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Hwang JK, Lipner SR. Blue Nail Discoloration: Literature Review and Diagnostic Algorithms. Am J Clin Dermatol 2023; 24:419-441. [PMID: 36971947 DOI: 10.1007/s40257-023-00768-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
Blue nail discoloration is a distinctive clinical presentation, and diagnosis is challenging given the broad differential diagnosis. A comprehensive review of the literature describing blue discoloration of one or multiple nails was performed using the PubMed, Embase, Scopus, and Web of Science databases. A total of 245 publications were included and grouped based on involvement of a single nail (monodactylic) or multiple nails (polydactylic). Monodactylic blue discoloration was associated with tumors or benign nevi, most commonly glomus tumors, followed by blue nevi and less commonly melanomas. Polydactylic blue discoloration was frequently associated with medications (such as minocycline, zidovudine, and hydroxyurea), toxic and exogenous exposures (such as silver), and other medical conditions (such as HIV/AIDS and systemic lupus erythematous). Patients presenting with blue nail discoloration warrant a thorough history, physical examination, and workup to rule out malignancy, systemic disease, or toxic exposure. We present diagnostic algorithms for monodactylic and polydactylic blue nail discoloration to guide workup and treatment plans.
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Andres E, Kerling F, Hamer H, Kasper B, Winterholler M. Behavioural changes in patients with intellectual disability treated with perampanel. Acta Neurol Scand 2017; 136:645-653. [PMID: 28568478 DOI: 10.1111/ane.12781] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this cross-sectional retrospective study was to assess the tolerability and efficacy of perampanel in patients with drug-resistant epilepsy who also suffered from intellectual disability (ID). PATIENTS AND METHODS We used an industry-independent, non-interventional retrospective evaluation based on standardized, daily seizure records. Twenty-seven patients with ID and drug-resistant epilepsy were started on perampanel between September 2012 and November 2015 after a 3-month observation period without perampanel treatment. Perampanel was given at a maximum dosage of 4-12 mg daily. Evaluation was carried out after 6, 12 and 24 months, including calculation of the retention rate. Mean seizure frequency was compared between the 3-month baseline period and subsequent 3-month treatment periods. The Clinical Global Impression scale was applied to assess qualitative changes in seizure severity, and the Aggressive Behaviour Scale (ABS) gave further insights into challenging behaviour. RESULTS Perampanel was efficacious and well tolerated in five of 25 patients. In 18 patients, perampanel treatment was stopped, mainly because of adverse events (n=6), lack of efficacy (n=3) or both (n=9). Behavioural changes were documented in 15 of 27 patients, with aggressive behaviour being the commonest effect; we observed ataxia (n=6) and sedation (n=8) in further patients. The ABS showed worsening of aggressive behaviour in six patients. CONCLUSIONS Perampanel was well tolerated and efficacious in one-fifth of our patients. We observed challenging behaviour, ataxia and sedation in a relevant number of patients with ID under perampanel treatment. Further studies are warranted to explore the tolerability of perampanel in patients with ID.
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Affiliation(s)
- E. Andres
- Department of Neurology and Epilepsy Center; Sana-Krankenhaus Rummelsberg (teaching hospital of the Friedrich-Alexander-Universität Erlangen-Nürnberg, FAU); Schwarzenbruck Germany
| | - F. Kerling
- Department of Neurology and Epilepsy Center; Sana-Krankenhaus Rummelsberg (teaching hospital of the Friedrich-Alexander-Universität Erlangen-Nürnberg, FAU); Schwarzenbruck Germany
| | - H. Hamer
- Department of Neurology; Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU); Erlangen Germany
| | - B. Kasper
- Department of Neurology; Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU); Erlangen Germany
| | - M. Winterholler
- Department of Neurology and Epilepsy Center; Sana-Krankenhaus Rummelsberg (teaching hospital of the Friedrich-Alexander-Universität Erlangen-Nürnberg, FAU); Schwarzenbruck Germany
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Huber B, Schmid G. A two-year retrospective evaluation of perampanel in patients with highly drug-resistant epilepsy and cognitive impairment. Epilepsy Behav 2017; 66:74-79. [PMID: 28038390 DOI: 10.1016/j.yebeh.2016.10.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE The objective of this work was to review systematically the efficacy and tolerability of perampanel (PER) in residential patients of an epilepsy center. METHOD We adopted an industry-independent noninterventional retrospective evaluation on the basis of the paper and electronic records complemented by personal information on the part of the treating neurologists. All patients (N=26, 15 females, mean age: 30, range 21-55years) started on PER from its introduction to the market in September 2012 until December 15th 2013 were included. Evaluation was carried out after 6, 12, and 24months of PER treatment. Changes in seizure frequency were calculated as the number of seizures during three months on PER compared to a three-month baseline period. The Clinical Global Impression Scale served as an instrument to record changes in seizure intensity beyond numerical values. Adverse effects were documented by means of the Liverpool Adverse Events Profile. RESULTS Most patients had structural or metabolic epilepsy, 2 patients suffered from Lennox-Gastaut syndrome, 2 from other symptomatic generalized epilepsy. All patients had grade III drug-resistant epilepsy. All patients had additional cognitive deficits of different degree. The retention rates were 61.5% after 6months, 46.2% after 12months, and 42.3% after 24months. The responder rates were 11.5% after 6months, 23.1% after 12months, and 7.7% after 24months. Partial responders (positive CGI and/or seizure reduction <50%) included, the respective values were 26.9%, 38.5%, and 23.1%. Only 1 patient was seizure free at 12months (but not at 24months). A loss of efficacy in the second year of treatment was suspected but the decrease of the responder rate could also be ascribed to a number of different circumstances. Adverse effects in the psychiatric field like irritability, aggression, increased sensitivity, and suicidal ideation/behavior occurred in 50% of the patients. They were the main reason to discontinue PER. CONCLUSIONS After one year of treatment PER showed reasonable efficacy in a particularly difficult-to-treat population. Psychiatric adverse effects forced discontinuation in many cases.
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Affiliation(s)
- Bernd Huber
- VBS Bethel, Ebenezerweg 18, 33617 Bielefeld, Germany.
| | - Gaby Schmid
- VBS Bethel, Ebenezerweg 18, 33617 Bielefeld, Germany.
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Nass RD, Kurth C, Kull A, Graf W, Kasper B, Hamer HM, Strzelczyk A, Elger CE, Steinhoff BJ, Surges R, Rosenow F. Adjunctive retigabine in refractory focal epilepsy: Postmarketing experience at four tertiary epilepsy care centers in Germany. Epilepsy Behav 2016; 56:54-8. [PMID: 26828693 DOI: 10.1016/j.yebeh.2015.12.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/24/2015] [Accepted: 12/25/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE Retigabine (RTG, ezogabine) is the first potassium channel-opening anticonvulsant drug approved for adjunctive treatment of focal epilepsies. We report on the postmarketing clinical efficacy, adverse events, and retention rates of RTG in adult patients with refractory focal epilepsy. METHODS Clinical features before and during RTG treatment were retrospectively collected from patients treated at four German epilepsy centers in 2011 and 2012. RESULTS A total of 195 patients were included. Daily RTG doses ranged from 100 to 1500 mg. Retigabine reduced seizure frequency or severity for 24.6% and led to seizure-freedom in 2.1% of the patients but had no apparent effect in 43.1% of the patients. Seizure aggravation occurred in 14.9%. The one-, two-, and three-year retention rates amounted to 32.6%, 7.2%, and 5.7%, respectively. Adverse events were reported by 76% of the patients and were mostly CNS-related. Blue discolorations were noted in three long-term responders. Three possible SUDEP cases occurred during the observation period, equalling an incidence rate of about 20 per 1000 patient years. CONCLUSIONS Our results are similar to other pivotal trials with respect to the long-term, open-label extensions and recent postmarketing studies. Despite the limitations of the retrospective design, our observational study suggests that RTG leads to good seizure control in a small number of patients with treatment-refractory seizures. However, because of the rather high percentage of patients who experienced significant adverse events, we consider RTG as a drug of reserve.
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Affiliation(s)
- R D Nass
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.
| | - C Kurth
- Epilepsiezentrum Kork, Kehl, Kork, Germany
| | - A Kull
- Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - W Graf
- Department of Neurology, University of Erlangen-Nuremberg, Germany
| | - B Kasper
- Department of Neurology, University of Erlangen-Nuremberg, Germany
| | - H M Hamer
- Department of Neurology, University of Erlangen-Nuremberg, Germany
| | - A Strzelczyk
- Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany; Epilepsy Center Frankfurt Rhine-Main, Goethe-University, Frankfurt am Main, Germany
| | - C E Elger
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - R Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - F Rosenow
- Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany; Epilepsy Center Frankfurt Rhine-Main, Goethe-University, Frankfurt am Main, Germany
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Elsas SM. A model on how to obtain data from botanical practitioners. Epilepsy Behav 2015; 52:333-7. [PMID: 26276416 DOI: 10.1016/j.yebeh.2015.07.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/03/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This paper addresses the challenge on how to obtain information from practitioners with experience in using medicinal plants. BACKGROUND Collecting information on medicinal uses of plants is very challenging; since botanical remedies are used within the context of multiple differing medical systems, practitioners differ in training from Western physicians and scientists, and active ingredients of botanicals vary with preparation method, growth, and harvest conditions. DESIGN/METHODS A model on how useful data on safety and efficacy can be obtained from botanical practitioners is presented, based on methods developed by the association of anthroposophic physicians in Europe, a system of integrative medicine which includes the use of botanicals and is practiced mostly by medical doctors. RESULTS Decades of experience by hundreds of practitioners are summarized and made accessible in a manual, which alphabetically lists the most commonly used botanicals and describes the most successful therapeutic experiences which could be confirmed by several of the contributing practitioners. CONCLUSIONS/RELEVANCE This approach of continuous, multilingual systematic collection of successful therapeutic experiences within a community of practitioners with similar goals and a common therapeutic framework can be used not only for the training of successful future botanical practitioners, but also for helping to identify promising botanicals for scientific research and to further their development, and could support their official registration with governing bodies in countries of their use. This article is part of a Special Issue entitled "Botanicals for Epilepsy".
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Affiliation(s)
- Siegward M Elsas
- Neurology and Research, Klinik Arlesheim, 4144 Arlesheim, Switzerland; Institute of Integrative Medicine, Chair for Theory of Medicine, Integrative and Anthroposophic Medicine, Witten/Herdecke University, 58313 Herdecke, Germany.
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Abstract
This article lays the background for, and discusses the practical issues surrounding, the adjunctive use of the last four antiepileptic drugs (AEDs) to be licensed for the treatment of pharmacoresistant focal seizures in the UK and elsewhere. More than 30% of adolescent and adult patients will not be fully controlled on the currently available therapeutic armamentarium. After not responding to their first three AED schedules, only a handful of patients attained seizure freedom on subsequent regimens. To optimise the response to any new AED in this setting, it is often necessary to reduce the existing drug burden. The pharmacology, tolerability and safety, and everyday use of lacosamide, eslicarbazepine acetate, retigabine (ezogabine) and perampanel will be reviewed and discussed. This will be accompanied by data from prospective audits with each drug undertaken at the Western Infirmary in Glasgow, Scotland, and a report of their successful introduction in an illustrative case. Overall, there is a large variation in the course of refractory epilepsy and the effect of AED therapy on this process seems minimal. Nevertheless, a number of patients will benefit from the introduction of each new AED, with some becoming seizure-free.
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Affiliation(s)
- Martin J Brodie
- Epilepsy Unit, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, Scotland, UK.
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Beacher NG, Brodie MJ, Goodall C. A case report: retigabine induced oral mucosal dyspigmentation of the hard palate. BMC Oral Health 2015; 15:122. [PMID: 26452759 PMCID: PMC4600339 DOI: 10.1186/s12903-015-0102-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/05/2015] [Indexed: 02/03/2023] Open
Abstract
Background Dyspigmentation of the oral mucosa has a multitude of aetiological causes. Retigabine, a new antiepileptic drug, has the potential side effect of inducing a blue/purple pigmentation of the oral mucosa in addition to the skin, lips, nails and retina of the eyes. This article presents a unique case of dyspigmentation present in the oral mucosa of the hard palate which has previously been unreported in the dental literature. Case presentation A 70 year old white male presented to a secondary care oral surgery department with an unusual asymptomatic pigmented lesion present in the hard palate of the oral cavity. The pigmentation was remarkable for its distinct blue/purple colouration which was associated with a similar discolouration of the nail beds of the hands. This is believed to be a side effect of the anti-epileptic medication retigabine. Conclusion The dental profession and wider healthcare community should be made fully aware of the potential side effect of oral dyspigmentation associated with the novel anti-epileptic medication retigabine. Enhanced knowledge of the causative role of retigabine in dyspigementation of the oral mucosa will allow the practitioner to make an appropriate diagnosis. As far the authors are aware this is reaction is unreported in the dental literature and should be disseminated to the wider oral health professional’s community.
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Affiliation(s)
- Nicholas G Beacher
- Special Care Dentistry, University of Glasgow Dental School, School of Medicine, College of Medical, Veterinary & Life Sciences, 378, Sauchiehall Street, Glasgow, G2 3JZ, UK.
| | - Martin J Brodie
- Medicine and Clinical Pharmacology, Western Infirmary, Epilepsy Unit, Western Infirmary, Glasgow, UK.
| | - Christine Goodall
- Oral Surgery and Sedation. University of Glasgow Dental School, School of Medicine, College of Medical, Veterinary & Life Sciences, Glasgow, UK.
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