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Background and object: The burden of neurological disorders in India is expected to increase due to the rapid demographic and epidemiological transition, with irrational drug use, which is also a global concern. Thus, drug utilization evaluation is designed to ensure appropriate medicine use within the healthcare settings. The aim of the study was to assess the rate and pattern of drug utilization in the management of neurological disorders. Materials and methods: A hospital-based cross-sectional drug utilization evaluation study on neurological drugs was carried out at the Department of Neurology over a span of six months. All legible prescriptions consisting neurological medications irrespective of patient's gender, aged ≥ 18 years were included for the study. The World Health Organization (WHO) core drug use indicators were used to assess the drug prescribing and utilization patterns. Results: A total of 310 prescriptions were reviewed, where male predominance was found to be 56.45%. Out of 310 prescriptions, drugs belonging to 26 neurological classes were prescribed for the management of various neurological disorders. The majority of patients were diagnosed with epilepsy and the most prescribed drugs per patient were phenytoin (14.8%) and valproic acid (6.45%). By following the WHO core drug prescribing indicators, 65.47% of drugs prescribed from the India National List of Essential Medicines, 2022, followed by 29.83% of drugs prescribed in generic name and 10.86% of prescriptions including injections. Conclusion: The study findings showed that the prescribing pattern in the Department of Neurology was in accordance with the WHO core prescribing indicators. But, the extent of polypharmacy prescriptions was very high. Therefore, interventions are very necessary to promote rational drug prescribing patterns and thus clinical pharmacists can contribute to assess and review the drug utilization pattern to optimize the drug therapy and improvement in patient safety. [ABSTRACT FROM AUTHOR]

Background: Out of 108 paediatric traumatic brain injuries admitted from January 2023 to December 2023, only 3 patients have early post traumatic seizures who had received phenytoin prophylaxis. Aim: To find out the prevalence of early post traumatic seizure in pediatric traumatic brain injuries despite phenytoin prophylaxis. Methods: In this prospective study all the paediatric traumatic brain injuries admitted to department of neurosurgery, Guntur medical college during 1st January 2023 to 31 st December 2023 are studied. Results: Among 108 patients admitted with traumatic brain injuries, only 3 patients have early post traumatic seizures who had received phenytoin prophylaxis. Conclusion: This is a study conducted at a district headquarter medical college level with radial population habitation and having highway proximity. Its having both urban and rural population in its catering area. Regular and multicentric studies will provide comprehensive and distinctive data about the usefulness of prophylactic phenytoin in prevention of early post traumatic seizures in traumatic brain injuries in this vast subcontinent of India. [ABSTRACT FROM AUTHOR]

Background Phenytoin is the most commonly used anti-epileptic drug (AED) in our set up due to its cost-effectiveness and easy availability. Significant fluctuations in serum phenytoin levels leading to toxicities or treatment failures make it an ideal candidate for therapeutic drug monitoring (TDM). Methods Patients of age =18 years who were put on phenytoin were enrolled in Data was analysed using SPSS version 20.0. Chi square test, Kruskal Wallis test were used to analyse the data. Relationship of serum phenytoin levels versus ADRs was analysed using Mann-Whitney test. Results A total of 105 patients enrolled in the study, twenty patients (19%) had normal or therapeutic serum phenytoin levels. Thirty-nine patients (37.2%) had sub therapeutic serum phenytoin levels, while forty-six patients (43.8%) had toxic serum phenytoin levels. A total of 91 ADRs of 20 different types were reported by 48 patients of the study population. The most common organ system involved was neurological (49.4%) followed by gastrointestinal (26.4%), Skin/Connective Tissue (19.8%) and Haematological (4.4%). ADRs were present in 5.13% of the patients with sub therapeutic levels of phenytoin against the 82.60% of the patients with toxic levels of phenytoin. ADRs were present in 40% of the patients with serum phenytoin levels in normal or therapeutic range. There was a statistically significant relationship between serum phenytoin levels and the proportion of ADRs (p<0.001). ADRs were most common in the age group of 21-40 years (53.6%) and least common in the age group of 61-80 years (33.3%). There was, however, no statistically significant relationship between age and ADRs (p=0.376). Conclusion The TDM of phenytoin should adopt a multi-disciplinary approach with active involvement of neuro-physicians, pharmacologists, pharmacists and other technical staff for improving the overall management of epilepsy. TDM data will provide the clinicians with greater insight into the factors determining the patient's response to drug therapy. [ABSTRACT FROM AUTHOR]

Objective: The prolonged usage of antiepileptic medicines has been linked to a reduction in bone mineral density (BMD), resulting in the risk of fracture. However, most evidence has been from western countries, predominantly in institutionalized patients. Furthermore, only a single antiepileptic drug (AED) has been evaluated. This study explores the impact of AEDs on bone health in ambulatory patients from North India. Methodology: A hospital-based observational study on sixty adult patients with epilepsy. All patients were already on AED (valproic acid [VPA], levetiracetam, and phenytoin) either as monotherapy or polytherapy. The serum levels of calcium, phosphorus, alkaline phosphatase, albumin, 25 (OH) Vitamin D, and intact parathyroid hormone were estimated. BMD was assessed at the lumbar spine and femur using a dual-energy X-ray absorptiometry scan. Results: The mean age of patients was 32.75 ± 5.9 years. 56.7% of subjects were female, and 43.3% were male. 40% of patients were taking VPA. Both cytochrome P450 inducing and noninducing AED resulted in a decline in T-score at the lumbar spine (P < 0.01). The BMD declined significantly as the duration of AED intake was prolonged (P < 0.001). Conclusions: In some patients, the intake of AEDs is prolonged, even lifelong. People living with epilepsy are predisposed to falls, and the adverse effects of AED on bone metabolism over time compound the risk of fractures. Thus, the physician needs to monitor all patients on AED for bone health and advise early intervention. [ABSTRACT FROM AUTHOR]

Introduction: An arsenal of Antiepileptic Drugs (AED) is used in the management of childhood seizure disorders. Most of them are taken long-term. These drugs have the potential to cause hyperlipidemia by inducing the P450 enzyme system. The alteration in lipid profile caused by long-term use of antiepileptic drugs in children needs to be studied to reduce the risk of future atherosclerosis. Aim: To analyse the effect of antiepileptic drugs on serum lipid profile in children with epilepsy in a tertiary care. Materials and Methods: This prospective descriptive study was conducted in the Outpatient and Inpatient Wards of the Department of Paediatrics and Neurology, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India, from February 2017 to September 2017. The study involved a total of 155 children, who were on monotherapy antiepileptic drugs for at least 6 months (33 on phenytoin, 42 on phenobarbitone, 20 on levetiracetam, 20 on carbamazepine, 40 on sodium valproate). A corresponding numbers of children, who attended the General Outpatient Department for acute upper respiratory tract and were otherwise healthy, were included as controls. A blood sample (3 mL) was drawn after an overnight fast for serum glucose, liver enzymes, total cholesterol, High Density Lipoprotein-Cholesterol (HDL-C), Low Density Lipoprotein-Cholesterol (LDL-C), Very Low Density Lipoprotein (VLDL) cholesterol and Triglycerides (TG) measurement. Chi-square test was performed to find out the significance of association and independent t-test was used to compare the mean between various groups. Results: Cytochrome P450 (CYP) enzyme inducers like carbamazepine, phenytoin and phenobarbitone significantly modified serum lipids in epileptic children when compared to healthy controls. In children on long-term phenytoin monotherapy, mean cholesterol levels were significantly higher in the cases compared to controls (156.73±31.93 mg/dL vs 105.03±8.60 mg/dL, p-value <0.0001), significantly elevated triglycerides (123.48±25.99 mg/dL vs 87.88±12.16 mg/dL, p-value <0.0001), and HDL-C level was significantly lower (44.52±10.14 mg/ dL vs 56.73±12.56 mg/dL, p-value <0.0001) than in controls. Phenobarbitone use was associated with significantly higher levels of cholesterol (164.97±34.41 mg/dL vs 107.76±9.28 mg/dL, p-value <0.0001), LDL (155.27±28.55 mg/dL vs 93.36±6.81 mg/ dL, p-value <0.0001), and triglycerides (125.55±42.19 mg/dL vs 86.30±8.12 mg/dL, p-value <0.001) and lower HDL (46.30±9.47 mg/dL vs 57.73±14.41 mg/dL, p-value <0.0001). Levetiracetam was not associated in significant alteration in both liver enzymes and lipid profile (p-value >0.05). Carbamazepine monotherapy was associated with higher levels of cholesterol (180.50±28.06 mg/dL vs 112.15±13.55 mg/dL, p-value <0.0001), LDL (138.85±22.55 mg/dL vs 82.45±12.12 mg/dL, p-value<0.0001) and triglycerides (142.80±9.48 mg/dL vs 85.40±6.29 mg/dL, p-value <0.0001) when compared to healthy controls. There was no alteration in lipid profile in valproate monotherapy. Valproate monotherapy was associated with significant increase in levels of SGOT and SGPT when compared to mean levels (40.35±11.208 (IU/L), and 40.70±8.809 (IU/L), respectively) observed in other AEDs and significant increase in SGPT levels when compared to healthy controls (36.50±10.61(IU/L) in cases vs 40.70±8.81 (IU/L) in controls). Conclusion: Levetiracetam did not produce significant changes in the serum lipid profile and liver enzymes and appears to be safe to use in children for long-term epilepsy management especially in children with baseline deranged lipid profile. [ABSTRACT FROM AUTHOR]

Background: In critically ill patients with low albumin, dose individualization of phenytoin is a challenge. The currently used Sheiner-Tozer equation does not accurately predict the free phenytoin concentration in serum and can result in incorrect dose modifications. The best measure to advocate in these patients is the direct-measurement of free phenytoin concentration. Aims and objectives: Phenytoin exhibits complex pharmacokinetics, requiring careful therapeutic drug monitoring. This study aimed to compare the accuracy of the established Sheiner-Tozer calculation method against the direct-measurement of free phenytoin concentration in serum by high performance liquid chromatography in critically ill patients with low albumin. Materials and methods: Blood specimens for direct-measurement of both total and free phenytoin concentration were obtained from 57 patients with hypoalbuminemia monitored in the intensive care unit. Results: The median [inter-quartile range (IQR)] for Sheiner-Tozer equation calculated total phenytoin concentration and direct-measured total was 17.14 (10.63-24.53) and 9.82 (6.02-13.85) µg mL-1, respectively. Approximately 53 and 5% of patients were found to be subtherapeutic and supratherapeutic for direct-measured total phenytoin concentrations, respectively. In contrast, on applying the Sheiner-Tozer calculation, 23 and 40% had subtherapeutic and supratherapeutic concentrations, respectively, for total phenytoin concentration. The median (IQR) for direct-measured, routine and Sheiner-Tozer equation calculated free phenytoin concentration were 1.92 (1.06-2.76), 0.98 (0.60-1.39), and 1.71 (1.06-2.45) μg mL-1, respectively. Only 45.7% of patients were in agreement with respect to the therapeutic category when direct-measured free was compared against routine calculation free. Conclusion: In patients with low albumin, free phenytoin concentration based on the Sheiner-Tozer corrected equation accurately classified patients based on their therapeutic category of free phenytoin in 73.7% of patients. Hence, for individualization of phenytoin dosage in critically ill patients with low albumin, we recommend direct-measurement of free phenytoin concentration. [ABSTRACT FROM AUTHOR]

Organising pneumonia can be idiopathic or as a result of other inciting factors such as drugs. Phenytoin has been implicated in significant side effects predominantly involving extrapulmonary sites. Pulmonary side effects are reported less frequently. Hereby, we report a first case of phenytoin-induced organising pneumonia from India and evidence of significant improvement after stopping the drug. [ABSTRACT FROM AUTHOR]

Many herbal plants are mentioned in Ayurveda for wound healing. Folklore medicine for various ailments including wound healing is being practiced in India. Ehretia Laevis Roxb. contains many such chemical compounds useful for promotion of healing & repair. Tissue renewal goes hand in hand with inflammation influenced by multiple processes. Ehretia Laevis Roxb. called Khandu Chakka & Ajan Vruksha and traditionally being used for wound healing, body pain & minor fractures in the form of local application by folklore in the state of Maharashtra India. Objectives of the present study is to know the effect of Ehretia Laevis Roxb. in the wound healing on the histological parameters in animal model. Phenytoin ointment as a control was used. The present study has found put that leaf extract paste of Ehretia Laevis Roxb. has enhanced the process of wound healing ascertained on histological parameters as compared to topical phenytoin application. Ehretia Laevis Roxb. paste is found to be immensely useful at wound healing as compared to Phenytoin. Ehretia Laevis Roxb. is concluded to promote the healing significantly as observed by feature of granulation, collagenisation & re epithelisation of the wounds suggesting early healing by primary intension [ABSTRACT FROM AUTHOR]

Background: Postpartum period in women is vulnerable to the occurrence and exacerbation of psychiatric disorders. Mothers with postpartum psychosis or bipolar disorder need treatment with psychotropic medications, especially atypical antipsychotics. However, many mothers and families will have reservations about the use of psychotropics during the perinatal period, particularly during breastfeeding because of its presumed side effects and adverse developmental outcomes of the child. Since there are limited data in this area, the present study aimed to examine the adverse effects, if any, and the short-term developmental outcome of infants exposed to atypical antipsychotics during breastfeeding. Methods: The study involved infants of postpartum women (n = 28) who were admitted in the mother and baby inpatient psychiatry unit of a tertiary care center in India. The medication side effects were checked every alternate day for 1-2 weeks using a checklist based on common side effects that infants may experience due to lactation exposure of atypical antipsychotics. Developmental assessments of the infants were done using the Developmental Assessment Scales for Indian Infants and through anthropometric measurements such as weight, length, head circumference, and chest circumference in follow-up when they came as an outpatient after 1-3 month interval. Results: The occurrence of adverse side effects was quite low (17.85%). The main side effects directly attributable to atypical antipsychotics were constipation and sedation. Of the 17 infants who attended follow-up, 52.9% (n = 9) showed some form of developmental delay at the time of the first follow-up. However, low birth weight, higher maternal age (>35 years), and exposure to medications (quetiapine and phenytoin) during pregnancy may be confounding risk factors. Conclusions: The acute adverse effects of atypical antipsychotics such as sedation and constipation in the infant through breast milk were seen in less than a fourth of the sample. Developmental delay was noted in a proportion of infants; however, this may be due to other risk factors. [ABSTRACT FROM AUTHOR]

Background: Phenytoin, mainly metabolized by cytochrome P450 enzyme system, has a narrow therapeutic index and may have adverse effects due to inter-individual variation in the dose requirement and genetic polymorphisms. This cross-sectional study was done to study the prevalence of cytochrome P450 CYP2C9 polymorphisms in Indian epileptic children and to see the effect of polymorphisms on serum levels in epileptic children on phenytoin monotherapy.Methods: We studied 89 epileptic children of North Indian population, randomly selected, to see the genotypic and allelic frequency of CYP2C9 and its association with drug levels on phenytoin monotherapy. Analysis was done using STATA 9 Software. The results were analyzed as prevalence at 95 % C.I. (Confidence Interval). The difference in mean phenytoin serum levels between wild and mutant alleles was tested using Student`s T test for independent samples. P value less than 0.05 was considered statistically significant.Results: CYP2C9*1, *2 & *3 allelic frequencies were 85.4, 4.5 and 10.1 % respectively. CYP2C9*3 allelic group showed significantly higher serum phenytoin levels compared to the wild variants (P = 0.009). There was no statistically significant difference in the dose received (P = 0.12) and side effects of CYP2C9*2 and CYP2C9*3 genotypes (P = 0.442 and 0.597 respectively) when compared with wild variant.Conclusion: CYP2C9*3 is more common than *2 in the present study. All the polymorphisms demonstrated in our study were heterozygous with no homozygosity. Serum phenytoin levels are higher in polymorphic groups (*3) which suggest their poor metabolizing nature. Genotyping may help to avoid toxicity and concentration-dependent adverse effects. [ABSTRACT FROM AUTHOR]

The article presents a research article on the study of adverse cutaneous drug reactions (ACDR) owing to antiepileptics at a rural-based tertiary-care center, Gujarat, India. Topics discussed include use of antiepileptics for neurological disorders, Stevens-Johnsons syndrome, and toxic epidermal necrolysis (TEN). Also being discussed are the commonly used antiepileptic drugs (AEDs) for the first-line treatment of epilepsy including phenytoin (PHT), carbamazepine (CBZ), and valproic acid.

Objectives: The prevalence of obesity is rapidly increasing among Indian children, who, in general, are more prone to develop metabolic complications at an early age. Valproate and phenytoin are commonly used antiepileptic drugs in children. This study aimed to assess the parameters of the metabolic syndrome in Indian children with epilepsy on valproate or phenytoin monotherapy. Methods: This cross‑sectional study recruited children from the Pediatric Epilepsy Clinic, Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi from March 2012 to September 2012. All consecutive children diagnosed with epilepsy as per International League Against Epilepsy definition aged 3–18 years on valproate or phenytoin monotherapy for at least 6 months were enrolled at a tertiary care children’s hospital in Northern India. After clinical and anthropometric evaluation (including body mass index [BMI] and waist circumference), the blood samples were analyzed for fasting serum glucose, total cholesterol, high‑density lipoprotein‑cholesterol, and serum triglyceride. Results: Children with BMI >95th centile and waist circumference >90th centile were not significantly different among children on valproate and phenytoin monotherapy. Children on valproate had significantly higher mean serum triglyceride (96.9 mg/dL vs. 77.6 mg/dL; P < 0.001) and total cholesterol (148.3 mg/dL vs. 132.8 mg/dL; P = 0.002) levels as compared to children on phenytoin monotherapy. Conclusions: The lipid abnormalities may be observed in children on valproate or phenytoin therapy and may warrant periodic screening. [ABSTRACT FROM AUTHOR]

Introduction: Women with epilepsy (WWE) have an increased risk for several endocrine disorders. Obesity and Polycystic Ovarian Syndrome (PCOS) are common side-effects of anticonvulsant drugs. Aim: To study the prevalence of Obesity, PCOS, Thyroid dysfunction in WWE on monotherapy with Carbamazepine (CBZ), Sodium Valproate (VAL) and Phenytoin (DPH) Material and Methods: Sixty WWE in the reproductive age group (13 - 45 yr) who are on at least 6 months of monotherapy with either CBZ (20) or VAL (20) or DPH (20) are subjects of the study. Their Anthropometric data is recorded. They are interviewed and investigated for PCOS and thyroid dysfunction. Twenty healthy women in the reproductive age group served as controls. BMI>25 is taken as cut-off for Obesity. PCOS is defined as menstrual irregularity and/or clinical /biochemical hyperandrogenism with ultrasound evidence of PCO as per the Rotterdam criteria. TSH <0.1 and >4 is taken as evidence of thyroid dysfunction. Women are grouped according to the anticonvulsant drug received and the data analyzed in each group. Results: The mean BMI among VAL and CBZ users is significantly higher than among DPH users (23.3 & 23.4 vs 20.4). There is no significant difference in incidence of PCOS among WWE using either DPH or VAL or CBZ. Elevated TSH>4 is seen more often in WWE on VAL (9/20) compared to CBZ (6/20) and DPH (3/20). WWE on CBZ, VAL and DPH did not differ in mean BMI, Obesity, PCOS compared to healthy controls. As compared to healthy controls, more WWE on drug therapy had significantly elevated TSH (1/20 vs 20/60). Conclusions: WWE on VAL and CBZ had significant weight gain compared to DPH users. Despite weight gain, there was no difference in the incidence of PCOS between the users of VAL, CBZ and DPH. As compared to healthy controls, more WWE on drug therapy had significantly elevated TSH, more so in the VAL group. [ABSTRACT FROM AUTHOR]

Context: In India, phenytoin is often prescribed as twice daily or thrice daily dosage schedules. In the West, this practice has been changed to a once daily regimen in most of the cases. Can we in India follow suit? Is our physical and genetic make up with regards to the phenytoin pharmacokinetics different? Does this necessitate a multiple dosing regimen to avoid adverse effects or even breakthrough seizures? Aims: This study was aimed at comparing 300mg once daily of phenytoin and 100mg tid of phenytoin in terms of its adverse effects, peak and trough serum concentrations. Settings and Design: Out patients attending the Neurology Department, Christian Medical College, Vellore, India. This was a prospective, randomized, double blinded, crossover study. Methods and Materials: Twenty-four patients were enrolled into the study. An informed consent was taken from them. Their liver and renal functions were checked. Their basal phenytoin levels were also estimated. Once the preliminary tests were found to be normal, the patients were inducted randomly into one of the two treatment arms, either 300mg once daily or 100mg thrice daily. Each arm was given for a 2 week period. Adverse effects were looked for and the peak and trough phenytoin concentrations were estimated. Statistical Analysis Used: The mean, SD and the P values were obtained by the Per Protocol and the ITT (Intention to Treat) analysis of the trough and peak serum levels by using Wilcoxon's signed rank test. Results: One patient experienced an adverse effect in the once daily regimen as compared to no adverse effects in the tid regimen. The adverse effect was not consequential to the patient. Statistically, the trough concentrations were not significantly different between the regimens, although the peak concentrations of the once daily regimen were significantly higher. Conclusions: In conclusion, it can be said that the once daily regimen can be prescribed for Indian patients with epilepsy. [ABSTRACT FROM AUTHOR]

The objective of this study is to evaluate the clinical and radiological characteristics and the outcome of status epilepticus (SE). 117 consecutive patients with SE were evaluated including their demographics, history of epilepsy, antiepileptic drug (AED) default, comorbidities, SE type and duration. The study included 22 children, 77 adults and 18 elderly patients with SE. Blood counts, serum chemistry, ECG, cranial MRI, cerebrospinal fluid and EEG were done. Patients were treated with IV phenytoin, valproate, lorazepam or diazepam as per a fixed protocol and responses to first and second drugs were noted. Death during hospital was recorded. The etiology of SE was infection in 53.8%, drug default in 7.9%, metabolic in 14.5%, stroke in 12.8% and miscellaneous in 11% of patients. 92.3% of patients had convulsive and 7.7% nonconvulsive SE. Cranial MRI was abnormal in 62%. Infection as an etiology was more common in children, drug default and metabolic causes in adults and stroke in adults and elderly. Following first AED, SE was controlled in 50%. 30% of patients remained refractory to second AED which was related to duration of SE and mortality. 29% patients died and death was higher in elderly (44%) compared to children (14%). Acute symptomatic SE is more common in developing countries. Refractory SE is associated with SE duration and mortality. [ABSTRACT FROM AUTHOR]

There is paucity of data regarding occurrence of reproductive endocrine disorders in Asian women with epilepsy (WWE) on antiepileptic drug (AED) therapy. To determine the occurrence of reproductive endocrine disorders in Indian WWE, by seizure type and the AED use. Consecutive 427 reproductive age WWE receiving various AEDs were screened for the occurrence of menstrual abnormalities, weight change, and hirsutism. Of these, 53 WWE with menstrual disturbances and/or hirsutism were further evaluated for ovarian morphology and reproductive hormonal profile. Menstrual abnormalities and/or hirsutism were observed in 83 of 427 (19.4%) WWE irrespective of epileptic seizure type; of these, 50 (60.2%) received valproate, 21 (25.3%) received carbamazepine, 11 (13.3%) received phenytoin, and one (1.2%) received phenobarbitone as the primary AED. Almost half of valproate-treated women had significant weight gain and obesity. Among 53 of 83 women evaluated further, 23.5% and 63.6% of valproate-treated women, 25% and 58.3% of carbamazepine-treated women, and none and 20% of phenytoin-treated women had polycystic ovaries (PCO) and hyperandrogenemia (HA), respectively. Valproate-treated women had significantly higher frequency of polycystic ovarian syndrome (PCOS) (11.8% vs. 2.5%, p < 0.0001) and mean serum testrosterone levels (1.78 vs. 1.36 ng/ml, p = 0.03), compared with women treated with other AEDs. Limitations include small number of women in antiepileptic subgroups and a high drop out rate in women who underwent ultrasound and endocrinological investigations. Menstrual abnormalities, weight gain, obesity, and PCOS are frequent and significantly higher in WWE receiving valproate, independent of seizure type. [ABSTRACT FROM AUTHOR]

Objective: To optimize the use of phenobarbital and/or phenytoin as frontline drugs for treatment of childhood epilepsy. Design: Before-and -after study. Setting: Epilepsy clinic at paediatric OPD, Sassoon General Hospital, Pune. Materials and Methods: Epilepsy is a condition in which seizures are triggered recurrently from within the brain. For epidemiological classification purpose epilepsy is considered to be present when two or more unprovoked seizures occur at an interval greater than twenty four hours apart. Seizures were classified as generalized and partial seizures, with underlying etiology investigated with EEG, CT scan in majority of the patients. Follow- up rate, seizure - control and antiepileptic drugs used among 151 children enrolled as on 31 March 2005 were compared with 106 children with new onset epilepsy enrolled as on February 2006. Eight children with breakthrough convulsion after a seizure free period of five to eighteen months were followed up after injection vitamin D. Nineteen children with poor control of seizures receiving polytherapy with newer antiepileptic drugs were assessed with frontline antiepileptic medication of phenobarbital and/or phenytoin. Serum calcium, phosphorus, alkaline phosphatase were done in seventy two consecutive children with seizure disorder. Results: During post protocol period good seizure control was achieved in 84.8% as against 80.7% and use of phenobarbital and/or phenytoin increased to 65.11% from 22.87%. Of the 8 cases with breakthrough seizures seven remained seizure free after vitamin D administration and with no dose enhancement of AED medications of the nineteen. Children receiving polytherapy thirteen children could be successfully switched to phenobarbital and/or phenytoin. Forty four (61%) children had hypocalcamia (less than 9 mg%), fifty seven (79%) children had raised alkaline phosphatase levels (more than 270 IU). Comments: Phenobarbital and/or phenytoin have been found to be effective frontline AED. Periodic administration of vitamin D plays a supportive role. [ABSTRACT FROM AUTHOR]

The article discusses research done on the use of the anticonvulsants phenobarbitone and phenytoin in neonates. It references the study "Phenobarbitone and Phenytoin for Treatment of Neonatal Seizures: Open-Label Randomized Controlled Trial" by G. Pathak and colleagues, published in the 2013 issue. The study was conducted within the resource constraints of a level II neonatal unit in India.

The authors report an Indian adult female patient with a history of generalized tonic clonic seizures who developed severe features of phenytoin (DPH) toxicity on therapeutic dosage of this antiepileptic drug. Administration of 300 mg/day of DPH in this patient resulted in toxic symptoms associated with an excessive serum DPH concentration of 33 microg/ml. The PCR-RFLP analysis revealed a homozygosity involving CYP2C9*3*3. This mutation results in a marked decrease in the enzymatic activity (CYP2C9) and leads to a decreased clearance of the drug which can lead to severe acute and chronic toxicity. On switching the antiepileptic therapy from DPH to sodium valproate, there was reversal of both. [ABSTRACT FROM AUTHOR]

Purpose: We report the efficacy and safety of lorazepam (LOR), phenytoin (PHT), valproate (VPA) and levetiracetam (LEV) as first and second choice antiepileptic drug (AED) in status epilepticus (SE) and their combinations in preventing refractory SE., Materials and Methods: The results of our two earlier trials on SE were compared; one evaluated VPA versus PHT (group I) and the other LOR versus LEV (group II). In group I, additional patients were recruited in addition to published data. The primary outcome was cessation of SE after first and second AEDs and secondary outcome was mortality and side effects. The efficacy of these four drugs as first and second choice was compared. The frequency of refractory seizure in groups I and II and their contributing factors were analyzed., Results: One hundred and seventeen patients were in group I and 79 in group II. The baseline characteristics of the patients were similar in LOR, LEV, VPA and PHT groups. As a first choice, LOR controlled SE in 75.1%, LEV in 76.3%, VPA in 55.4% and PHT in 44.2% patients. As a second choice, LEV was effective in 88.9%, LOR in 70%, VPA in 74.1% and PHT in 25% patients. Refractory SE was more frequent in group I than group II (29.9% versus 10.5%), however, complications and mortality were higher in group II., Conclusion: LOR and LEV combination was superior in reducing refractory SE but at the cost of higher complications and death.

Objectives: Health-related quality of life (QOL) is an important outcome in epilepsy treatment. Very few studies have been carried out on the quality of life in epilepsy (QOLIE-31) in India. The present study aimed to determine the level of health-related QOLIE-31 in patients of epilepsy., Materials and Methods: This was a cross-sectional, questionnaire-based study conducted in a tertiary care teaching hospital. Respondents were adults aged at least 18-year-old with a diagnosis of epilepsy. QOLIE-31 was used for collecting data on health-related QOL. The unpaired t-test or one-way analysis of variance was used to compare means of QOL scores between groups., Results: Totally, 60 patients of epilepsy were included in the study. The mean (standard deviation) total score of QOLIE-31 was 64.61. A score of cognitive and medication effect were significantly better in carbamazepine group as compared to valproate group., Conclusions: Patients on monotherapy had a better QOL as compared to patients receiving polytherapy.

The article examines the features of Pemphis vulgaris. Pemphigus vulgaris clinical presentation includes a relatively younger age of onset, less extensive lesions, a low prevalence of oral lesions, and the requirement of a lower dose of corticosteroids for its control. The usual dosage to control such patients in India is 60-100 milligrams prednisolone daily. Patient, failed to respond even to a massive dose of corticosteroids. It is well known that phenobarbitone and diphenylhydantoin are potent inducers of the hepatic microsomal enzyme system, which in turn is responsible for the degradation of many drugs, including corticosteroids.