6 research outputs found
Intracranial mature teratoma in an adult patient: a case report
Introduction: Primary intracranial teratoma is a subtype of germ cell tumors, classified into three subtypes. They occur very rarely, with only several reported individual cases in adults. ----- Case Description: We present a patient with an intermittent headache in the right frontal region. Magnetic resonance imaging (MRI) revealed a right sided high frontal parasagittal mass that compressed the falx, the right lateral ventricle, as well as the brain parenchyma. Patient underwent surgical treatment. Histopathological analysis described mature teratoma. Four months after the surgical treatment there were no signs of residual intracranial mass or relapse. ----- Discussion: Primary intracranial teratoma in adults has a nonspecific clinical presentation. MRI reveals a solitary irregular mass with multilocularity and mixed signals derived from different tissues. The patients age, biochemical markers, and patohistological analysis are necessary to confirm the diagnosis. ----- Conclusion: Teratoma treatment strategy still remains controversial. It includes radical resection whenever possible. Since the residual portion of mature teratoma may contain part of immature or malignant tissue, tumor recurrence after surgical removal is possible. Also, new tumor mass could occur at other sites intracranial after the initial one was removed. Thus, although patients usually recover, they should be followed-up for a long period of time
Incidencija akutnih simptomatskih napadaja kod bolesnika s COVID-19: monocentriÄno istraživanje
The most common neurological symptoms in patients with SARS-CoV-2 infection
are headache, myalgia, encephalopathy, dizziness, dysgeusia and anosmia, making more than 90
percent of neurological manifestations of COVID-19. Other neurological manifestations such as
stroke, movement disorder symptoms or epileptic seizures are rare but rather devastating, with possible
lethal outcome. The primary aim of this study was to estimate the prevalence of acute symptomatic
seizures among COVID-19 patients, while secondary aim was to determine their possible etiology.
Out of 5382 patients with COVID-19 admitted to Dubrava University Hospital from November
1, 2020 until June 1, 2021, 38 (seizure rate 0.7%) of them had acute symptomatic seizures. Of these 38
patients, 29 (76.3%) had new-onset epileptic seizures and nine (23.7%) patients with previous epilepsy
history had breakthrough seizures during COVID-19. Although acute symptomatic seizures are
an infrequent complication of COVID-19, seizure risk must be considered in these patients, particularly
in the group of patients with a severe course of the disease. Accumulation of proinflammatory
cytokines may contribute to the occurrence of seizures in patients with COVID-19, but seizures may
also be secondary to primary brain pathology related to COVID-19, such as stroke or encephalitis.NajÄeÅ”Äi neuroloÅ”ki simptomi kod bolesnika s infekcijom SARS-CoV-2 su glavobolja, mialgija, encefalopatija, vrtoglavica,
disgeuzija i anosmija, a Äine viÅ”e od 90% neuroloÅ”kih manifestacija ove bolesti. Ostala neuroloÅ”ka zbivanja poput moždanog
udara, poremeÄaja pokreta ili epileptiÄkih napada nisu Äesta, ali su potencijalno teÅ”ke komplikacije s moguÄim smrtnim
ishodom. Primarni cilj ove studije bio je procijeniti uÄestalost akutnih simptomatskih napadaja kod bolesnika s COVID-19,
dok je sekundarni cilj bio utvrditi njihovu moguÄu etiologiju. Od ukupno 5382 bolesnika hospitaliziranih u KliniÄkoj bolnici
Dubrava od 1. studenoga 2020. godine do 1. lipnja 2021. njih 38 (0,7%) je imalo akutne simptomatske napadaje. Od tih
38 bolesnika 29 (76,3%) ih je imalo novonastale epileptiÄke napadaje bez ranije anamneze epilepsije, dok je njih 9 (23,7%)
imalo anamnezu dobro kontrolirane epilepsije uz pojavu epileptiÄkih napadaja tijekom bolesti COVID-19. Iako su akutni
simptomatski napadaji rijetka komplikacija bolesti COVID-19, treba razmiÅ”ljati o epileptiÄkim napadajima kod ovih bolesnika,
osobito kod onih s teŔkim oblikom bolesti. Nakupljanje proupalnih citokina može doprinijeti pojavi napadaja u bolesnika
s COVID-19, ali napadaji mogu takoÄer biti posljedica primarnog zbivanja na mozgu uslijed bolesti COVID-19,
poput moždanog udara ili encefalitisa
Antiepileptics and Drug Interactions
Antiepileptici (AEL) lijekovi su u kliniÄkoj primjeni dugi niz godina, a osim u lijeÄenju epilepsija, rabe se i u drugim stanjima poput migrene, neuropatske boli ili psihijatrijskih poremeÄaja, uglavnom kao kroniÄna terapija. Iako se njihova primjena preporuÄuje u obliku monoterapije, zbog karaktera bolesti Äesto se primjenjuju i kao politerapija. Rabe se u svim dobnim skupinama, a Äesto i u bolesnika s komorbiditetom, odnosno komedikacijom, Å”to znatno poveÄava moguÄnost interakcija s drugim lijekovima, a time i rizik od nuspojava. Stoga je, s obzirom na Å”iroku primjenu u kliniÄkoj praksi, osim o indikacijskom podruÄju i uÄinkovitosti, nužno voditi raÄuna i o njihovim interakcijama s drugim lijekovima.Antiepileptic drugs (AEDs) have been used in clinical practice for many years. They have also been used for the treatment of conditions other than epilepsy, such as migraine, neuropathic pain and psychiatric conditions, mostly as chronic therapy. Although AED monotherapy is recommended, the character of the disease often requires that AEDs be used as part of polytherapy. AEDs are used in all age groups, frequently in patients with comorbidities requiring co-medication, which significantly increases the possibility of drug interactions and the risk of side effects. Thus, given the widespread use in clinical practice, it is highly important to consider not only the range of indications and the efficacy of AEDs, but also their possible interactions with other drugs
Antiepileptics and Drug Interactions
Antiepileptici (AEL) lijekovi su u kliniÄkoj primjeni dugi niz godina, a osim u lijeÄenju epilepsija, rabe se i u drugim stanjima poput migrene, neuropatske boli ili psihijatrijskih poremeÄaja, uglavnom kao kroniÄna terapija. Iako se njihova primjena preporuÄuje u obliku monoterapije, zbog karaktera bolesti Äesto se primjenjuju i kao politerapija. Rabe se u svim dobnim skupinama, a Äesto i u bolesnika s komorbiditetom, odnosno komedikacijom, Å”to znatno poveÄava moguÄnost interakcija s drugim lijekovima, a time i rizik od nuspojava. Stoga je, s obzirom na Å”iroku primjenu u kliniÄkoj praksi, osim o indikacijskom podruÄju i uÄinkovitosti, nužno voditi raÄuna i o njihovim interakcijama s drugim lijekovima.Antiepileptic drugs (AEDs) have been used in clinical practice for many years. They have also been used for the treatment of conditions other than epilepsy, such as migraine, neuropathic pain and psychiatric conditions, mostly as chronic therapy. Although AED monotherapy is recommended, the character of the disease often requires that AEDs be used as part of polytherapy. AEDs are used in all age groups, frequently in patients with comorbidities requiring co-medication, which significantly increases the possibility of drug interactions and the risk of side effects. Thus, given the widespread use in clinical practice, it is highly important to consider not only the range of indications and the efficacy of AEDs, but also their possible interactions with other drugs
Smjernice za farmakoloÅ”ko lijeÄenje epilepsije
SAŽETAK
MeÄunarodne smjernice za farmakoloÅ”ko lijeÄenje epilepsija opÄenite su, sveobuhvatne i ne prepoznaju lokalne specifiÄnosti poput ekonomskih i tehniÄkih moguÄnosti u pojedinim državama, dostupnosti pojedinih antiepileptika ili drugih metoda lijeÄenja i sliÄno. Stoga se nameÄe potreba izrade nacionalnih smjernica, Äiji su zapravo temelj meÄunarodne smjernice Internacionalne lige protiv epilepsije. Hrvatske smjernice za farmakoloÅ”ko lijeÄenje epilepsija plod su suradnje svih relevantnih struÄnih druÅ”tava i referentnih centara u RH, na Äelu s Hrvatskom ligom protiv epilepsije te Hrvatskim neuroloÅ”kim druÅ”tvom i Hrvatskim druÅ”tvom za djeÄju neurologiju Hrvatskoga lijeÄniÄkog zbora, a odražavaju aktualne socioekonomske i regulatorne specifiÄnosti u naÅ”oj zemlji, najnovije spoznaje farmakoloÅ”kih profila i uÄinkovitosti pojedinih antiepileptika kao i ekspertna miÅ”ljenja. AntiepileptiÄka terapija se uvodi nakon postavljanja dijagnoze epilepsije, stoga profilaktiÄka primjena nije opravdana. Nakon postavljanja dijagnoze potrebno je bolesnika informirati o prognozi bolesti, moguÄnostima lijeÄenja i samopomoÄi, životnim ograniÄenjima te moguÄim neželjenim dogaÄajima. Ciljevi farmakoterapije epilepsija su potpuna kontrola napada uz izbjegavanje nuspojava te održavanje ili poboljÅ”anje kvalitete života. Zlatni standard lijeÄenja je monoterapija odnosno primjena adekvatnog antiepileptika u adekvatnoj dozi. Izbor i titracija lijeka su individualni, a temelje se na smjernicama za lijeÄenje pojedinih vrsta napada, karakteristikama bolesnika i regulatorno specifiÄnim Äimbenicima. Nakon neuspjeha inicijalne monoterapije, potrebna je reevalucija anamnestiÄkih i dijagnostiÄkih podataka te potom postupna i spora zamjena antiepileptika. Racionalna politerapija podrazumijeva kombinaciju dvaju antiepileptika razliÄitih mehanizama djelovanja, prvog ili eventualno drugog izbora za postavljenju dijagnozu, niskoga interakcijskog potencijala, razliÄitog profila nuspojava i sinergistiÄkog ili aditivnog djelovanja. Zamjena generiÄkih ili originalnog i generiÄkog oblika lijeka nije preporuÄljiva, a poglavito nakon postizanja remisije ili prilikom uzimanja visokih doza lijeka. Ukidanje antiepileptiÄke terapije treba biti postupno i sporo, u sluÄaju politerapije jedan po jedan lijek, a u donoÅ”enju odluke o ukidanju, kao i o uvoÄenju antiepileptika, mora biti ukljuÄen bolesnik i njegova obitelj
Bearing variant alleles at uridine glucuronosyltransferase polymorphisms UGT2B7 -161Cā>āT (rs7668258) or UGT1A4*3 c.142Ā Tā>āG (rs2011425) has no relevant consequences for lamotrigine troughs in adults with epilepsy
Purpose: To estimate whether epilepsy patients with variant UGT2B7 -161C > T (rs7668258) or UGT1A4*3 c.142 T > G (rs2011425) alleles differ from their wild-type (wt) peers in exposure to lamotrigine.
Methods: Consecutive adults on lamotrigine monotherapy or lamotrigine + valproate co-treatment undergoing routine therapeutic drug monitoring, otherwise generally healthy and free of interacting drugs, were genotyped for UGT2B7 -161C > T and UGT1A4*3 c.142 T > G. Heterozygous, variant homozygous, or combined heterozygous/variant homozygous subjects were compared to their wt controls for dose-adjusted lamotrigine troughs with adjustment for age, sex, body weight, rs7668258/rs2011425, polymorphisms of efflux transporter proteins ABCG2 c.421C > A (rs2231142) and ABCB1 1236C > T (rs1128503), and level of exposure to valproate using covariate entropy balancing.
Results: Of the 471 included patients, 328 (69.6%) were on monotherapy and 143 were co-treated with valproate. Dose-adjusted lamotrigine troughs in UGT2B7 -161C > T heterozygous (CT, n = 237) or variant homozygous (TT, n = 115) subjects were closely similar to those in their wt controls (CC, n = 119): geometric means ratios (GMRs) (frequentist and Bayes) 1.00 (95%CI 0.86-1.16) and 1.00 (95%CrI 0.83-1.22) for CT vs. CC; and 0.97 (0.81-1.17) and 0.97 (0.80-1.20) for TT vs. CC subjects. Lamotrigine troughs were also closely similar in UGT1A4*3 c.142 T > G variant carriers (n = 106: 102 TG + 4 GG subjects) and wt controls (TT, n = 365): GMR = 0.95 (0.81-1.12) frequentist, 0.96 (0.80-1.16) Bayes. GMRs for variant carriers vs. wt controls were around unity also at different levels of exposure to valproate.
Conclusion: Dose-adjusted lamotrigine troughs in epilepsy patients with variant UGT2B7 -161C > T or UGT1A4*3 c.142 T > G alleles are equivalent to those in their respective wt peers