Association between antiepileptic drug dose and long-term response in patients with refractory epilepsy.

Seizures in patients with medically refractory epilepsy remain a substantial clinical challenge, not least because of the dearth of evidence-based guidelines as to which antiepileptic drug (AED) regimens are the most effective, and what doses of these drugs to employ. We sought to determine whether there were regions in the dosage range of commonly used AEDs that were associated with superior efficacy in patients with refractory epilepsy. We retrospectively analyzed treatment records from 164 institutionalized, developmentally disabled patients with refractory epilepsy, averaging 17years of followup per patient.

Choosing staff members reduces time in mechanical restraint due to self-injurious behaviour and requesting restraint.

Background: Using mechanical restraints to protect a person who engaged in dangerous self-injury was decreased by manipulation of an establishing operation involving the client choosing the staff person who would work with her.

Materials And Methods: The client was a 28-year-old woman diagnosed with autism, bipolar disorder, static cerebral encephalopathy, moderate intellectual disabilities, hypotonia and musculoskeletal deformities. She had a history of biting herself and further bites could produce irreversible nerve damage.

Adapted Digital Music Players for Individuals with Severe Impairments.

Portable music production devices, such as radios, cassette players and MP3 players have characteristics that make them less than ideal for teaching the cause-and-effect relationships that would enable children and adults with severe impairments to control them independently and appropriately. Even when adapted for control with adaptive switches, the relationship between switch closure and on-off operation results in contingency characteristics that can inhibit learning. Some solutions to these problems are described, and for those individuals who can learn with complex contingencies, some promising products are reviewed.

Elevation of carbamazepine-10,11-epoxide by quetiapine.

A 52-year-old woman and a 56-year-old man who were receiving carbamazepine experienced markedly elevated levels of its active metabolite, carbamazepine-10,11-epoxide (CBZ-E), after starting quetiapine therapy. The CBZ-E:carbamazepine ratio increased 3-4-fold in each patient. Levels of CBZ-E returned to baseline after discontinuing this drug combination.