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Preeclampsia, also called toxemia of pregnancy, is a condition of hypertension, proteinuria, and edema that usually occurs in the third trimester of pregnancy. The condition may progress to eclampsia, or seizures and coma. The physiological mechanisms underlying eclampsia are not understood, and therapy is limited to treating symptoms. Many clinicians advocate the continued use of magnesium sulfate in the treatment of eclamptic seizures, but this has led to some confusion. Magnesium sulfate is not an anticonvulsant. Magnesium sulfate has found some use in the treatment of selected cases of cerebral ischemia (decreased blood flow in the brain), and it may turn out that its value in eclampsia results from a similar ''anti-brain damage'' effect. However, the authors state that when seizures occur, anticonvulsant therapy must be initiated. Since eclamptic seizures are electrophysiologically indistinguishable from generalized tonic-clonic seizures, it does not seem unreasonable to apply similar treatment. Such treatment includes, of course, drugs such as phenytoin (dilantin). Compared with magnesium sulfate, phenytoin causes fewer side effects, is better tolerated by patients, and has a lower incidence of hypotonic contractions. The authors emphasize that they are not addressing the use of magnesium sulfate in the treatment of preeclampsia, or whether magnesium sulfate might modify some of the physiological factors leading to eclampsia. They suggest, however, that rather than continue to accept without challenge the preeminence of magnesium sulfate in the treatment of eclampsia, the effectiveness of different agents in the control of eclamptic seizures should be evaluated by controlled clinical trials. (Consumer Summary produced by Reliance Medical Information, Inc.)

Adrenoleukodystrophy is an X-linked metabolic disorder with very-long-chain fatty acid (VLCFA) accumulation and multifocal nervous system demyelination, often with early involvement of visual pathways. Dietary therapy with glycerol trioleate and glycerol trierucate (Lorenzo oil) diminishes VLCFA levels. In a study of patients with the adrenomyeloneuropathy phenotype of adrenoleukodystrophy, we used pattern-reversal visual evoked potentials to evaluate visual pathways before and after treatment. Of 108 patients tested, all 26 women and 68 of the 82 men had normal potentials at baseline. Seventy patients were retested at 1 year, at which time VLCFA levels were markedly diminished. Of them, the responses in the 10 men who showed abnormalities at baseline remained abnormal; the latencies in 4 men with initially normal responses became abnormal. No patients improved. There were no correlations between disease duration prior to treatment, baseline P100 latencies, VLCFA levels, or the change in P100 latencies and VLCFA levels after dietary treatment for 1 year. Pattern-reversal visual evoked potentials were abnormal in 17% of the men with adrenoleukodystrophy, and there was no evidence that reduction of VLCFA levels improved or retarded visual pathway demyelination. (1993;34:169-174) Peter W. Kaplan et al, Department of Neurology, Francis Scott Key Medical Center, 4940 Eastern Ave, Baltimore, MD 21224.

Epilepsy is a condition of the central nervous system that is characterized by recurrent seizures. The goal of management is to make patients seizure free without intolerable adverse effects from treatment. Men and women differ in their physiologic makeup and therefore have different needs that must be considered when attempting to attain this goal. There are special concerns for women of child-bearing years with regard to contraception, pregnancy, and teratogenicity that should be consided during counseling and selection of appropriate treatment. There are also emerging concerns about the interaction of antiepileptic drugs and endocrine function that can affect ovarian function, induce polycystic ovary (PCO)-like syndrome, and threaten fertility. Systemic adverse effects can have a negative impact on weight, cosmetic appearance, sexual function, and bone health. Individualized treatment coupling antiepileptic drug use and the specific phase of impact of the reproductive cycle must be considered in treatment selection. Important concerns regarding long-term therapy are being raised as there are more treatment options to consider because of the plethora of new antiepileptic drugs that are available, often with more favorable pharmacokinetics and different adverse event profiles. Also, sex hormone fluctuations during maturation may exacerbate seizures at particular points during the life cycle for women, including menarche, during menses, during pregnancy, or later in the perimenopausal years, often presenting a uniquely challenging aspect to treatment. As the number of available treatment options for epilepsy increases, the optimal goal for primary care physicians is to work as a team with obstetricians, gynecologists, and neurologists in an effort to ensure the best treatment of women with epilepsy. [ABSTRACT FROM AUTHOR]

Presents a case report on an aged man with severe tophaceous gout affecting the proximal hand joints. Clinical presentation of the patient; Medical diagnosis administered to the patient.