Open, Double-Blind and Long-Term Study of Vigabatrin in Chronic Epilepsy

We performed an open, double-blind, and long-term study of vigabatrin (gamma-vinyl-GABA, GVG) in patients with treatment-resistant epilepsy who were receiving only one or at most two standard antiepileptic drugs (AEDs). The novel design included a parallel, double-blind, placebo-controlled phase that minimized the number of patients receiving placebo and allowed determination of the optimum dose of GVG for each patient before initiation of the double-blind phase. The study was divided into four phases. The first phase was a 6-week period of baseline observation. In the second phase, GVG was added openly to previous AEDs for 8 weeks. During the first 2 weeks of this phase, the dose of GVG was increased weekly and then, in the absence of adverse effects, was held constant for the next 6 weeks. At the end of this open phase, seizure frequency during the 6 weeks of constant treatment was compared with the baseline seizure frequency for each patient. Patients who experienced reduction greater than 50% in the frequency of any seizure type during the open phase were defined as responders. These responders were then entered into the third and double-blind phase, in which they were randomly allocated wither to continue active GVG treatment or placebo for 8 weeks. Thirty-three patients entered the study; 31 of 33 patients completed the initial open phase. Twenty patients achieved a reduction greater than or equal to 50% in the frequency of one or more seizure types and were eligible for the double-blind phase; 10 were randomized to continue GVG and 10 were randomized to placebo.(ABSTRACT TRUNCATED AT 250 WORDS)     

Origin of olfacto-gustatory alliesthesia: Intestinal sensitivity to carbohydrate concentration?

Gustatory and olfactory alliesthesia was observed in nine healthy adult humans who received on three different days an intragastric load of 50 g glucose dissolved into various amounts of water in order to make 100, 200 and 400 ml of solution. Maximal alliesthesia to sweet stimuli was observed with the smallest volume, i.e., highest concentration. Comparison of these results with previous results [7], obtained not by varying the volume but by varying the glucose mass, shows identity. Maximal alliesthesia to olfactory anchovy and Viandox^R was also observed after ingestion of the most concentrated gastric load. Maximal negative alliesthesia was observed about 45 min after the gastric load; thereafter alliesthesia tended to decrease. A gastric 200 ml load containing 40 g Mannitol, a nonabsorbed sugar, was followed by a strong negative alliesthesia to alimentary stimuli. Ten g glucose in 20 ml solution produced a more intense and rapid alliesthesia when injected into the duodenum than when injected into the stomach. It may be concluded that postinjective negative alliesthesia for alimentary stimuli can be caused by intraduodenal concentration of nutrients, probably sensed by duodenal nervous chemoreceptors.     

Influence of a monotonous food on body weight regulation in humans

Four human subjects were fed ad lib with a bland diet for a period of 3 weeks. Their body weight decreased by 3.13 kg during this period. It was observed that the shift of the palatability response to sucrose solutions induced by a gastric glucose load (alliesthesia) was not affected by such a reduction of body weight. This result was compared to a previous experiment showing a decreased alliesthesia after a body weight loss due to the restriction of a palatable diet. These results confirm the role of the palatability of the diet on the maintenance of a body weight level and provide evidence for an interaction between the two factors in determining the oral satiation process.     

Lidocaine intoxication in newborn following maternal pudendal anesthesia: report of three cases

Pudendal nerve block may be indicated during instrumental delivery in situations where peridural anesthesia is unavailable. We report three cases of neonatal lidocaine intoxication following maternal pudendal block during delivery. Clinical features were hypotonia, pupillary mydriasis fixed to light, apnea, cyanosis and seizures. Two neonates required mechanical ventilation. Lidocaine was found in the serum of two babies. In all three cases, recovery was complete. The pharmacokinetics of lidocaine in a highly vascularized perineum during labor increase the risk of neonatal intoxication. A possible intoxication by local anesthetics should be considered in neonates presenting an acute distress in the delivery room.     

Hypokaliemic periodic paralysis and pregnancy: perinatal management. A case report

Familial hypokalemic periodic paralysis (FHPP) is a rare inherited disease characterized by a dysfunction of the membrane ion channels. Clinical manifestations are attacks of hypokaliemia with flaccid muscle paralysis. Paralysis is sometimes severe but always reversible with symptomatic treatment. Pregnancy and delivery have been reported to exacerbate FHPP. Authors report a case of FHPP during pregnancy with a favourable outcome. Vaginal delivery is usually possible with monitoring and epidural analgesia, avoiding active maternal expulsive efforts (passive descent of the fetus and elective outlet forceps) and other stimulating factors (carbohydrate loads, maternal stress, betamimetics, epinephrine...). Administration of IV potassium supplementation is often necessary.     

Anesthetic management of 52 deliveries in parturients with idiopathic thrombocytopenic purpura

Objectives

To study the anesthetic management of parturients with idiopathic thrombocytopenic purpura (ITP) which is a frequent cause of thrombocytopenia in pregnant women and may lead to a dilemma since a low platelet count usually dictates not to perform epidural anesthesia.

Materials and methods

We report a retrospective study assessing the anesthetic management of 39 parturients with ITP corresponding to 52 deliveries found in a database of 10,203 deliveries over a 52-month-period.

Results

On the day of delivery, 32 parturients (61.5%) had a platelet count less than 100,000/mm³ and 19 (36.5%) received a neuraxial block. Six parturients with a platelet count less than 100,000 mm³ (19%) received neuraxial analgesia. The lowest platelet count among women who received epidural analgesia was 88,000/mm³. No anesthetic or neurological complication occurred.

Conclusion

Regional anesthesia should not necessary be withheld in ITP when the platelet count is less than 100,000/mm³.