Chapters authored
Epidemiology and Risk Factors for Suicide Among Adult Patients with Epilepsy
Suicides constitute a serious public health issue worldwide. The number of suicide victims has been increasing over the years. Susceptibility to suicidal behaviour depends on the interaction of a number of factors. The reasons for taking a decision on committing suicide may objectively seem prosaic, and yet, according to the victim, cannot be resolved in any other way. Very often, it is the disease which is a risk factor for suicide. Suicidal thoughts, suicidal behaviours and suicide attempts as well as committed suicides occur far more frequently in epileptic patients than in the general population. There are many reasons for suicides committed by patients suffering from epilepsy. This paper presents basic data on epidemiology and risk factors of suicide attempts among patients with epilepsy. Risk factors in this group of patients include, inter alia, prior suicide attempts, co-morbidity of epilepsy with depression and other mental disorders, early onset (before 18 years of age), type and frequency of epileptic seizures and the use of anti-epileptic drugs, particularly in polytherapy.
Part of the book: Epileptology
Epidemiological Study of Acute Poisoning for Antiepileptic Drugs: A 2-Year Retrospective Study in Cracow, Poland
The aim of this study was designed to examine the rate of occurrence of antiepileptic drug overdose in 2002 and 2012 in Cracow, Poland, and analyze the demographics and clinical features of the patients Antiepileptic drugs (AEDs) intoxication. A retrospective study included all the patients admitted in to the Toxicology Units in Cracow for AED intoxications in 2002 and in 2012. Patients were identified of discharge diagnoses (ICD-10). AED intoxication were 5.40% of the total admissions. Mean age of the patients was 35.88 ± 12.54 years. The female-to-male ratio was 1:1.7. The most frequent AED was carbamazepine (n = 140), followed by valproate (n = 31). The most frequent motivation was intentional intoxication (n = 166, 94.86%). Ethanol was coingested by 51 patients (29.14%). Most of the patients ingested other drugs (32%). Antiepileptic drugs intoxication accounted for only of 7.13% of all cases admitted to the abovementioned toxicology units in 2002 and 2012 in Cracow. Our studies show that most of the AED poisoning cases in those years were caused by drugs belonging to the old generation antiepileptic drugs, including carbamazepine and valproic acid. The majority of the intoxication cases was related to suicidal poisoning and commonest identified reason of self-intoxication were issues with self including attention-seeking behavior.
Part of the book: Epileptology
Acute Valproic Acid Intoxication: An Attempt at Estimating the Correlation Between Serum Level and Clinical Manifestations
We investigated the association between serum valproic acid (VPA) levels and clinical conditions in patients after acute intoxication with this drug. We performed a retrospective study of cases of VPA intoxications hospitalized in Toxicology Unit in Cracow in 2 years of observation. The study included 26 patients (age: 35.69 ± 12.93 years). In all patients, the VPA plasma level was higher than the therapeutic range, mean ± SD: 275.32 ± 135.97 μg/ml. About half of poisoned patients described in this report were treated with VPA prior to the poisoning. We noted four cases of mixed VPA intoxications with ethanol. Acute pulmonary failure was observed in two persons. The mean hospital stay for all patients was 4.69 days. This analysis demonstrates that increased serum VPA levels, in acute intoxication with this drug, were associated with the severity of poisoning — in PSS (P = 0.019) and in Matthews coma scale (P = 0.022), diastolic pressure (P = 0.022) and length of stay in hospital (P = 0.001). No correlation was detected between the serum VPA concentration and the heart rate and systolic blood pressure. In persons treated with VPA earlier, the course of poisoning was less severe, although these results were not statistically significant.
Part of the book: Epileptology