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Krämer G. Antiepileptikainduzierte Sehstörungen*. AKTUELLE NEUROLOGIE 2000. [DOI: 10.1055/s-2007-1017579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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77
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Schmidt D, Gram L, Brodie M, Krämer G, Perucca E, Kälviäinen R, Elger CE. Tiagabine in the treatment of epilepsy--a clinical review with a guide for the prescribing physician. Epilepsy Res 2000; 41:245-51. [PMID: 10962215 DOI: 10.1016/s0920-1211(00)00149-2] [Citation(s) in RCA: 186] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Tiagabine is currently recommended mainly as add-on therapy in adults and children above 12 years with partial epilepsy not satisfactorily controlled with other antiepileptic drugs. Based on available evidence and our clinical experience, tiagabine should be used preferably in patients sharing one or more of the following additional features, (i) a history of drug-induced cutaneous adverse events; (ii) mild to moderate epilepsy allowing for a slow titration and gradual onset of anticonvulsant action over a few weeks; (iii) patients for whom it is particularly important to avoid a deterioration in cognitive performance; and, (iv) patients who failed to respond to previous treatment with sodium channel blocker agents as they may particularly benefit from the introduction of tiagabine, due to its GABAergic mechanism of action. Tiagabine can also be used successfully in other patients with refractory partial epilepsy. Tiagabine is not indicated for patients with generalized or unclassified epilepsies and for patients with severely impaired liver function.
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Abstract
This study aimed to evaluate the use of ictal EEG recordings combined with simultaneous surface EMG in the diagnosis and analysis of motor events, both epileptic and nonepileptic. All ictal registrations were performed utilizing radio/cable telemetry. Routine recordings consisted of 18-channel EEG plus 8-channels bipolar surface EMG in freely moving patients. Combined ictal EEG-EMG recordings in freely moving patients enabled us to identify and define the following pathomechanisms of epileptic drop seizures, epileptic axial spasms, atonic, myoclonic-atonic, and akinetic seizures. Precise differentiation could be made between tonic and nontonic postural seizures and between startle-induced reflex seizures and hyperekplexia. The findings from telemetered ictal recordings in freely moving patients with combined EEG and surface EMG offer the only means of identifying, defining, and differentiating motor events, both epileptic and nonepileptic, of a short duration that cannot be properly differentiated by clinical examination alone.
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Ried S, Hilfiker P, Mothersill IW, Krämer G. From clinical observation to long-term monitoring: diagnostic developments in conservative epileptology. Epilepsia 2000; 41 Suppl 3:S2-9. [PMID: 11001330 DOI: 10.1111/j.1528-1157.2000.tb01528.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The diagnostic goals in nonsurgical (conservative) epileptology differ from presurgical diagnostic aims. The resulting development of diagnostic methods in a tertiary-level epilepsy center is shown and the major technical and organizational consequences of this difference for diagnostic long-term monitoring (LTM) as opposed to presurgical LTM are investigated. A total of 133 consecutive daytime LTM investigations using radio telemetry were reviewed and seizure parameters such as type, duration, method of seizure detection, and need of mobility were evaluated and compared to presurgical LTM. Compared to presurgical LTM, partial seizures were relatively rare (17.8%) and short epileptic or nonepileptic motor events lasting <1 s, such as myoclonic, atonic, short tonic seizures, spasms, tics, or startle reactions, are frequent (34.9%). Of all seizures, 23% had no or minor ictal EEG changes, subtle symptomatology without signaling by a patient or accompanying person, and could be detected only by continuous online surveillance by an experienced EEG technician. Due to the nature of the patient population in diagnostic LTM, there is an increased need for ictal and interictal mobility (radio telemetry). LTM in conservative epileptology requires more intense human surveillance for seizure detection and increased patient mobility compared to presurgical LTM.
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Stefan H, Fröscher W, Krämer G, Schmidt D. [Drug therapy before and after surgery for epilepsy. Critical review and recommendations]. DER NERVENARZT 2000; 71:451-8. [PMID: 10919139 DOI: 10.1007/s001150050606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As a result of a critical review of the literature and a survey at German epilepsy centers of usual pre- and postoperative drug treatment, the following strategy is recommended: 1. Patients under consideration for surgery should be referred to specialists. Experience has shown that surgery is reasonable for only about a third of all patients with refractory epilepsies. The patient should first have been treated for at least 3 years with at least two first-line drugs in monotherapy and subsequent combined therapy. This applies only to medial temporal lobe epilepsies with very good postoperative prognoses. All other surgically removable epilepsy syndromes with less positive prognosis should be treated with additional antiepileptic drugs before any surgery. 2. There is no exception to the continuation of drug treatment after epilepsy surgery. If the patient remains free of seizures for at least 2 years, discontinuing the drug treatment can be discussed, just as with patients who are free of seizures due to drug treatment alone. In general, the less successful the operative therapy, the longer and more intensive the drug treatment.
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81
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Krämer G, Reichmann H. Neuromuskuläre Erkrankungen und Führerschein. AKTUELLE NEUROLOGIE 2000. [DOI: 10.1055/s-2007-1017547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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82
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Krämer G, Deuschl G. Parkinson und Führerschein: Neue Begutachtungs-Leitlinien. AKTUELLE NEUROLOGIE 2000. [DOI: 10.1055/s-2007-1017540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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83
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Dannhardt G, Kiefer W, Krämer G, Maehrlein S, Nowe U, Fiebich B. The pyrrole moiety as a template for COX-1/COX-2 inhibitors. Eur J Med Chem 2000; 35:499-510. [PMID: 10889329 DOI: 10.1016/s0223-5234(00)00150-1] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aroyl- and thiophene-substituted pyrrole derivatives have been synthesized as a new class of COX-1/COX-2 inhibitors. The inhibition of COX-1 was evaluated in a biological system using bovine PMNLs as the enzyme source, whereas LPS-stimulated human monocytes served as the enzyme source for inducible COX-2. The determination of the concentration of arachidonic acid metabolites was performed by HPLC for COX-1 and RIA for COX-2. Variation of the substitution pattern led to a series of active compounds which showed inhibition for COX-1 and COX-2. Structural requirements for the development of COX-1/COX-2 inhibitors are discussed.
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84
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Krämer G, Widder B. Zerebrale Durchblutungsstörungen und Führerschein. AKTUELLE NEUROLOGIE 2000. [DOI: 10.1055/s-2007-1017528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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85
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Krämer G. Epilepsie und Führerschein: Neue Begutachtungs-Leitlinien. AKTUELLE NEUROLOGIE 2000. [DOI: 10.1055/s-2007-1017526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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86
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Trenité DG, Binnie CD, Harding GF, Wilkins A, Covanis T, Eeg-Olofsson O, Goosens L, Henriksen O, Krämer G, Leyten F, Da Silva FH, Da Silva AM, Naquet R, Pedersen B, Ricci S, Rubboli G, Spekreijse H, Waltz S. Medical technology assessment photic stimulation--standardization of screening methods. Neurophysiol Clin 1999; 29:318-24. [PMID: 10546250 DOI: 10.1016/s0987-7053(99)90045-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
RATIONALE In many EEG laboratories in Europe, intermittent photic stimulation (IPS) is not performed routinely, and consequently, great variation exists in the type of photo stimulator used, the methodology employed, and the interpretation of the EEG curves, thus leading to different outcomes. METHODOLOGY It was decided to hold a consensus meeting with experts in the field of photic stimulation from various European countries. This meeting was held at the Stichting Epilepsie Instellingen Nederland, Heemstede, the Netherlands. The consensus reached was presented and discussed at the 9th European Congress of Clinical Neurophysiology in Ljubjana in June 1998. RESULTS Patients should be positioned at a distance of 30 cm from the photic stimulator (nasion to lamp) with dim surrounding lights, just enough to see the patient. Flashes should be delivered in separate trains of 10 s for each frequency, with intervals of 7 s minimum. First stimulation occurs with eyes open followed after 5 s by eye closure, while starting at 1 Hz progressing to 20 Hz, unless generalised epileptiform discharges are evoked at a lower frequency. Then, frequencies should start at 60 Hz decreasing to 25 Hz. The following frequencies should be used: 1, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 60, 50, 40, 30 and 25 Hz. The total duration is a maximum of 6 min (patients without a reaction to IPS). In interpreting the evoked responses, a clear distinction should be made between epileptiform responses confined to the occipital area (OSW), starting occipitally and spreading to frontal regions (OGSW), or generalised from the start (GSW). Other responses include generalised spikes (OR). CONCLUSION This standard is safe, relatively quick, simple and reliable. Comparison of data within patients and between patients of various laboratories will also be possible. This will improve the quality of the care of the individual patient and make collaborative research possible.
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König SA, Elger CE, Vasella F, Schmidt D, Bergmann A, Boenigk HE, Despland PA, Genton P, Krämer G, Löscher W, Mayer T, Nau H, Schneble H, Siemes H, Stefan H, Wolf P. Empfehlungen zu Blutuntersuchungen und der klinischen Überwachung zur FrÜherkennung des Valproat-assoziierten Leberversagens. Monatsschr Kinderheilkd 1999. [DOI: 10.1007/s001120050487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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88
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Wad N, Bourgeois B, Krämer G. Serum protein binding of desmethyl-methsuximide. Clin Neuropharmacol 1999; 22:239-40. [PMID: 10442255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Serum protein binding of desmethyl-methsuximide (DM-MSM) in serum from 23 patients on polytherapy were determined using ultrafiltration and high-performance liquid chromatography. Desmethyl-methsuximide, The active metabolite of methsuximide (MSM), was found to have a moderate protein binding ranging between 45% and 60%.
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Krämer G. Krankheit und Führerschein: Sind Neurologen und andere Fachärzte für die Begutachtung in Deutschland nicht mehr kompetent? AKTUELLE NEUROLOGIE 1999. [DOI: 10.1055/s-2007-1017615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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90
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Zahner B, Stefan H, Blankenhorn V, Krämer G, Richens A, Thümler R, Mumford JP. Once-daily versus twice-daily vigabatrin: is there a difference? The results of a double-blind pilot study. Epilepsia 1999; 40:311-5. [PMID: 10080511 DOI: 10.1111/j.1528-1157.1999.tb00710.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Vigabatrin (VGB) has been approved in Europe and is prescribed for either once or twice-daily administration. This choice has been based on the pharmacodynamic activity of VGB. The purpose of this study was to compare the efficacy and tolerability of these two different medication regimens. METHODS The study design was a double-blind randomized two-period cross-over study in adults who had responded to add-on VGB for previously uncontrolled seizures. Each study period consisted of three months. Patients were maintained on the same daily dose of VGB to which they had demonstrated a clinical response. In addition to the primary efficacy criteria of seizure frequency on the two treatment regimens, this study included blinded ratings of overall efficacy and "well being" by both physician and patient. The primary tolerability criterion was the reported incidence of adverse events by phase. RESULTS Fifty patients were initially entered into the study, and 13 patients withdrew before completion, only one reported as due to an adverse event. There was no statistical difference in seizure frequency or the tolerability of the medication. Blinded physician and patient rating scales for seizure control, and patient well being showed a nonstatistical trend toward once-daily administration as compared with twice-daily administration. CONCLUSIONS This clinical study provides support for the pharmacological evidence that this preparation may be administered on a once or twice daily basis, depending on the individual patient's preference, total dosage and co-medication.
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Barnstedt J, Kappelmann N, Appenzeller I, Fromm A, Gölz M, Grewing M, Gringel W, Haas C, Hopfensitz W, Krämer G, Krautter J, Lindenberger A, Mandel H, Widmann H. The ORFEUS II Echelle Spectrometer:
Instrument description, performance and data reduction. ACTA ACUST UNITED AC 1999. [DOI: 10.1051/aas:1999156] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Fröscher W, Krämer G, Schmidt D, Stefan H. [Serum concentration of anticonvulsants. Practical guidelines for measuring and useful interpretation. Therapy Committee of the German Section of the International Epilepsy League]. DER NERVENARZT 1999; 70:172-7. [PMID: 10098154 DOI: 10.1007/s001150050419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The clinical relevance of being informed on the serum concentration of antiepileptic drugs has been judged very differently during the last decades. Therefore the Commission on the treatment of epilepsy (German section of the International League against Epilepsy) had the task to outline the importance of therapeutic monitoring of anticonvulsant serum concentrations. The possibility of determining the serum concentration of anticonvulsants induced the elaboration of "therapeutic drug level ranges". The usefulness of determining serum concentrations of antiepileptic drugs in clinical management of patients with epilepsy depends decisively on the following questions: Can the efficacy of antiepileptic drug treatment be increased by serum concentration monitoring? Can the rate of adverse effects of antiepileptic drugs be reduced by serum concentration monitoring? Clinical experience suggests numerous indications of therapeutic drug monitoring, scientific studies however, supporting these empirical guidelines are not available. Therefore, therapeutic drug monitoring may be restricted for some special situations which have to be justified in every single case. Tailored determinations with specific purposes are e.g.: resistance to therapy, including suspected irregular intake; suspected intoxication, particularly during combined therapy; the possibility of significant changes in the dosage-serum concentration relationship (interactions with other drugs, unusual pharmacokinetics in childhood, in pregnancy etc.).
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93
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Krämer G, Bourgeois BFD. Die neuen Antiepileptika. AKTUELLE NEUROLOGIE 1998. [DOI: 10.1055/s-2007-1017710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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94
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König SA, Elger CE, Vassella F, Schmidt D, Bergmann A, Boenigk HE, Despland PA, Genton P, Krämer G, Löscher W, Mayer T, Nau H, Schneble H, Siemes H, Stefan H, Wolf P. [Recommendations for blood studies and clinical monitoring in early detection of valproate-associated liver failure. Results of a consensus conferences 9 May - 11 May 1997 in Berlin]. DER NERVENARZT 1998; 69:835-40. [PMID: 9834471 DOI: 10.1007/s001150050351] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Valproate is a frequently used antiepileptic drug. It is associated with rare but serious adverse effects like liver failure. The first symptom is impairment of the patient's well being. Isolated changes of standard laboratory liver parameters are not reliable early indicators. Thus, according to the knowledge of today, prophylactic blood screening cannot predict complications. On the contrary, clinical symptoms are the most relevant indicators of impending complications, eventually supported by laboratory findings. An abrupt withdrawal of valproate and administering carnitin in parallel can interrupt the otherwise fatal course of the complication and induce a subsequent recovery. At a Consensus Conference the current knowledge about early detection and therapy of the valproate-induced serious hepatotoxicity was discussed. The results regarding recommended laboratory screening, as well as diagnostic and therapeutic strategies are reported.
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95
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Dorn T, Krämer G. Genetik der Epilepsien. AKTUELLE NEUROLOGIE 1998. [DOI: 10.1055/s-2007-1017684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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96
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Buck A, Frey LD, Bläuenstein P, Krämer G, Siegel A, Weber B, Schubiger PA, Wieser HG. Monoamine oxidase B single-photon emission tomography with [123I]Ro 43-0463: imaging in volunteers and patients with temporal lobe epilepsy. EUROPEAN JOURNAL OF NUCLEAR MEDICINE 1998; 25:464-70. [PMID: 9575241 DOI: 10.1007/s002590050245] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Imaging of monoamine oxidase of subtype B (MAO B) is of interest in various neurological diseases. In the past non-invasive assessment of MAO B has only been possible with positron emission tomography (PET) ligands. Given the limited availability of PET, a single-photon emission tomography (SPET) ligand would be desirable. In this study SPET imaging with the new MAO B inhibitor [123I]Ro 43-0463 was performed in five volunteers and nine patients with temporal lobe epilepsy (TLE). In two volunteers a second study was performed 12 h following blockade with deprenyl. In the TLE patients the tracer was administered as bolus (n = 4) or as prolonged infusion (n = 5). The regional uptake pattern correlated well with the known distribution of MAO B. In the two blocking studies ligand uptake was substantially reduced compared with baseline. In the TLE patients increased uptake was found in the ipsilateral mesial temporal lobe and, surprisingly, in the ipsilateral putamen. This study indicates the potential of the new SPET ligand [123I]Ro 43-0463 to map MAO B concentration in the human brain. The new finding of increased MAO B in the putamen of TLE patients needs further studies to elucidate its exact pathophysiology.
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Dillmann U, Heide G, Krämer G, Hopf HC, Schimrigk K. Evoked isometric muscle contractions in myopathies: analysis of pathophysiological properties by different stimulus patterns. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1998; 109:63-9. [PMID: 11003065 DOI: 10.1016/s0924-980x(97)00059-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Isometric twitches of the adductor pollicis muscle following ulnar nerve stimulation were investigated in healthy subjects (n = 35) and patients with different types of myopathies (myotonic dystrophy, n = 19; limb girdle muscular dystrophy, n = 10; metabolic myopathy, n = 6). The changes within the rising part (i.e. within the contraction time, CT) of the isometric twitches after single stimuli were similar in myotonic and limb girdle dystrophies: the first part of CT, which lasts until the maximal contraction rate is achieved, was shortened, whereas the following second part of CT, which lasts until the maximal twitch force is achieved, was normal. In metabolic myopathies the first part was normal, whereas the second part was prolonged. The relaxation was prolonged in all types of myopathies, particularly in metabolic myopathies. Using double stimuli with short interstimulus intervals (ISI), the absolute refractory period of the muscle contraction (healthy subjects: 1.35 +/- 0.16 ms) was shortened in patients with myotonic dystrophy (1.02 +/- 0.11 ms). In the other types of myopathies, the absolute refractory period was only shortened provided that the single twitch force was clearly reduced. A similar dependence on a reduced single twitch force was also found with regard to the maximal force development with two stimuli and the corresponding ISI: the force contributed by a second stimulus was pathologically enhanced if the single twitch force was clearly reduced. The ISI related to the maximal force with two stimuli was shifted towards very short values (healthy subjects: 10.5 ms, myotonic dystrophy: 4.6 ms, limb girdle dystrophies: 5.0 ms). Our results can be attributed to altered kinetics of calcium release and uptake by the sarcoplasmic reticulum in myopathies.
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98
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Wad N, Krämer G. Sensitive high-performance liquid chromatographic method with fluorometric detection for the simultaneous determination of gabapentin and vigabatrin in serum and urine. JOURNAL OF CHROMATOGRAPHY. B, BIOMEDICAL SCIENCES AND APPLICATIONS 1998; 705:154-8. [PMID: 9498684 DOI: 10.1016/s0378-4347(97)00521-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Serum concentrations of the antiepileptic drug gabapentin (GBP) are usually determined by high-performance liquid chromatography (HPLC) using UV photometric detection after pre-column derivatization with 2,4,6-trinitrobenzenesulphonic acid. Vigabatrin levels in serum are determined by HPLC using fluorescence detection. Like vigabatrin (VGB), gabapentin has also a primary amine group that easily reacts with o-phthaldialdehyde reagent and produces a fluorescing substance. By the use of fluorometric detection, GBP can be determined more simply, sensitively and simultaneously with VGB. The day-to-day coefficient of variation for the determination of GBP in a pooled serum was 4.0% (n=17; serum concentration, 13.8 micromol/l) and forVGB was 3.1% (n=21; serum concentration, 26.4 micromol/l). The lower limit of detection is 0.5 micromol/l for both drugs and the method is linear up to 500 micromol/l for GBP and 1300 micromol/l for VGB.
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Krämer G. [Characteristics of pharmacotherapy of epilepsy in the elderly]. PRAXIS 1997; 86:1418-1423. [PMID: 9381039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Parallel to the steady increase of the percentage of elderly people, treatment of epilepsy in the elderly is becoming more common. The pharmacotherapy of epilepsy in the elderly differs in some aspects from treatment in younger patients. In general, due to pharmacokinetic and pharmacodynamic changes with reduction of metabolism and elimination, dose reductions are suitable to avoid drug intoxications. A standard treatment rule is to "start low and go slow". As the prognosis is favourable in the majority of patients the choice of a drug is influenced not only by its efficacy but also by possible side effects.
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100
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Wad N, Guenat C, Krämer G. Carbamazepine: detection of another metabolite in serum, 9 hydroxymethyl-10-carbamoyl acridan. Ther Drug Monit 1997; 19:314-7. [PMID: 9200773 DOI: 10.1097/00007691-199706000-00012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In this article, the authors discuss 9-hydroxymethyl-10-carbamoyl acridan (9-OH-CBZ), another metabolite of carbamazepine (CBZ) found in serum. The retention time of unconjugated 9-OH-CBZ should be known when using a chromatographic method, because it appears in concentrations varying from one eighth to one third of the CBZ-10,11-epoxide (CBZ-E) concentration and may therefore cause analytical interactions. Liquid chromatography/electrospray mass spectrometry ((LC/ES-MS) in a serum extract identified and confirmed 9-OH-CBZ. The amount of 9-OH-CBZ present as conjugate in serum was between 42% and 65%. The correlation factor values (r) between serum concentrations of 9-OH-CBZ and 10,11-dihydro-10,11-trans-dihydroxy-CBZ (trans-CBZ-diol), CBZ-E, and CBZ in 100 serum samples were 0.77, 0.80, and 0.53, respectively. The origin of 9-OH-CBZ is discussed.
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