Sulthiame add-on therapy for epilepsy

Background This is an updated version of the Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2015, Issue 10. Epilepsy is a common neurological condition, characterised by recurrent seizures. Most people respond to conventional antiepileptic drugs, however, around 30% will continue to experience seizures, despite treatment with multiple antiepileptic drugs. Sulthiame, also known as sultiame, is a widely used antiepileptic drug in Europe and Israel. We present a summary of the evidence for the use of sulthiame as add-on therapy in epilepsy. Objectives To assess the efficacy and tolerability of sulthiame as add-on therapy for people with epilepsy of any aetiology compared with placebo or another antiepileptic drug. Search methods For the latest update, we searched the Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group’s Specialized Register and CENTRAL (17 January 2019), MEDLINE Ovid (1946 to January 16, 2019), ClinicalTrials.gov and the WHO ICTRP Search Portal (17 January 2019). We imposed no language restrictions. We contacted the manufacturers of sulthiame, and researchers in the field to seek any ongoing or unpublished studies. Selection criteria Randomised controlled trials of add-on sulthiame, with any level of blinding (single, double or unblinded) in people of any age, with epilepsy of any aetiology. Data collection and analysis Two review authors independently selected trials for inclusion, and extracted relevant data. We assessed these outcomes: (1) 50% or greater reduction in seizure frequency between baseline and end of follow-up; (2) complete cessation of seizures during follow-up; (3) mean seizure frequency; (4) time-to-treatment withdrawal; (5) adverse effects; and (6) quality of life. We used intention-to-treat for primary analyses. We presented results as risk ratios (RR) with 95% confidence intervals (CIs). However, due to the paucity of trials, we mainly conducted a narrative analysis. Sulthiame add-on therapy for epilepsy (Review) 1 Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. For Preview Only Main results We included one placebo-controlled trial that recruited 37 infants with newly diagnosed West syndrome. This trial was funded by DESITIN Pharma, Germany. During the study, sulthiame was given as an add-on therapy to pyridoxine. No data were reported for the outcomes: 50% or greater reduction in seizure frequency between baseline and end of follow-up; mean seizure frequency; or quality of life. For complete cessation of seizures during a nine-day follow-up period for add-on sulthiame versus placebo, the RR was 11.14 (95% CI 0.67 to 184.47; very low-certainty evidence), however, this difference was not shown to be statistically significant (P = 0.09). The number of infants experiencing one or more adverse events was not significantly different between the two treatment groups (RR 0.85, 95% CI 0.44 to 1.64; very low-certainty evidence; P = 0.63). Somnolence was more prevalent amongst infants randomised to add-on sulthiame compared to placebo, but again, the difference was not statistically significant (RR 3.40, 95% CI 0.42 to 27.59; very low-certainty evidence; P = 0.25). We were unable to conduct meaningful analysis of time-to-treatment withdrawal and adverse effects due to incomplete data. Authors’ conclusions Sulthiame may lead to a cessation of seizures when used as an add-on therapy to pyridoxine in infants with West syndrome, however, we are very uncertain about the reliability of this finding. The included study was small and had a significant risk of bias, largely due to the lack of details regarding blinding and the incomplete reporting of outcomes. Both issues negatively impacted the certainty of the evidence. No conclusions can be drawn about the occurrence of adverse effects, change in quality of life, or mean reduction in seizure frequency. No evidence exists for the use of sulthiame as an add-on therapy in people with epilepsy outside West syndrome. Large, multi-centre randomised controlled trials are needed to inform clinical practice, if sulthiame is to be used as an add-on therapy for epileps

Factor temperatura en el uso de antibióticos constatando con el método de antibiograma

Los antimicrobianos en medicina veterinaria se utilizan con fines terapéuticos, profilácticos, metafilácticos y como promotores de crecimiento. Para este último fin existen en el mercado pellets adicionados con estas sustancias. La preparación del mismo culmina con la exposición del alimento al secado a diferentes temperaturas. El presente trabajo tuvo como objetivo evaluar el mantenimiento de la efectividad de enrofloxacina y oxitetraciclina frente a un microorganismo sensible a la misma luego de ser sometido a 60 ºC durante 1 y 2 horas. A tal fin, se realizó la técnica de antibiograma, mediante el método de Kirby Bauer, recomendado por Clinical and Laboratory Standards Institute (CLSI). Se utilizó como microorganismo sensible un inóculo ajustado al 0,5 de la escala Mc Farland de la cepa de Escherichia coli ATCC 25922. El mismo fue sembrado por diseminación con hisopo en una placa conteniendo agar Müller Hinton. Además, se prepararon discos de papel de filtro a los que se les agregó 30 μg de oxitetraciclina o 5 μg de enrofloxacina, que fueron secados por corriente de aire estéril en cabina de Bioseguridad; se expusieron a 0,1 y 2 horas a 60 ºC y se colocaron en las placas conteniendo el microorganismo. Luego de la incubación a 37 ºC durante 24 horas se procedió a la lectura e interpretación, midiendo los halos obtenidos y cotejando con las tablas correspondientes a fin de determinar si el microorganismo resultó resistente, medianamente sensible o sensible frente a cada disco. Los ensayos se realizaron por duplicado, dando un total de 12 discos distribuidos en 2 placas de Petri. Los antibiogramas realizados presentaron halos de inhibición de 30 mm en los discos de oxitetraciclina secados a temperatura ambiente y a 60 ºC durante 1 y 2 horas. Por otro lado, los halos de inhibición alrededor de los tres discos de enrofloxacina fueron todos de 19 mm de diámetro. Todo esto denota una nula variación del tamaño en los discos secados por corriente de aire estéril en cabina de bioseguridad con respecto a aquellos secados en estufa a altas temperaturas durante diferentes períodos de tiempo. De esta manera, concluimos que el secado de alimentos, adicionados con antibióticos, mediante calor seco a una temperatura de 60º C durante un período de 1 o 2 horas, no afecta la efectividad del agente químico frente a los microorganismos

Importancia de la estandarización de la técnica del antibiograma y su implicancia en la clínica

Las infecciones bacterianas suelen tratarse con el uso de antibióticos. La resistencia a los quimioterapéuticos es un problema para el médico veterinario y pone en riesgo la aplicación de tratamientos adecuados. Es por ello que debe realizar un trabajo en conjunto con el Laboratorio de Microbiología a fin de determinar, para cada caso, el tratamiento óptimo e impedir el incremento de microorganismos resistentes. En el laboratorio, la técnica para determinar la sensibilidad o resistencia de un microorganismo a uno o más antibióticos se denomina antibiograma y el método de Kirby Bauer es el seleccionado a nivel mundial. Su técnica se encuentra perfectamente estandarizada, predeterminando factores como el tipo de microorganismos (no exigentes y de crecimiento rápido), el medio de cultivo (Müeller Hinton), el espesor del medio en la placa de Petri (4 mm), la concentración del inóculo (0,5 de la escala de Mc Farland), el tiempo de incubación (18 a 24 h) y la lectura e interpretación de los resultados. El objetivo del presente trabajo fue evaluar el efecto de modificaciones en el espesor del medio de cultivo y en la concentración del inóculo en el resultado de la prueba. A tal fin, se fraccionó Müeller Hinton, en placas de Petri, en cantidad suficiente como para obtener un espesor de 2, 4 y 6 mm. Por otro lado, se prepararon dos inóculos, de concentración 0,5 y 5 de la escala de Mc Farland, de una cepa de Escherichia coli aislada por el Servicio de Diagnóstico Bacteriológico y Micológico de esta Facultad. Se procedió a realizar antibiogramas para evaluar el efecto de los antibióticos Gentamicina (GEN), Cefotaxima (CTX) y Ceftazidima (CAZ) combinando los tres espesores del medio con las dos concentraciones del inóculo, obteniendo un total de 6 combinaciones. Los ensayos se realizaron por triplicado y fueron analizados mediante ANOVA y el test pos hoc correspondiente. Los resultados obtenidos indicaron que, como era de esperarse, cada antibiótico responde de manera distinta a las modificaciones en la técnica. Para CAZ, el aumento en la concentración del inóculo sin tener en cuenta la variación en el espesor del medio, incrementa significativamente el tamaño de los halos. Para GEN, el aumento del espesor del medio sin tener en cuenta la concentración del inóculo, disminuye significativamente el tamaño del halo. Finalmente, para CTX no se observaron diferencias significativas. Es importante destacar que en nuestro estudio, las modificaciones de los parámetros estudiados no modificó la categoría del microorganismo (sensible o resistente) frente a un antibiótico. Sin embargo, se observaron variaciones de entre -6 y +9,5 mm en el tamaño de los halos de inhibición, respecto a los valores obtenidos usando los parámetros estandarizados. Desviaciones de esta magnitud podrían, en otras circunstancias (otros antibióticos y/o microorganismos), modificar la categoría del germen de sensible a resistente o viceversa. Podemos clasificar a los errores que se pueden cometer al realizar esta técnica en menores y mayores. Los primeros serían, por ejemplo, informar un germen como resistente (siendo realmente sensible) a un antibiótico, lo que implicaría simplemente no utilizar ese quimioterápico sin mayores consecuencias. Los segundos serían, por ejemplo, informar un germen como sensible (siendo realmente resistente) a un antibiótico, lo que induciría al uso de ese quimioterápico con el consecuente fracaso terapéutico y el riesgo en la salud del paciente

Subacute sclerosing panencephalitis in Croatia (1994–2004)

We studied five patients with SSPE during a 10-year period (1994–2004). The first clinical symptoms developed at the age of 5–11 years. All patients were vaccinated regularly against measles according to the official immunization schedule. One patient had measles at the age of 18 months. Two of them had a history of morbilliform rash (unrecognized measles) at the age of six and seven months, respectively. In two patients, with no history of measles before vaccination the disease started after varicella infection.Using complement-fixation (F) test and EIA, antibodies to measles virus (MV) were detected in the CSF and sera of all patients. The CF-antibody titers ranged from 1:1024 to 1:65536 in sera and from 1:16 to 1:128 in CSF samples. MV antigen was detected in brain imprints using IFA in two patients. Electron microscopic analysis revealed intranuclear viral inclusions (MV nucleocapsids). Using RT-PCR, viral RNA was found in both patients. Nucleotide sequence analysis showed that the viruses found in the brain tissue belonged to the wild-type MV D6 genotype [7]

Sulthiame add-on therapy for epilepsy

Background: Epilepsy is a common neurological condition characterised by recurrent seizures. Most patients respond to conventional antiepileptic drugs, however, around 30% will continue to experience seizures despite multiple antiepileptic drugs. Sulthiame is a widely used antiepileptic drug in Europe and Israel. We present a summary of the evidence for the use of sulthiame as add‐on therapy in epilepsy. Objectives: To compare the efficacy and side‐effect profile of sulthiame as add‐on therapy compared with placebo or another antiepileptic drug. Search methods: We searched the Cochrane Epilepsy Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and the WHO IRCTRP Search Portal on 28th August 2012. No language restrictions were imposed. We contacted the manufacturers of sulthiame and researchers in the field to seek any ongoing or unpublished studies. Selection criteria: Randomised placebo‐controlled add‐on trials of sulthiame in people of any age with epilepsy of any aetiology. Data collection and analysis: Two review authors independently selected trials for inclusion and extracted relevant data. The following outcomes were assessed: (1) reduction in seizure frequency of 50% or greater between baseline and end of follow‐up (2) complete cessation of seizures during follow‐up (3) mean seizure frequency (4) time to treatment withdrawal (5) adverse drug effects (6) quality of life scoring. Primary analyses were intention‐to‐treat. Narrative analysis is presented. Main results: One trial was included representing 37 patients with a new diagnosis of West syndrome. Sulthiame was given as an add‐on therapy to pyridoxine. No data were reported for outcomes (1), (3) or (6). Overall risk ratio (RR) with 95% confidence intervals (CI) for complete cessation of seizures during a nine‐day follow‐up period versus placebo was 0.71 (95% CI 0.53 to 0.96). Meaningful analysis of time to treatment withdrawal and adverse drug effects was impossible due to incomplete data. Authors' conclusions: Sulthiame may lead to a cessation of seizures when used as an add‐on therapy to pyridoxine in patients with West syndrome. The included study was small and had a significant risk of bias which limits the impact of the evidence. No conclusions can be drawn on the occurrence of adverse drug effects, change in quality of life or mean reduction in seizure frequency. No evidence exists for the use of sulthiame as an add‐on therapy in patients with epilepsy outside West syndrome. Large, multi‐centre randomised controlled trials are necessary to inform clinical practice if sulthiame is to be used as an add‐on therapy for epilepsy