BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7543.736 (Published 23 March 2006) Cite this as: BMJ 2006;332:736

Children who take antiepileptic drugs are prone to developing hyperhomocysteinaemia, and the risk goes up with multidrug regimens and duration of drug taking. The condition is present in about 15% of children taking antiepileptic drugs long term. A double blind trial of oral folic acid supplementation in children taking such drugs reports that folic acid successfully increased folate concentrations and normalised homocysteine concentrations (Epilepsia 2005;46: 1677-83).

A new entity is creeping into the medical literature—osteonecrosis of the mandible or maxilla associated with the use of new generation bisphosphonates (used to treat osteoporosis, metastatic bone disease, and Paget's disease). Most patients can be managed with simple surgical debridement and stopping the drug, but some require quite radical intervention (Laryngoscope 2006;116: 115-20). The authors suggest best practice includes dental assessments before starting bisphosphonate treatment and close monitoring of oral hygiene.

The single question that effectively identifies patients who don't think asthma is a chronic disease (and therefore don't manage it as one) is: “Do you think you have asthma all the time, or only when you are having symptoms?” Poor self management of asthma is associated with the “no symptoms, no asthma” belief, …

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