'altro della barra per 20 volte. L'analisi dei dati, eseguita automaticamente dal calcolatore, è basata sul calcolo di quattro parametri: velocità picco dell'occhio durante il movimento di inseguimento lento (APEV); velocità tipica del target (TTV); indice di matching percentuale della mira dopo la rimozione dei saccadi (PTMI); velocità tipica di matching della mira dopo rimozione dei saccadi (TMTV). L'APEV è costituito dal valore medio della velocità di inseguimento lento dell'occhio quando quest'ultima ha raggiunto il massimo in ciascuna delle varie velocità della mira. Il TTV è definito come il valore della velocità del target in cui il guadagno percentuale dell'APEV è diminuito a circa un terzo rispetto al massimo guadagno percentuale. Questo valore fornisce un indice complessivo che esprime la rapidità con cui il guadagno percentuale dell'APEV diminuisce con l'aumentare della velocità del target. Il PTMI è un parametro che descrive invece la performance globale del movimento di inseguimento lento dell'occhio per ciascuna velocità del target. TMTV rappresenta infine la velocità del target in cui PTMI è diminuita a circa il 37% e costituisce un indice complessivo della rapidità con cui PTMI diminuisce con l'aumentare la velocità di target. Questo tipo di parametrizzazione dei movimenti di inseguimento lento è stata studiata in 28 volontari sani ed in un paziente affetto da una malattia neurologica (demenza di Alzheimer). I risultati indicano che questo metodo di analisi fornisce informazioni che possono essere utili in campo clinico.
    Notes: Abstract The study of ocular movements has been increasingly used to detect subtle pathological modifications, caused by a wide variety of neurological diseases. We have developed a new microcomputer-based method for the analysis of smoothpursuit ocular movements induced by constant velocity targets moving unpredictably at different velocities (including velocity values as high as 100 deg/s). The ocular movements are recorded by an electro-oculographic technique using silversilver chloride electrodes fixed near the inner and outer canthi of both eyes. The signals are amplified by two DC amplifiers after a low-pass filtering (50Hz), sampled at 250 Hz and digitized in a 12-bit form by an analog/digital converter. For each patient's evaluation, a series of 20 sweeps of the target is generated. The data analysis, which is performed automatically by the microcomputer, is based one the calculation of four parameters: average peak eye velocity (APEV); typical target velocity (TTV); percent target matching index after saccade removal (PTMI); typical matching target velocity (TMTV) after saccade removal. APEV is calculated as the average of the peak velocities estimated from the 20 sweeps. The purpose of TTV, which is defined as the value of target velocity at which the percent gain has decreased to slightly more than one third of the maximum percent gain, is to provide an overall index of the rate at which the percent gain decreases as the target velocity increases. PTMI describes the eye performance for each value of target velocity. TMTV, which represents the target velocity at which the PTMI has decreased to approximately 37%, is an overall index of the rate at which the PTMI decreases as the target velocity increases. This parametrization of smooth pursuit has been tested in 28 healthy volunteers and in one patient with a neurological disease. Our results indicate that our method can provide a reliable and quantitative parametrization of smooth pursuit.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02336949
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    Paper (German National Licenses)
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  • 7
    Electronic Resource
    Electronic Resource
    Human heart rate variability and sleep stages (1996)
    Springer
    Neurological sciences 17 (1996), S. 437-439 
    Details
    ISSN: 1590-3478
    Keywords: Heart rate variability (HRV) ; Sleep scoring ; Autonomic nervous system (ANS) ; Spectral analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Sommario Allo scopo di comprendere meglio le modificazioni del tono del sistema nervoso autonomo durante la notte, è stata valutata la variabilità del ritmo cardiaco (HRV) negli stadi del sonno, impiegando una metodica autoregressiva di analisi spettrale. Ciascuna registrazione consisteva di elettroencefalogramma, elettro-oculogramma, elettromiografia, spirometria ed elettrocardiogramma, campionati e registrati in forma digitale. L'ipnogramma è stato ottenuto ispettivamente, mentre l'analisi dell'HRV è stata eseguita con un software dedicato, utilizzando l'algoritmo di Burg e calcolando il rapporto LF/HF (LF: 0.04–0.12 Hz; HF: 0.15–0.35 Hz) per ciascuno stadio del sonno. Sono stati arruolati nello studio 7 soggetti sani (4 maschi, età media 35 anni). I nostri risultati mostrano una progressiva e significativa diminuzione di LF/HF dallo stadio 1 al 4, imputabile ad un aumento del tono del parasimpatico (aumento della componente HF), mentre il valore del rapporto durante veglia, REM e fase 1 è risultato simile (circa 1).
    Notes: Abstract With the aim of better understanding the dynamic changes in sympatho-vagal tone occurring during the night, human heart rate variability (HRV) during the various sleep stages was evaluated by means of autoregressive spectral analysis. Each recording consisted of an electroencephalogram, an electrooculogram, and electromyogram, an electrocardiogram, and a spirometry trace. All of the data were sampled and stored in digital form. Sleep was analysed visually, but HRV was analysed off-line by means of original software using Burg's algorithm to calculate the LF/HF ratio (LF: 0.04–0.12 Hz; HF: 0.15–0.35 Hz) for each sleep stage. Seven healthy subjects (four males; mean age 35 years) were enrolled in the study. Our findings show a progressive and significant reduction in the LF/HF ratio through sleep stages S1–S4, as a result of an increase in the HF component; this indicates the prevalence of parasympathetic activity during slow-wave sleep. During wakefulness, S1 and REM, the LF/HF values were similar and close to 1.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01997720
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