Use of risperidone in children with epilepsy

Objective. Although the atypical antipsychotic medications appear to be safe in patients with epilepsy, few studies have specifically addressed the use of risperidone in children with seizures. The objective of this study was to evaluate behavior improvement and seizure outcome in children with epilepsy and behavioral disorders (self-injurious, aggressive, or destructive behavior) after introduction of risperidone. Methods. In this prospective study, 54 patients were evaluated, 38 boys and 16 girls, aged 2-18 (mean = 10). The dose of risperidone ranged from 0.01 to 0.14 mg/kg/day (mean = 0.038 mg/kg/day). Risperidone was introduced gradually. The titration rate was determined by clinical response. The data were collected from patients' follow-up visits and clinical files. Exacerbation of seizures was established as an increase in seizure frequency after introduction of risperidone, with return to baseline seizure frequency after risperidone withdrawal. Results. Seizure frequency was not affected by risperidone in 51 patients (94.5%). Only two (4%) patients experienced seizure exacerbation after the introduction of risperidone. In one patient, the effect of risperidone on seizure control could not be established. After introduction of the risperidone, 38 (70.4%) patients manifested improvement in behavior. Conclusion. Our data suggest that risperidone can be used in pediatric patients with epilepsy and that seizure outcome is not changed in most children with epilepsy and psychiatric comorbidity. In addition, behavior improvement is usually achieved in most patients. (C) 2007 Elsevier Inc. All rights, reserved.10341241

Dolichoectasia—an evolving arterial disease

Dolichoectasia is an arterial disease that causes dilatation and/or tortuosity of the affected vessel. The prevalence of dolichoectasia increases with age, and this disease is also associated with other traditional cardiovascular risk factors. Multiple pathophysiological processes might lead to the development of dolichoectatic vessels, and activation of metalloproteinases and irregular turbulent blood flow seem to cause irreversible disruption of the internal elastic lamina. Intracranial dolichoectasia commonly presents with ischemic or hemorrhagic stroke, and/or cranial neuropathies. The posterior circulation is more frequently affected by the dolichoectatic process than the anterior circulation. A positive diagnosis of dolichoectasia requires visual assessment of vessel shape and, if the posterior circulation is affected, application of Smoker's criteria. Reproducible criteria that aid diagnosis of dolichoectasia in the anterior circulation are lacking. No specific treatment for dolichoectasia exists, and the surgical and medical therapies that have been used to treat this condition have not been systematically evaluated. More evidence is needed to better understand the underlying dilatatory artheriopathy that causes this disease, and to determine whether patients with dolichoectasia might benefit from early diagnosis. In this article, we provide a comprehensive review of current knowledge regarding dolichoectasia, and highlight gaps in our knowledge to aid future research