Epilepsy Medication Proving Ineffective Over Time

Epilepsy Medication Proving Ineffective Over Time

A new critical review by Dr. Wolfgang Loscher and Dr. Dieter Schmidt shows that repeated administration of antiepileptic drug (AED) therapy has diminishing results in preventing seizures in epileptic patients. In clinical trials, the number of patients remaining seizure-free declines over time with prolonged treatment. This review explores how acquired tolerance, the adaptive response of the body to foreign substances, as opposed to innate tolerance (which occurs in patients naturally resistant to certain medications) is responsible for this diminishing effect.

Hannover, Germany (PRWEB) September 8, 2006

A new critical review by Dr. Wolfgang Loscher and Dr. Dieter Schmidt shows that repeated administration of antiepileptic drug (AED) therapy has diminishing results in preventing seizures in epileptic patients. In clinical trials, the number of patients remaining seizure-free declines over time with prolonged treatment. This review explores how acquired tolerance, the adaptive response of the body to foreign substances, as opposed to innate tolerance (which occurs in patients naturally resistant to certain medications) is responsible for this diminishing effect.

The risk of developing a tolerance to AEDs was traditionally thought to be small. Loscher and Schmidt, however, conclude that while AED tolerance is not a serious issue for most sufferers of epilepsy, it is a significant aspect of treatment in some patients. A few may even develop a cross-tolerance to similar medication. This “multi-drug resistance” is of serious concern to patients with medically intractable epilepsy.

The findings directly conflict with the treatment method many doctors are currently using. It is standard practice to increase AED dosage until adequate seizure control is obtained. However, this protocol presents a number of issues. The threat of medication tolerance is generally overlooked, as is the idea that epilepsy can be a progressive disease and does not develop at a fixed rate. Further, patients may acquire a tolerance to some effects of a particular drug, but not all.

Loscher and Schmidt have spent decades studying the effects of AEDs, however, Loscher believes that AED tolerance is a topic that has yet to be fully explored, and that more long-term clinical trials are becoming increasingly necessary. “Despite the convincing experimental evidence,” Loscher says, “tolerance to the effectiveness of AEDs seems to have been forgotten.”

Research is currently being done on the effects of placebo and conditional tolerance (a mental, conditioned-response effect that the mind has over the body). Doctors are also studying the effects of lower initial and target doses of AEDs. The possibility exists that many patients are being initially over medicated poses a significant challenge to doctors and scientists working toward effective seizure control.

This study is published in the current issue of Epilepsia. Media wishing to receive a PDF of this article please contact journalnews @ bos. blackwellpublishing. net

Dr. Wolfgang Loescher is Professor and Director of the Department of Pharmacology, Toxicology and Pharmacy at the University of Veterinary Medicine, Hannover as well as Head of the Centre for Systems Neuroscience in Hannover, Germany. He can be contacted at wolfgang. loescher @ tiho-hannover. edu

Epilepsia is published on behalf of The International League Against Epilepsy (www. ilae-epilepsy. org/ (http://www. ilae-epilepsy. org/)), the world’s preeminent association of physicians and other health professionals working towards a world where no person's life is limited by Epilepsy. Its mission is to provide the highest quality of care and well-being for those afflicted with the condition and other related seizure disorders.

Blackwell Publishing is the world’s leading society publisher, partnering with 665 academic and professional societies. Blackwell publishes over 800 journals and, to date has published more than 6,000 books, across a wide range of academic, medical, and professional subjects.

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Heart Aflutter? Remarkable New Images Show What it Looks Like in 4-D

Heart Aflutter? Remarkable New Images Show What it Looks Like in 4-D

Researchers at the University of Wisconsin School of Medicine and Public Health (SMPH) now have pictures that are better than anything that’s come before. With the new technology they’ve developed, the scientists produce remarkable images to measure how fast blood is flowing through various places in the heart and the major arteries around it.

Madison, WI (Vocus) March 8, 2010

What does the racing heart of someone in love—or on a fast treadmill—really look like?

Researchers at the University of Wisconsin School of Medicine and Public Health (SMPH) (http://www. med. wisc. edu/) now have pictures that are better than anything that’s come before. With the new technology they’ve developed, the scientists produce remarkable images to measure how fast blood is flowing through various places in the heart and the major arteries around it.

Physicians given a preview are wowed by what they see, according to Dr. Oliver Wieben (http://www. medphysics. wisc. edu/medphys_docs/people/wieben/), an SMPH medical physicist who has been working on the technology for several years, and Dr. Christopher Francois (http://findadoctor. uwhealth. org/findadoctor/Provider. action?_sourcePage=/results. jsp&id=8106), an SMPH radiologist specializing in heart imaging.

Even lay people can appreciate the revealing colorful pictures (http://www. med. wisc. edu/files/smph/docs/news_and_events/heart-images. pdf).

In the images, blood flowing through the heart is seen as a bundle of long threads or filaments, color-coded to indicate the speed of the flow at various locations in the heart. Blue threads represent the relatively slow flow that occurs throughout the heart when it is relaxed, while green threads indicate blood flowing faster during contraction.

In patients with heart problems making blood flow abnormally fast, the threads appear red or yellow. In addition to flow velocity at various spots, the images show the direction the blood is flowing and the effect of any obstructions or deviations on blood flow, such as in patients with Tetralogy of Fallot, the condition snowboarder Shaun White had repaired as a child.

A 10-minute session in an MRI scanner is all it takes. Patients don’t need to hold their breath, the procedure is completely non-invasive and requires no contrast agent or general anesthesia. Squirmy children may need sedation to keep them still.

Physicians have measured blood velocity with standard MRIs for about 20 years, but it hasn’t been optimal. To acquire the 20 to 30 slices that are usually needed to scan the entire heart with an MRI, it can take between 45 and 90 minutes. Since patients must not move during the procedure, younger patients often require general anesthesia, which isn’t always desirable, especially for children with heart problems.

Ultrasound is another common technique used to look at blood flow in the heart, but the chest bone and other anatomy can make it hard to see some portions of the heart and vessels surrounding it.

What’s more, ultrasound and MRI images are typically two-dimensional representations, at times 3-D. But the new technique supplies 4-D information—three spatial dimensions plus time as the fourth dimension.

The new technique is known as PC VIPR (Phase Contrast Vastly undersampled Isotropic Projection Reconstruction).

“In designing this, we threw out all the old rules of radiology and came up with a new way to acquire data that allows us to do the imaging much faster while still getting excellent quality,” Wieben says. “We’re also developing new ways to display the complex flow data on a 2D monitor.”

The Wisconsin scientists are excited about extending the technology to analyzing blood vessel walls as well. PC VIPR can be used to identify areas of weakening in the vessel wall or areas under increased stress, which can lead to aneurysms or build-up of damaging plaque.

The new technology will be particularly useful for adults and children with congenital heart disease, the most common birth defect.

“This is a new paradigm in cardiac imaging,” says Francois. “It will allow physicians to see things they haven’t seen before in all their complexity.”

The technology is still in the research stage, but it has been tested on hundreds of volunteers and patients. Wieben and Francois hope it will be available for use in hospitals in three or four years.

Contact:

Dian Land

(608) 261-1034

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