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Objective A multicenter study of phenobarbital versus valproate (i.e., the China 2-P vs. V study) was conducted to compare the efficacy and safety of phenobarbital and valproate for generalized convulsive status epilepticus (SE) in a multicenter trial design. Methods Three improvements (uniform intravenous pumping, pump speed adjustment according to adverse events and blood drug level monitoring) over a previous study were made regarding an intravenous regimen of phenobarbital and valproate in a multicenter, prospective, randomized, controlled study. Long-term electroencephalography (EEG) monitoring was performed after initial drug treatment. Termination, relapse, adverse event and poor prognosis rates in patients with generalized convulsive status epilepticus (GCSE) were compared. Results The rate of GCSE termination within one hour were significantly higher in the phenobarbital group (33 cases) than in the valproate group (36 cases) (84.8 % vs. 63.9 %, P = 0.048), but the rates of nontermination of EEG epileptic discharge within one hour were similar between the two groups (12.1 % vs. 8.3 %, P = 0.702). The relapse and adverse event rates were not significantly different between groups, but 3 hypoventilation events and 1 hypotension event occurred in the phenobarbital group compared to 0 in the valproate group. There were no cases of epileptiform EEG discharge relapse in the phenobarbital group, compared to 1 case in the valproate group. Conclusions The phenobarbital regimen evaluated in this study has a higher GCSE termination rate than the valproate regimen, indicating that the former is suitable for countries, regions and individuals with limited access to new antiepileptic drugs or limited economic means.

Electroencephalographic reactivity (EEG-R) is a major predictor of outcome in comatose patients; however, the inter-rater reliability is limited due to the lack of homogeneous stimuli and quantitative interpretation.EEG-R testing was employed in comatose patients by quantifiable electrical stimulation. Reactivity at different frequency bands was computed as the difference between pre- and post-stimulations in power spectra and connectivity function (including magnitude squared coherence and transfer entropy). The clinical outcomes were dichotomized as good and poor according to the recovery of consciousness. Signal discrimination of EEG-R was compared between the two groups.A total of 18 patients (43%) regained consciousness at a 3-month follow-up. In the patients who regained consciousness, the EEG power increased significantly (P 0.05) at the Alpha and Beta frequency bands after stimulation as compared to those with no behavioral awakening. Also, connectivity enhancement (including linear and nonlinear analysis) in the Beta and Gamma bands and connectivity decrease (nonlinear transfer entropy analysis) in the Delta band after stimulus were observed in the good outcome group.In this study, the combined use of quantifiable stimulation and quantitative analysis shed new light on differentiating brain responses in comatose patients with good and poor outcomes as well as exploring the nature of EEG changes concerning the recovery of consciousness.The combination of quantifiable electrical stimulation and quantitative analysis with spectral power and connectivity for the EEG-R may be a promising method to predict the outcome of comatose patients.

Disintegrant is a typical excipient that improves the solubility, dissolution and bioavailability of drug. In this study, the application of nanocrystalline cellulose (NCC) as a potential disintegrant in the preparation of tablet was investigated. Angle of repose of NCC was 44.26° which was between L-HPC and MCC suggesting a good fluidity of NCC. Swelling property of NCC was between CMS-Na and MCC indicating that NCC was of good absorbent ability. Carbonate calcium tablet of which NCC was used as a disintegrant exhibited fastest disintegration time than known disintegrants. The disintegration and dissolution tests demonstrated that NCC showed effective disintegrant properties, e.g. consistently fast disintegration, rapid dissolution, and effectiveness at low concentrations. Thus, we believe that NCC has a great potential as a disintegrant in tablets.