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Zonisamide (ZNS) is an antiepileptic drug (AED) that has been associated with psychiatric adverse events (PAE) and cognitive adverse events (CAE); controlled studies evaluating these adverse events are limited. Our objectives were to 1) determine the incidence of PAE and CAE leading to the discontinuation of ZNS and 2) identify risk factors for PAE and CAE associated with the discontinuation of ZNS.

AbstractLong-term phosphorus (P) loading to lakes has resulted in accumulation of P in sediments. Internal nutrient loading from sediments of shallow lakes such as Lake Okeechobee, Florida, has become a major concern in restoration programs. The objectives of this study were to determine (1) the potential impact of dredging on dissolved reactive P (DRP) flux out of sediments and (2) the equilibrium P concentration (EPCw) of post-dredge sediments. Intact sediment cores from one location representing P-laden mud sediments of the lake were obtained. Four simulated dredging treatments were implemented: control (no dredging-current conditions); top 30 cm; 45 cm; and 55 cm sediment removal. Phosphorus release/retention characteristics of sediments were determined at water-column DRP concentrations of 0, 0.016, 0.032, 0.064, and 0.128 mg/L. The water column in each core was replaced at approximately 60-day intervals, for a period of 1.2 years, with fresh lake water spiked with respective P concentrations. Significant decreases in water column DRP were observed only in sediment cores with 0–30 cm dredging. At ambient water column DRP levels, the P fluxes during the first 32 days were 0.4, 0.1, 0.4 and 0.2 mg P/m2/day for the 0, 30, 45, and 55 cm dredging treatments, respectively, and accounted for 11–38% of total P released during the 431 day study.At the end of the 1.2-year study, estimated EPCwwere on the order of 0.033, 0.008, 0.022, and 0.037 mg P/L for 0, 30, 45 and 55 cm dredging treatments, respectively. Dredging the top 55 cm sediments would result in the removal of approximately 123 g P/m2, as compared to 80 and 108 g P/m2for 30 and 45 cm dredging, respectively. Laboratory experiments suggest that dredging can reduce internal P loading. However, further evaluation is needed to determine the extent to which the controlled laboratory experiments can be used to predict fluxes in the lake under natural conditions, and the long-term sustainability of improving water quality by dredging.