RESEARCH Scientists Identify A

Total Page:16

File Type:pdf, Size:1020Kb

RESEARCH Scientists Identify A Issue 13, Summer 2015 RESEARCH Scientists identify a genetic cause for photosensitivity Photosensitive epilepsy, page 6 FAMILY How canine epilepsy could help us to understand more about human epilepsy Dogs and epilepsy, page 8 MEDICAL Is epilepsy affecting your sex life? Epilepsy, men and sex, page 15 www.epilepsysociety.org.uk EPILEPSY REVIEW Three billion has been a significant number this summer. First the spacecraft New Horizons travelled three billion miles to send back images from Pluto, the last unexplored major body in our solar system. The excitement of scientists at NASA rippled around the world. Closer to home, there were ripples of excitement on a smaller, but still significant scale, as research into the three billion bases that make up our DNA, shone a light on the genetics of epilepsy. While space exploration reveals the secrets It’s a jigsaw where we don’t even know of a world at the far edge of our solar system, how many pieces will be in the final picture. epilepsy research is beginning to reveal the Our research is ongoing and you can help us secrets deep within our DNA, secrets that are to shape the direction it will follow by taking slowly helping to identify the causes of epilepsy. part in our online research survey. When it Our researchers at Epilepsy Society have comes to epilepsy research we want to know made ground-breaking progress in three what is important to you, what you hope key areas associated with epilepsy: sudden we will achieve and how this could make unexpected death in epilepsy (SUDEP), a difference to your life. You can find out photosensitivity and the ketogenic diet. how to take part in the survey on page 23. Using the most advanced technology, our Research and exploration are full of researchers can look in minute detail at the surprises and one revelation that has caught genomes of people with epilepsy and begin NASA scientists off guard is news that Pluto to unravel the complex genetic architecture has a plasma tail caused by the planet's that contributes to the condition. This is atmosphere being stripped away by solar helping scientists begin to understand why winds. This edition of Epilepsy Review reveals some people could be at a higher risk of that epilepsy too can have a tail. Turn to SUDEP, why some people may be sensitive page 8 to read about canine epilepsy and to flashing lights and why some people how research into dogs with epilepsy with drug resistant epilepsy respond well – and tails – could contribute to a better to the ketogenic diet while others don’t. understanding of the condition in humans. Director of clinical genetics at Epilepsy Society, Professor Sanjay Sisodiya is quick to point out that these are all small steps. There are no absolute answers yet, but Nicola Swanborough pieces of the jigsaw are gradually emerging. Editor FRONT COVER Editor Nicola Swanborough Epilepsy Society Best friends: Tina Thompson Email [email protected] Chalfont St Peter, Bucks SL9 0RJ You can view more of Tina's work Telephone 01494 601 417 www.epilepsysociety.org.uk at www.epilepsysociety.org.uk/ To receive Epilepsy Review, email us at the Registered charity no 206186 artists-and-epilepsy address above, or see back cover A company limited by guarantee Registered number 492761 England Views expressed by contributors in this publication are not necessarily those of Epilepsy Society Designed by Ben Dugdale Design www.bendugdale.com Information may change after printing and is not Printed by Lefa Print a substitute for advice from your own doctors. www.lefaprint.com Epilepsy Society is not responsible for any actions Printed on chlorine free paper taken as a result of using this information from sustainable forests NEWS 3 AEDs RESEARCH Perampanel offers Breakthrough greater hope A new treatment option is offering in understanding hope of better seizure control and potential seizure freedom for people causes of SUDEP with drug-resistant generalised tonic clonic seizures (GTC). Perampanel, developed by Eisai and licensed in the UK in 2013 for the Scientists have made an important and a greater genetic understanding treatment of focal seizures, has now breakthrough in understanding the will help identify precision treatments, been approved for use in generalised causes of premature death in people as well as pinpointing the causes and seizures that affect both sides of the with epilepsy. risk factors associated with the condition. brain at once. Researchers, led by those from This study is the largest of its kind People with these seizures often fall Epilepsy Society and University College so far, analysing the sequences of resulting in potential physical injuries. London, have discovered that an 18 people who died of SUDEP, Frequent generalised tonic clonic seizures individual’s genetic make-up may 87 living people with epilepsy and can also increase a person’s risk of Sudden contribute to the risk of sudden 1,479 non-epilepsy disease controls. Unexpected Death in Epilepsy (SUDEP). unexpected death in epilepsy (SUDEP). Sanjay Sisodiya, director of clinical Until recently there have been SUDEP causes the death of 600 genetics at Epilepsy Society and limited medications licensed for these people each year in the UK. It is professor of neurology at University seizures. But now the European thought to be more likely in people College London said: ‘This discovery is Commission has granted marketing with frequent convulsive seizures, an important step in understanding the authorisation approval for perampanel, than in those with infrequent seizures. causes of sudden death in epilepsy. It for use as an add-on therapy for This latest breakthrough brings us gives the scientific community a further generalised tonic clonic seizures in a step closer to determining risk in hint at how the genetic make-up of a adults and adolescents over 12. individual people, with the eventual person with epilepsy might contribute Clinical data for the drug, was aim of preventing deaths through to the risk of this devastating outcome. presented at the European Academy personalised diagnosis and treatment. ‘As we look towards more accurate of Neurology in Berlin and showed: By analysing the genes of a person estimation of individual risk, more – 30.9 per cent of people taking with epilepsy, medical professionals personalised treatment and perhaps perampanel were free of may, in the future, be able to identify prevention of SUDEP in the future, we GTC seizures compared with the heightened risk of SUDEP in need to test our findings further and 12.3 per cent taking a placebo advance, contributing towards the would welcome further collaboration.’ – there was a greater reduction quest for prevention. This research was funded by Dravet in GTC seizures in those on Genetic sequencing is playing Syndrome UK with contributions from perampanel (76.5 per cent) an increasingly important role in other bodies. SUDEP can occur in any compared to those who took healthcare, as it may help patients epilepsy, but is more common in some, placebo (38.4 per cent) receive more tailored treatment for such as Dravet Syndrome, a severe – people treated with perampanel had their conditions. Epilepsy affects more form of childhood epilepsy. an improved quality of life compared than half a million people in the UK www.epilepsysociety.org.uk/sudep to those taking a placebo. Epilepsy app for healthcare professionals Epilepsy Society is launching will enable clinicians to access its new app for healthcare up-to-date information about professionals to help support them all aspects of epilepsy care and in treating and caring for people management at the click of with epilepsy. The Epilepsy Manual a button. It has the potential will be free to download and to have a real impact on the will provide instant access to lives of people with epilepsy.’ comprehensive information about The app will be available this epilepsy for non-specialists. summer on Android and iOS: Jenny Nightingale, epilepsy www.epilepsysociety.org.uk/ specialist nurse said: ‘This resource manual 4 NEWS GENETIC RESEARCH A&E GOVERNMENT Ketogenic diet Postcode lottery Backing genomics There is a wide disparity in the The world’s only minister for life treatment of people with epilepsy who sciences, George Freeman, has are taken to A&E following a seizure, underlined the Government’s a recent study reveals. NASH – the commitment to genomics and its National Audit of Seizure management support for centres of excellence in Hospitals – looked at the services that are promoting innovative and care available to people with healthcare across the UK. epilepsy and found considerable Genomics is the diagnosis and variability across the entire care path treatment of an individual by looking with the need for more organised at their DNA. This is being pioneered A new study has highlighted the and accessible care. in the treatment of epilepsy at importance of exploring further The study looked at over 4,500 Epilepsy Society’s Chalfont Centre genetic factors which may attendances in 154 emergency in Buckinghamshire. explain why some people with departments across the UK. Speaking in Westminster at the epilepsy respond to ketogenic Assessments were often found to be launch of the All Party Parliamentary diet therapies while others don’t. incomplete. Witness statements were Group for Life Sciences, the UK Ketogenic diet therapies only taken in 75 per cent of first seizure parliamentary under secretary of state switch the body’s energy fuels patients. In this same group, only for health said: ‘We must unlock the from glucose to ‘ketone bodies’. 55 per cent were referred to a power of genomics and data and This is particularly beneficial for neurologist or epilepsy specialist and bring them more quickly to patients.
Recommended publications
  • 18 December 2020 – to Date)
    (18 December 2020 – to date) MEDICINES AND RELATED SUBSTANCES ACT 101 OF 1965 (Gazette No. 1171, Notice No. 1002 dated 7 July 1965. Commencement date: 1 April 1966 [Proc. No. 94, Gazette No. 1413] SCHEDULES Government Notice 935 in Government Gazette 31387 dated 5 September 2008. Commencement date: 5 September 2008. As amended by: Government Notice R1230 in Government Gazette 32838 dated 31 December 2009. Commencement date: 31 December 2009. Government Notice R227 in Government Gazette 35149 dated 15 March 2012. Commencement date: 15 March 2012. Government Notice R674 in Government Gazette 36827 dated 13 September 2013. Commencement date: 13 September 2013. Government Notice R690 in Government Gazette 36850 dated 20 September 2013. Commencement date: 20 September 2013. Government Notice R104 in Government Gazette 37318 dated 11 February 2014. Commencement date: 11 February 2014. Government Notice R352 in Government Gazette 37622 dated 8 May 2014. Commencement date: 8 May 2014. Government Notice R234 in Government Gazette 38586 dated 20 March 2015. Commencement date: 20 March 2015. Government Notice 254 in Government Gazette 39815 dated 15 March 2016. Commencement date: 15 March 2016. Government Notice 620 in Government Gazette 40041 dated 3 June 2016. Commencement date: 3 June 2016. Prepared by: Page 2 of 199 Government Notice 748 in Government Gazette 41009 dated 28 July 2017. Commencement date: 28 July 2017. Government Notice 1261 in Government Gazette 41256 dated 17 November 2017. Commencement date: 17 November 2017. Government Notice R1098 in Government Gazette 41971 dated 12 October 2018. Commencement date: 12 October 2018. Government Notice R1262 in Government Gazette 42052 dated 23 November 2018.
    [Show full text]
  • Therapeutic Class Overview Anticonvulsants
    Therapeutic Class Overview Anticonvulsants INTRODUCTION Epilepsy is a disease of the brain defined by any of the following (Fisher et al 2014): ○ At least 2 unprovoked (or reflex) seizures occurring > 24 hours apart; ○ 1 unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after 2 unprovoked seizures, occurring over the next 10 years; ○ Diagnosis of an epilepsy syndrome. Types of seizures include generalized seizures, focal (partial) seizures, and status epilepticus (Centers for Disease Control and Prevention [CDC] 2018, Epilepsy Foundation 2016). ○ Generalized seizures affect both sides of the brain and include: . Tonic-clonic (grand mal): begin with stiffening of the limbs, followed by jerking of the limbs and face . Myoclonic: characterized by rapid, brief contractions of body muscles, usually on both sides of the body at the same time . Atonic: characterized by abrupt loss of muscle tone; they are also called drop attacks or akinetic seizures and can result in injury due to falls . Absence (petit mal): characterized by brief lapses of awareness, sometimes with staring, that begin and end abruptly; they are more common in children than adults and may be accompanied by brief myoclonic jerking of the eyelids or facial muscles, a loss of muscle tone, or automatisms. ○ Focal seizures are located in just 1 area of the brain and include: . Simple: affect a small part of the brain; can affect movement, sensations, and emotion, without a loss of consciousness . Complex: affect a larger area of the brain than simple focal seizures and the patient loses awareness; episodes typically begin with a blank stare, followed by chewing movements, picking at or fumbling with clothing, mumbling, and performing repeated unorganized movements or wandering; they may also be called “temporal lobe epilepsy” or “psychomotor epilepsy” .
    [Show full text]
  • Pexion, Imepitoin
    ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE VETERINARY MEDICINAL PRODUCT Pexion 100 mg tablets for dogs Pexion 400 mg tablets for dogs 2. QUALITATIVE AND QUANTITATIVE COMPOSITION One tablet contains: Active substance: Imepitoin 100 mg Imepitoin 400 mg For the full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM Tablets White, oblong, half-scored tablets with embedded logo “I 01” (100 mg) or “I 02” (400 mg) on one side. The tablet can be divided into equal halves. 4. CLINICAL PARTICULARS 4.1 Target species Dog 4.2 Indications for use, specifying the target species For the reduction of the frequency of generalised seizures due to idiopathic epilepsy in dogs for use after careful evaluation of alternative treatment options. 4.3 Contraindications Do not use in case of hypersensitivity to the active substance or to any of the excipients. Do not use in dogs with severely impaired hepatic function, severe renal or severe cardiovascular disorders (see section 4.7). 4.4 Special warnings The pharmacological response to imepitoin may vary and efficacy may not be complete. Nevertheless imepitoin is considered to be a suitable treatment option in some dogs because of its safety profile (see section 5.1). On treatment, some dogs will be free of seizures, in other dogs a reduction of the number of seizures will be observed, whilst others may be non-responders. In non-responders, an increase in seizure frequency may be observed. Should seizures not be adequately controlled, further diagnostic measures and other antiepileptic treatment should be considered. The benefit/risk assessment for the individual dog should take into account the details in the product literature.
    [Show full text]
  • Evaluation of Pexion® (Imepitoin) for Treatment of Storm Anxiety in Dogs: a Randomised, Double-Blind, Placebo-Controlled Trial
    Received: 20 July 2020 Revised: 7 October 2020 Accepted: 3 December 2020 DOI: 10.1002/vetr.18 ORIGINAL RESEARCH Evaluation of Pexion® (imepitoin) for treatment of storm anxiety in dogs: A randomised, double-blind, placebo-controlled trial Irina Perdew1 Carrie Emke1 Brianna Johnson1 Vaidehi Dixit2 Yukun Song2 Emily H. Griffith2 Philip Watson3 Margaret E. Gruen1 1 Department of Clinical Sciences, North Abstract Carolina State University College of Background: While often grouped with other noise aversions, fearful Veterinary Medicine, Raleigh, North Carolina, USA behaviour during storms is considered more complex than noise aversion 2 Department of Statistics, North Carolina alone. The objective here was to assess the effect of imepitoin for the treat- State University College of Sciences, Raleigh, ment of storm anxiety in dogs. North Carolina, USA Methods: In this double-blind, placebo-controlled randomised study, eligible 3 Ingelheim am Rhein, Boehringer-Ingelheim dogs completed a baseline then were randomised to receive either imepitoin Vetmedica GmbH, Ludwigshafen am Rhein, (n = 30; 30 mg/kg BID) or placebo (n = 15) for 28 days. During storms, owners Germany rated their dog’s intensity for 16 behaviours using a Likert scale. Weekly, own- Correspondence ers rated intensity and frequency of these behaviours. Summary scores were Margaret E. Gruen, Department of Clinical compared to baseline and between groups. Sciences, North Carolina State University Results and Conclusions: Imepitoin was significantly superior to placebo in College of Veterinary Medicine, 1060 William Moore Drive, Raleigh NC 27607, USA. storm logs and weekly surveys for weeks 2 and 4, and in the end-of-study sur- Email: [email protected] vey.
    [Show full text]
  • Epilepsy and Communication
    fasic England Gloss ry Epilepsy and communication Epilepsy is a chronic disorder of the brain • Temporal Lobe epilepsy characterised by recurrent seizures, which affects • Dravet syndrome people worldwide (WHO, 2016). The World Health Organisation deKnes a seizure as a transient loss of There are a range of communication difficulties function of all or part of the brain due to excessive associated with epilepsy. For some people, electrical discharges in a group of brain cells. Physical, communication difficulties can become more sensory or other functions can be temporarily lost. pronounced at times immediately before, during or after seizure activity. Epilepsy affects 1 in 177 young people under the age of 25 so there are around 112,000 young people with Communication difficulties may include: epilepsy in the UK (Joint Epilepsy Council, 2011). In 75% • Comprehension difficulties: Children may Knd it of people, seizures are well controlled with medication hard to understand what others are saying to but 25% continue to have seizures despite treatment. them or what is expected of them, and may struggle to understand environmental cues, daily Epilepsy can be linked with learning, behavioural and routines or activity sequences. speech and language difficulties. This is increasingly • Attention and listening difficulties: Children recognised and the risks are greater if epilepsy occurs may have difficulties in attending to spoken before 2 years of age. Parkinson (1994) found that language, or to an activity. from a small study of children referred for assessment of their epilepsy, 40% had undiagnosed language • Expressive difficulties: It may be hard for impairment of varying degrees of severity.
    [Show full text]
  • 14582 IBE Newsletter 2003
    International Bureau for Epilepsy Annual Report 2003 Setting the Standard From Our Vision IBE has a vision of the world where everywhere ignorance and fear about epilepsy are replaced by understanding and care. Our Mission IBE exists to improve the social condition and quality of life of people with epilepsy and those who care for them. Our Goals • ORGANISATION To provide an international umbrella organisation for national epilepsy organisations whose primary purpose is to improve the social condition and quality of life of people with epilepsy and those who care for them. • SUPPORT To provide a strong global network to support the development of new Chapters, to support existing Chapters to develop to their fullest potential and to encourage co-operation and contact between Chapters. • COMMUNICATION To promote the facts about epilepsy and to communicate IBE’s vision, mission and messages to the widest possible audience. • EDUCATION To increase understanding and knowledge of epilepsy. • REPRESENTATION To provide an international and global platform for the representation of epilepsy. 2 International Bureau for Epilepsy Foreward During my fifteen years working, first in the British Parliament and Government and now in the European Parliament, I have seen and welcomed an ever-increasing awareness of the importance and benefits of strong partnerships. Networks and alliances are more than just “buzz words” – they are proven methods of achieving desired goals. They may not be easy to achieve, but, once in place, they make it simpler for patients, carers, professionals and academics to explain health needs and options for action and they make it easier for policy-makers to listen and to understand what is needed.
    [Show full text]
  • A Clinical Guide to Epileptic Syndromes and Their Treatment
    Published August 13, 2008 as 10.3174/ajnr.A1231 dures and principles of treatment. These chapters are particu- BOOK REVIEW larly important for readers unfamiliar with the overall clinical presentation of the epilepsies and their diagnostic evaluation. A Clinical Guide to Epileptic Omitting these topics was a certain pitfall that has been Syndromes and Their Treatment, avoided. Basic techniques used in the evaluation of patients with of epilepsy, including anatomic and functional neuroim- 2nd ed. aging, are also included. The discussion of the relative value of C.P. Panayiotopoulos, ed. London, UK: Springer-Verlag; 2007, 578 EEG and its problems is particularly valuable. pages, 100 illustrations, $99.00. Subsequent chapters are devoted to the meat of the book, the epilepsy syndromes. These are presented in age-based he syndromic classification of epileptic seizures has been chronologic order, beginning with syndromes in the neonate evolving for more than a quarter century. Piggy-backed T and infant and continuing through syndromes in adults. onto major advances in neurophysiology and neuroimaging, Complete coverage of reflex seizures and reflex epilepsies in the current nomenclature of specific clinical epilepsy syn- chapter 16 is particularly welcome. Chapter 17 covers a group dromes now supersedes earlier seizure classifications based of disorders that are associated with epileptic seizures. The exclusively on seizure types. The practice of epilepsy has thus chapter gives excellent coverage of these disorders but makes joined mainstream medicine through its newfound ability to no pretenses at being comprehensive. For example, coverage link the signs and symptoms of epilepsy with specific under- of important disorders with epilepsy such as the Wolf- lying disorders.
    [Show full text]
  • Idiopathic Epilepsy in Dogs – Part One: Patient Approach
    Vet Times The website for the veterinary profession https://www.vettimes.co.uk Idiopathic epilepsy in dogs – part one: patient approach Author : Jacques Penderis, Holger Volk Categories : Vets Date : February 9, 2015 Dogs with recurrent epileptic seizures, and where no interictal neurological deficits or abnormalities on routine diagnostic tests are evident, have traditionally been defined as having “idiopathic epilepsy”. Rather than being a specific, single diagnosis, it is probable idiopathic epilepsy represents a complex interplay between genetic predisposition and intrinsic and extrinsic environmental factors, and the term “presumed genetic” has also been suggested to define these patients. A genetic basis for idiopathic epilepsy has been proposed in a number of breeds, including the golden retriever, Labrador retriever, Bernese mountain dog, Irish wolfhound, English springer spaniel, Keeshond, Hungarian vizsla, standard poodle, border collie and Finnish spitz (Viitmaa et al, 2013) and a possible susceptibility locus for epileptic seizures has been characterised in the Belgian shepherd dog (Seppälä et al, 2012). Reflecting its importance in veterinary medicine, idiopathic epilepsy is reported as the most common chronic neurological disease in dogs, with a prevalence of around 0.6 per cent in first opinion practice. Generalised seizures (where there is impairment of consciousness) are the most common type of epileptic seizure in dogs, while partial seizures appear to be relatively more common in cats; this, in part, represents the tendency for dogs with idiopathic epilepsy to have generalised seizures, or focal seizures with rapid secondary generalisation. The accurate description of generalised seizures in a patient with suspected idiopathic epilepsy is important, firstly to differentiate the episodes from other causes of collapse (for example, syncope) and secondly because the presence of generalised seizures is one of the criteria for making a diagnosis of idiopathic epilepsy.
    [Show full text]
  • Best Practice Guidelines for Training
    Best practice guidelines for training professional carers in the administration of Buccal (Oromucosal) Midazolam for the treatment of prolonged and / or clusters of epileptic seizures in the community Safe & Effective | Kind & Caring | Exceeding Expectation Epilepsy Nurses Association (ESNA) June 2019 1. Foreword One of the most important components of epilepsy care is the pre-hospital community management of prolonged or repeated seizures, which, if untreated, can increase the risk of status epilepticus. Convulsive status epilepticus is a medical emergency requiring admission to hospital and has a mortality rate of up to 20 per cent. Effective management of seizures in the community in people at high risk of status epilepticus could significantly reduce mortality, morbidity and emergency health care utilisation. The Joint Epilepsy Council issued guidance until it was disbanded in 2015, leaving a vacuum in the review and update of clinical guidelines. Unfortunately, the clinical processes ensuring the safety and consistency of buccal midazolam usage demonstrates considerable heterogeneity. There are no current guidelines, standards or pathways to ensure the safety of all involved in the process i.e. patient, carer or professional. ESNA is an organisation principally formed by nurses with an interest in epilepsy. Most ESNA members support or complete training for buccal midazolam to ensure core competencies are up to date and patient safety is protected. ESNA is joined by the International League Against Epilepsy (British Chapter) and the Royal College of Psychiatrists (ID Faculty) as the other principal specialist clinical stakeholders with an interest to ensure governance in this complex care area is addressed robustly. ESNA has collaborated with the ILAE and the Royal College of Psychiatrists to produce updated buccal midazolam guidance.
    [Show full text]
  • Diazepam and Kava Combination Article
    Journal of Advanced Research (2014) 5, 587–594 Cairo University Journal of Advanced Research ORIGINAL ARTICLE Enhanced efficacy and reduced side effects of diazepam by kava combination Rasha A. Tawfiq a, Noha N. Nassar b,*, Wafaa I. El-Eraky c, Ezzeldein S. El-Denshary b a Egyptian Patent Office, Academy of Scientific Research and Technology, 101 Kasr El-Eini St., Cairo, Egypt b Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Kasr El-Eini St., Cairo, Egypt c Department of Pharmacology, National Research Center, El-Tahrir St., Giza, Egypt ARTICLE INFO ABSTRACT Article history: The long term use of antiepileptic drugs possesses many unwanted effects; thus, new safe com- Received 2 April 2013 binations are urgently mandated. Hence, the present study aimed to investigate the anticonvul- Received in revised form 18 July 2013 sant effect of kava alone or in combination with a synthetic anticonvulsant drug, diazepam Accepted 15 August 2013 (DZ). To this end, female Wistar rats were divided into two subsets, each comprising 6 groups Available online 22 August 2013 as follows: group (i) received 1% Tween 80 p.o. and served as control, while groups (ii) and (iii) received kava at two dose levels (100 and 200 mg/kg, p.o.). The remaining three groups received Keywords: (iv) DZ alone (10 mg/kg p.o.) or kava in combination with DZ (v) (5 mg/kg, p.o.) or (vi) (10 mg/ Kava kg, p.o.). Results of the present study revealed that kava increased the maximal electroshock Diazepam seizure threshold (MEST) and enhanced the anticonvulsant effect of diazepam following both Anticonvulsant acute and chronic treatment.
    [Show full text]
  • WSAVA List of Essential Medicines for Cats and Dogs
    The World Small Animal Veterinary Association (WSAVA) List of Essential Medicines for Cats and Dogs Version 1; January 20th, 2020 Members of the WSAVA Therapeutic Guidelines Group (TGG) Steagall PV, Pelligand L, Page SW, Bourgeois M, Weese S, Manigot G, Dublin D, Ferreira JP, Guardabassi L © 2020 WSAVA All Rights Reserved Contents Background ................................................................................................................................... 2 Definition ...................................................................................................................................... 2 Using the List of Essential Medicines ............................................................................................ 2 Criteria for selection of essential medicines ................................................................................. 3 Anaesthetic, analgesic, sedative and emergency drugs ............................................................... 4 Antimicrobial drugs ....................................................................................................................... 7 Antibacterial and antiprotozoal drugs ....................................................................................... 7 Systemic administration ........................................................................................................ 7 Topical administration ........................................................................................................... 9 Antifungal drugs .....................................................................................................................
    [Show full text]
  • Tegretol (Carbamazepine)
    Page 3 Tegretol® carbamazepine USP Chewable Tablets of 100 mg - red-speckled, pink Tablets of 200 mg – pink Suspension of 100 mg/5 mL Tegretol®-XR (carbamazepine extended-release tablets) 100 mg, 200 mg, 400 mg Rx only Prescribing Information WARNING SERIOUS DERMATOLOGIC REACTIONS AND HLA-B*1502 ALLELE SERIOUS AND SOMETIMES FATAL DERMATOLOGIC REACTIONS, INCLUDING TOXIC EPIDERMAL NECROLYSIS (TEN) AND STEVENS-JOHNSON SYNDROME (SJS), HAVE BEEN REPORTED DURING TREATMENT WITH TEGRETOL. THESE REACTIONS ARE ESTIMATED TO OCCUR IN 1 TO 6 PER 10,000 NEW USERS IN COUNTRIES WITH MAINLY CAUCASIAN POPULATIONS, BUT THE RISK IN SOME ASIAN COUNTRIES IS ESTIMATED TO BE ABOUT 10 TIMES HIGHER. STUDIES IN PATIENTS OF CHINESE ANCESTRY HAVE FOUND A STRONG ASSOCIATION BETWEEN THE RISK OF DEVELOPING SJS/TEN AND THE PRESENCE OF HLA-B*1502, AN INHERITED ALLELIC VARIANT OF THE HLA-B GENE. HLA-B*1502 IS FOUND ALMOST EXCLUSIVELY IN PATIENTS WITH ANCESTRY ACROSS BROAD AREAS OF ASIA. PATIENTS WITH ANCESTRY IN GENETICALLY AT- RISK POPULATIONS SHOULD BE SCREENED FOR THE PRESENCE OF HLA-B*1502 PRIOR TO INITIATING TREATMENT WITH TEGRETOL. PATIENTS TESTING POSITIVE FOR THE ALLELE SHOULD NOT BE TREATED WITH TEGRETOL UNLESS THE BENEFIT CLEARLY OUTWEIGHS THE RISK (SEE WARNINGS AND PRECAUTIONS/LABORATORY TESTS). APLASTIC ANEMIA AND AGRANULOCYTOSIS APLASTIC ANEMIA AND AGRANULOCYTOSIS HAVE BEEN REPORTED IN ASSOCIATION WITH THE USE OF TEGRETOL. DATA FROM A POPULATION-BASED CASE CONTROL STUDY DEMONSTRATE THAT THE RISK OF DEVELOPING THESE REACTIONS IS 5-8 TIMES GREATER THAN IN THE GENERAL POPULATION. HOWEVER, THE OVERALL RISK OF THESE REACTIONS IN THE UNTREATED GENERAL POPULATION IS LOW, APPROXIMATELY SIX PATIENTS PER ONE MILLION POPULATION PER YEAR FOR AGRANULOCYTOSIS AND TWO PATIENTS PER ONE MILLION POPULATION PER YEAR FOR APLASTIC ANEMIA.
    [Show full text]