31 research outputs found

    Safety of switching from brand-name to generic levetiracetam in patients with epilepsy

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    Magdalena Bosak, Agnieszka SĹ‚owik, Wojciech Turaj Department of Neurology, Jagiellonian University Medical College, Kraków, Poland Purpose: The approach to the use of generic antiepileptic drugs has recently evolved from major concern to general acceptance, but the evidence related specifically to the safety of switching from brand-name to generic levetiracetam (LEV) is scarce. The aim of the study was to assess the risk of increased frequency of seizures or other adverse events after replacement of a brand-name LEV with a generic one.Patients and methods: This retrospective analysis included 159 patients treated with LEV in a tertiary outpatient epilepsy clinic. We included all patients diagnosed with epilepsy who were treated with LEV as at March 1, 2013. Most patients were forced to switch to the generic LEV because of the sudden rise in cost of the branded LEV. We recorded data on age, sex, age at onset of epilepsy, type of epilepsy, and its treatment. We analyzed data from one visit before potential switching and from two visits after the potential switching. The interval between visits was typically 3 months. We registered an increase in the frequency of seizures and in the occurrence of adverse events.Results: Among 151 subjects who switched to generic LEV after March 1, 2013, increased frequency of seizures was noted in 9 patients (6%) during the first follow-up visit. Patients with increased frequency of seizures did not differ from other patients regarding sex, age, age at the onset of epilepsy, and the median dose of LEV before switching or the median duration of treatment with LEV before switching. Two patients returned to brand-name LEV. Adverse events were noted in six other patients (4%) and included somnolence, irritability, or dizziness.Conclusion: Switching from brand-name to generic LEV is generally safe. Keywords: levetiracetam, generic, branded, epilepsy, switching, adverse event&nbsp

    Menstrual disorders and their determinants among women with epilepsy

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    Magdalena Bosak, Agnieszka SĹ‚owik, Wojciech Turaj Department of Neurology, Jagiellonian University Medical College, Krakow, Poland Introduction: The purpose of the present study was to assess the prevalence and determinants of menstrual cycle disorders among women with epilepsy. Materials and methods: The study included consecutive women with epilepsy who visited a university epilepsy clinic. A number of variables, including demographics, characteristics of epilepsy and its treatment, and data related to reproductive health (regularity of menstrual cycle, number of pregnancies and childbirths), were collected from medical records, seizure diaries, and a dedicated questionnaire. Results: The study involved 271 women with epilepsy. Focal epilepsy was diagnosed in 182 (67.2%) patients; 108 (39.8%) women had rare seizures (<1 per year), and 164 patients (60.5%) were on monotherapy. Menstrual abnormalities were found in 78 patients (28.8%). Independent variables associated with irregular cycle included younger age at onset of epilepsy (OR=0.95 per 1-year increase; P=0.008), current use of clonazepam (OR=5.36; P=0.010), and chronic use of medication(s) other than antiepileptic drug(s) (AEDs; OR=2.48; P=0.003). Childbirth rate was low in our cohort (0.50 per patient); independent predictors of being childless in studied patients included younger age, presence of menstrual disorders, and greater number of currently used AEDs. Conclusion: Menstrual disturbances were present in 28.8% of studied women with epilepsy. Increased prevalence of menstrual abnormalities was associated with epilepsy itself (younger age at onset of epilepsy) and its treatment (ongoing use of clonazepam), as well as with chronic use of medications other than AEDs. Keywords: menstrual disorders, medications, side effect, women, reproductive healt

    Forgotten coast, forgotten people: sustainable development and disproportionate impacts from Hurricane Michael in Gulf County, Florida

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    A central challenge for sustainable development is how societies are to avoid, minimize or address impacts from anthropogenic climate change. However, competing perspectives on “what should be sustained” lead to widely different understandings of what mitigation, adaptation and loss and damage entail and how best to approach them. We provide a novel conceptual and empirical comparison of two contrasting sustainable development-based approaches to the study of impacts from climate-related extreme events: Capital Theory and capability-based Human Development. We use our analysis of immediate residential property value and housing capacity impacts caused by Hurricane Michael in Gulf County, Florida, to demonstrate how the sustainable development theory used to assess and interpret impacts greatly affects the identification of whom and where is objectively “most impacted.” Through a comparison of the two approaches, we identify relative advantages and disadvantages, emphasizing that while both provide coherent, comprehensive, and integrative approaches to climate-related impact assessment, the capability approach is much less likely to lead researchers and practitioners to overlook the most disadvantaged communities when compared to Capital Theory

    Forgotten coast, forgotten people: sustainable development and disproportionate impacts from Hurricane Michael in Gulf County, Florida

    Get PDF
    A central challenge for sustainable development is how societies are to avoid, minimize or address impacts from anthropogenic climate change. However, competing perspectives on “what should be sustained” lead to widely different understandings of what mitigation, adaptation and loss and damage entail and how best to approach them. We provide a novel conceptual and empirical comparison of two contrasting sustainable development-based approaches to the study of impacts from climate-related extreme events: Capital Theory and capability-based Human Development. We use our analysis of immediate residential property value and housing capacity impacts caused by Hurricane Michael in Gulf County, Florida, to demonstrate how the sustainable development theory used to assess and interpret impacts greatly affects the identification of whom and where is objectively “most impacted.” Through a comparison of the two approaches, we identify relative advantages and disadvantages, emphasizing that while both provide coherent, comprehensive, and integrative approaches to climate-related impact assessment, the capability approach is much less likely to lead researchers and practitioners to overlook the most disadvantaged communities when compared to Capital Theory

    Depressogenic medications and other risk factors for depression among Polish patients with epilepsy

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    Magdalena Bosak,1 Wojciech Turaj,1 Dominika Dudek,2 Marcin Siwek,2 Andrzej Szczudlik1 1Department of Neurology, 2Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland Purpose: The aim of this study was to assess the prevalence of depression among patients with epilepsy and to establish the risk factors of depression in that group, with special focus on the use of potentially depressogenic medications. Patients and methods: We studied 289 consecutive patients who visited epilepsy outpatient clinic (University Hospital of Krakow) and met inclusion criteria. All patients were screened with Beck Depression Inventory (BDI), and those with BDI score ≥12 were further evaluated by a psychiatrist. Results: Mean age of patients was 35.7 years, and mean duration of epilepsy was 14.7 years. Idiopathic generalized epilepsy was diagnosed in 63 patients (21.8%), focal epilepsy was found in 189 subjects (65.4%), and unclassified epilepsy was diagnosed in 37 patients (12.8%). Frequent seizures (>1 per month) were reported in 107 patients (37.0%). Thirty-five patients (12.1%) reported an ongoing treatment with one or more of the predefined potentially depressogenic medication (ß-blockers, combined estrogen and progestogen, corticosteroid, or flunarizine). In a group of 115 patients (39.8%) who scored ≥12 points in BDI, depression was finally diagnosed in 84 subjects (29.1%) after psychiatric evaluation. Only 20 of those patients (23.8%) were treated with antidepressant. Independent variables associated with the diagnosis of depression in the logistic regression model included frequent seizures (odds ratio [OR] =2.43 [95% confidence interval, 95% CI =1.38–4.29], P=0.002), use of potentially depression-inducing medications (OR =3.33 [95% CI =1.50–7.39], P=0.003), age (OR =1.03 [95% CI =1.01–1.05] per year], P=0.005), and use of oxcarbazepine (OR =2.26 [95% CI =1.04–4.9], P=0.038). Conclusion: The prevalence of depression among consecutive Polish patients with epilepsy reached 29.1%. Less than quarter of them received antidepressant treatment at the moment of evaluation. Independent variables associated with depression included age, frequent seizures, and the use of oxcarbazepine or predefined depressogenic medications. Keywords: epilepsy, depression, medication, seizures, risk factors, side effect

    Forgotten coast, forgotten people: sustainable development and disproportionate impacts from Hurricane Michael in Gulf County, Florida

    No full text
    A central challenge for sustainable development is how societies are to avoid, minimize or address impacts from anthropogenic climate change. However, competing perspectives on “what should be sustained” lead to widely different understandings of what mitigation, adaptation and loss and damage entail and how best to approach them. We provide a novel conceptual and empirical comparison of two contrasting sustainable development-based approaches to the study of impacts from climate-related extreme events: Capital Theory and capability-based Human Development. We use our analysis of immediate residential property value and housing capacity impacts caused by Hurricane Michael in Gulf County, Florida, to demonstrate how the sustainable development theory used to assess and interpret impacts greatly affects the identification of whom and where is objectively “most impacted.” Through a comparison of the two approaches, we identify relative advantages and disadvantages, emphasizing that while both provide coherent, comprehensive, and integrative approaches to climate-related impact assessment, the capability approach is much less likely to lead researchers and practitioners to overlook the most disadvantaged communities when compared to Capital Theory

    ADHD prescription patterns and medication adherence in children and adolescents during the COVID-19 pandemic in an urban academic setting

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    Abstract Background COVID-19 impacted all students, especially those with attention deficit hyperactivity disorder (ADHD), putting them at risk for disruption to their medication regimen and school performance. Our study aimed to identify if ADHD medication regimens were disrupted through analyzing prescription refills and if telehealth management demonstrated a higher rate of adherence. Methods A total of 396 patients from the General Academic Pediatrics (GAP) clinic at Children’s Hospital of The King’s Daughters (CHKD) were included in the study. Patients were between the ages of 8–18 with a history of ADHD for three or more years that was medically managed with four or more prescription refills between January 2019 and May 2022. A retrospective chart review collected age, sex, race, refill schedule, appointment schedule, and number of telehealth appointments. Data analysis compared the variables and defined “pre-pandemic months” as January 2019 through March 2020 and “pandemic months” as April 2020 through June 2022. Results The total percentage of patients who had their ADHD medications during pre-pandemic months ranged from 40 to 66% versus 31–44% during pandemic months. Additionally, the total percentage of patients who had quarterly ADHD management appointments during pre-pandemic months ranged between 59 and 70% versus 33–50% during pandemic months. The number of months with ADHD prescription refills over the last three years was significantly higher among those who had both virtual and in-person visits than those who had just in-person visits, p < 0.001. Regarding race, Black patients had a lower number of medication refills compared to White patients when controlled for appointment type. They also had a lower number of total appointments, but there was not a significant difference in the number of virtual appointments. Conclusions Since the start of the pandemic, ADHD patients have both refilled their prescriptions and returned to clinic less frequently. This data suggests a need to re-evaluate the ADHD symptoms of GAP patients periodically and return them to a more consistent medication regimen. Telehealth appointments are a potential solution to increase adherence. However, racial inequities found in this study need to be addressed
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