Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Side effect of phenobarbital and carbamazepine in childhood epilepsy
- S. Nizam Ahmed, Zaeem A. Siddiqi, Khurshid A. Khan (9 June 2007)
-
In this, the 21st century, are there yet 'no known CAUSES' for epilepsy?
- Celine M Aranjo (11 June 2007)
-
Treatment of Epilepsy in Developing Countries
- Eldryd Parry, Yoseph Mamo, Shitaye Alemu, and Martin Prevett (21 June 2007)
-
Side effects of phenobarbital and carbamazepine in childhood epilepsy
- Arayamparambil C. Anilkumar (22 June 2007)
-
Trade off between cost and side effects
- Rizaldy Pinzon (22 June 2007)
|
|
|||
|
S. Nizam Ahmed, Epileptologist University of Alberta, T6G2B7, Zaeem A. Siddiqi, Khurshid A. Khan
Send response to journal:
|
Banu et.al. present a very useful and practical study with wide applications. However, they did not address a very important issue. What were the starting and maximal doses of these 2 drugs? How did these doses compare with the phenobarbital doses in those studies that demonstrated significant behavioral problems or drop in IQ? Can the dosage explain the differences when compared to the previous studies? Sincerely, S. Nizam Ahmed, MD, FRCPC Assistant Professor - Neurology Clinical Epileptologist Director - Clinical Neurophysiology Laboratory University of Alberta, Canada Competing interests: None declared |
|||
|
|
|||
|
Celine M Aranjo, Senior G.P. NSW, 2208, Australia
Send response to journal:
|
Dear colleagues, Being a GP, I am constantly searching for those articles/studies that can propose causes for acquired epilepsies, this is because in addition to AED, the causative agent/s can be treated side-by-side, if found to be treatable. In particular, I find missing evidence of parasitology testing in most of these registered RCTs e.g. infections especially as in neurocycticercosis, ecchinococcosis, schistosomiasis affecting the CNS, a.s.o. Apart from neurological assessment and psychological assessment, little else is mentioned about assessments like FBC, Immune globulins, ELISA, PCR, or for that matter, stool/urine tests before the start of AEDs---in this study pheno-barbitone and carbamazepine. There are as well, more sophisticated tests, probably beyond the reach of many developing countries. The impact of such RCTs on developed countries is however, rather disasterous, in that despite having the facilities for testing, in order to ascertain a cause/causes, these are omitted and epilepsies are treated with only AEDs, as encouraged by WHO Competing interests: None declared |
|||
|
|
|||
|
Eldryd Parry, Honorary Professor The Tropical Health and Education Trust (THET), London W1G OAE, Yoseph Mamo, Shitaye Alemu, and Martin Prevett
Send response to journal:
|
In their valuable paper on the use of phenobarbital among epilepsy patients in their hospital in Bangladesh, Banu et al (1) state that clinic visits involved great effort and sometimes hardship. Their experience mirrors ours in Ethiopia. We found that poor people from rural areas, confronted by the impossible costs and disturbance of travel, just could not attend the Jimma (2) and Gondar (3,4) teaching hospitals’ clinics. We therefore decided to decentralise care to rural health centres so that the poor could receive care at the health centres nearest their homes. We trained the health centre nurses to manage chronic disease (dominantly epilepsy, diabetes and rheumatic heart disease), and now regularly give them follow up training, and monthly supervision visits by a physician and senior managing nurse from the teaching hospital. We plan to extend the service wider, subject to the health centres being able to ensure the supply of necessary drugs. We have more than five thousand patients with epilepsy registered at health centres and, while we are still seeing patients who find it difficult to attend the clinics, the model of care that we have developed is the only sure way in which rural poor with chronic disease can have any hope of receiving the treatment they need. 1.Banu SH. Jahan M, Koli UK, Ferdousi S, Khan NZ, Neville B. Side effects of phenobarbital and carbamazepine in childhood epilepsy: randomised controlled trial BMJ 2007;334:2007-10 2.Mamo Y, Seid E, Adams S, Gardiner A, Parry E A primary health care approach to the management of chronic disease in Ethiopia: an example for other countries Clinical Medicine 2007;7:228-231 3. Berhanu S, Alemu S, Asmera J, Prevett M. Primary care treatment of epilepsy in rural Ethiopia. Ethiop J Health Dev 2002;16:235-240 4. Berhanu S, Prevett M. Treatment of epilepsy in rural Ethiopia: 2 year follow-up. Ethiop J Health Dev 2004;18:31-34 Competing interests: None declared |
|||
|
|
|||
|
Arayamparambil C. Anilkumar, Pediatric Neurology Fellow, Dept of Neurology SUNY Downstate Med Ctr, Brooklyn, NY 11213
Send response to journal:
|
The treatment of epilepsy in children of developing countries, and the trial comparing Phenobarbital and Carbamazepine bring out interesting points. The previously published studies on hyperactivity and behavior problems due to Phenobarbital highlight the age of the patient as the deciding factor. Younger children present with more hyperactivity than the older folks. Somehow, the GABA receptors show maturational differences in their response to Phenobarbital, which can explain the differences in the action in different age groups. As far as this current study by Banu et al. goes, it is difficult to ascertain the dosage differences in initiation and maintenance as pointed out by Nizam Ahmed . Regarding the question on the investigations for epilepsy put forward by Celine M Aranjo,- “ In this, the 21st century, are there yet 'no known causes' for epilepsy?”- I agree that in the developing countries, parasitic infestation of the CNS may be an issue in the partial onset seizures; but serological/ microbiological testing of blood , stool etc. mentioned probably are not going to be of much impact than a neuroimaging in identifying the etiology and the treatment of a CNS pathology. I am not quite sure, whether there was a definite algorithm for defining the epilepsy diagnosis based on seizure semiology, EEG and neuroimaging was established or not. The authors mention that other investigations were performed as clinically indicated. Competing interests: None declared |
|||
|
|
|||
|
Rizaldy Pinzon, Neurologist Neurology Department Bethesda Hospital Yogyakarta INDONESIA 55224
Send response to journal:
|
The trial of Dr. Banu and colleagues found no significant difference in behavioral side effects with phenobarbital and carbamazepine. This trial is needed because in many developing countries, the only available anti epileptic drugs in primary health centers is phenobarbital. In many countries without any coverage from health insurance system, long term epilepsy treatment must consider the treatment cost. Many patients withdrawal from the treatment program because of the cost. Phenobarbital is an effective treatment for many epilepsy syndromes, the most common side effects is drowsiness. In school-aged children, the measurement of side effects should also consider the day-time drowsiness, and the cognitive profile. In practice, commonly phenobarbital is used before sleep. This trial will help many health practitioners in developing countries. Competing interests: None declared |
|||