Clinical considerations in transitioning patients with epilepsy from clonazepam to clobazam: a case series.

IntroductionIn treating refractory epilepsy, many clinicians are interested in methods used to transition patients receiving clonazepam to clobazam to maintain or increase seizure control, improve tolerability of patients' overall drug therapy regimens, and to enhance quality of life for patients and their families. However, no published guidelines assist clinicians in successfully accomplishing this change safely.Case presentationsThe following three case reports provide insight into the transition from clonazepam to clobazam. First, an 8-year-old Caucasian boy with cryptogenic Lennox-Gastaut syndrome beginning at 3.5 years of age, who was experiencing multiple daily generalized tonic-clonic, absence, myoclonic, and tonic seizures at presentation. Second, a 25-year-old, left-handed, White Hispanic man with moderate mental retardation and medically refractory seizures that he began experiencing at 1 year of age, secondary to tuberous sclerosis. When first presented to an epilepsy center, he had been receiving levetiracetam, valproate, and clonazepam, but reported having ongoing and frequent seizures. Third, a 69-year-old Korean woman who had been healthy until she had a stroke in 2009 with subsequent right hemiparesis; as a result, she became less physically and socially active, and had her first convulsive seizure approximately 4 months after the stroke.ConclusionsFrom these cases, we observe that a rough estimate of final clobazam dosage for each mg of clonazepam under substitution is likely to be at least 10-fold, probably closer to 15-fold for many patients, and as high as 20-fold for a few. Consideration and discussion of the pharmacokinetic, pharmacologic, and clinical properties of 1,4- and 1,5-benzodiazepine action provide a rationale on why and how these transitions were successful

University-Community Engagement and Public Relations Education: A Replication and Extension of Service-Learning Assessment in the Public Relations Campaigns Course

This study replicated and extended Werder and Strand’s 2011 research by framing service-learning within the larger context of a university’s overall community engagement strategy and by including alumni within the survey population.  The findings supported a general service-learning assessment instrument measuring students’ perceptions of their development of key public relations skills, along with citizenship and social responsibility mindsets, as a result of their participation in community-based projects in a public relations capstone course. While the results, overall, were consistent with Werder and Strand's study, there were notable differences. For example, this study found that there were no statistically significant difference in means— by gender, time, and client type—for most variables. However, alumni who had worked for businesses in a town designated as an official community engagement partner had higher mean scores on three items: community involvement, strategic planning skills, and ability to work with others.  The findings contribute to the collective understanding of community engagement, public relations education and practice, and the lasting impact of service-learning on students post-graduation. Whether service-learning values such as citizenship and social responsibility "stick" after graduation is a key consideration for any profession, but especially for public relations

Inconsistent Divergence of Mitochondrial-DNA in the Spontaneously Hypertensive Rat

We have recently shown that the spontaneously hypertensive rat (SHR) and the Wistar-Kyoto (WKY) rat differ at a frequency of 1 per 62 bases in their nuclear DNA (Hypertension 1992;19:425-427). Given the origin of these strains this level of divergence was unexpected. To investigate the origin of this nuclear divergence we have examined mitochondrial DNA. Mitochondrial DNA was isolated from SHR and WKY rats, digested with several restriction enzymes, electrophoresed in 1.0% agarose gels, and the fragments visualized with ethidium bromide staining. This approach allowed us to analyze 220 base pairs of mitochondrial DNA. No differences were detected between SHR and WKY rats. Comparison with the King-Holtzman rat strain produced differences at an average of 1 per 52 base pairs. We also examined several SHR and WKY rats from within our colonies and found no differences suggesting intrastrain homogeneity for mitochondrial DNA phenotypes. These data indicate that the SHR and WKY rat share a recent, common maternal ancestor. This result is consistent with the published origins of the SHR and WKY rat strains. Together with the nuclear divergence results, the data suggest that the original Wistar colony from which SHR and WKY rats were derived was probably highly polymorphic for nuclear genes

Fred and Steve Hellman and Roger Redoing Interview

Transcript of an oral history interview with Fred and Steve Hellman and Roger Redoing by Debbie Perry and Delores Roe on their experiences during the Vietnam War in May of 1998

Handbook for Aboriginal Alcohol and Drug Work

The Handbook for Aboriginal Alcohol and Drug Work is a practical tool written for Aboriginal drug and alcohol workers, mental health workers and others working in this field. It offers a detailed look at alcohol and drug work from clinical, through to prevention, early intervention and harm reduction. This handbook is also likely to help people working to improve policy and those advocating for change. The idea for it came from workers all over Australia. They told us that they needed an easy to use handbook that can help them respond to the range of alcohol and drug issues they face every day. They also told us that such a book needs to take into account the complex challenges facing workers when helping clients, their families and, sometimes, whole communities