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Resolution was defined as achieving the severity component of the remission criteria (simultaneous ratings of mild or less on 8 of the PANSS items evaluating the core symptoms of schizophrenia). Analysis of a 6-week open label study with olanzapine 5-20 mg in 306 patients with acute exacerbation, shows resolution to be a clinically meaningful measure and an achievable outcome for treatment of acute psychosis.

OBJECTIVE This 6-week, open-label study with olanzapine was designed to determine the onset of antipsychotic action of a 10-mg/day starting dose of olanzapine, continued as a fixed dose for at least 4 weeks. METHODS A total of 306 patients experiencing an acute exacerbation of schizophrenia were prospectively followed-up. Response was defined as a 20% improvement on the Positive And Negative Syndrome Scale (PANSS) positive score, sustained until week 6. Onset of action was defined as the time point at which a 20% improvement in positive symptoms occurred and was maintained to week 6. RESULTS Significant improvements from baseline were observed throughout the study with respect to PANSS positive and PANSS total score (P<0.001). Within the first week of treatment, 20.6% of patients showed a 20% decrease in PANSS positive score, which was maintained until week 6. By weeks 2, 3 and 4 the percentage of responders had risen to 38.2, 49.7 and 52.3%, respectively. Olanzapine 10 mg/day was well tolerated, with the frequency of extrapyramidal symptoms and sexual dysfunction markedly lower following treatment than at baseline. CONCLUSION In this clinical open study, about half of the patients showed a response within 3 weeks, which is at least maintained until week 6.

Purpose: To evaluate the long-term clinical usefulness of levetiracetam (LEV, Keppra((R))(1)) as add-on therapy in patients with refractory epilepsy., Methods: Data for all 1422 patients with refractory epilepsy treated with LEV during the development program were analyzed for changes in seizure frequency per week, seizure freedom, and adverse events., Results: Median percent reduction from baseline in seizure frequency per week over the whole treatment period was 39.6%, and no decrease over time was observed within each cohort exposed to LEV for durations ranging from 6 to 54 months. The median treatment period was 399 days (range 1-8 years). The proportion of responders during the first 3 months of LEV treatment was 39.2%. This proportion remained stable at 6 months (36.1%). Overall, 38.6 and 20.1% of patients had reductions in seizure frequency of at least 50 and 75%. Sixty-five (4.6%) patients were seizure-free over their entire treatment period, compared with 167 (11.7%) and 126 (8.9%) during their last 6 and 12 months of follow-up. Ninety-seven (19.8%) of 491 patients who received only one other antiepileptic drug (AED) in addition to LEV were seizure-free during their last 6 months. The proportion of patients who reduced their number of concomitant AEDs was 14.4% (205 patients), while 5.5% (79 patients) were treated with LEV only at the end of follow-up. Accidental injury (28.0%), infection (26.6%), headache (25.8%), somnolence (23%), asthenia (22.6%), and dizziness (18.9%) were among the most common adverse events., Conclusion: LEV offers sustained efficacy in patients with refractory partial seizures, and its long-term tolerability is similar to that seen in the short-term placebo-controlled trials.

Piracetam (PIR) and levetiracetam (LEV), an S-enantiomer, are pyrrolidone derivatives that share similar chemical structures but have distinct pharmacological profiles and consequently different clinical uses. Although the mode of action of neither drug has been fully elucidated, they do not interact with inhibitory or excitatory neurotransmission or alter membrane excitability. A brain-specific stereoselective binding site has been identified for which LEV and other S-enantiomers, but not PIR, have high affinity. In preclinical studies, PIR significantly improves learning and memory; in contrast, LEV has less effect but is much more active in preventing seizures. Both drugs have a high therapeutic index and are well tolerated. PIR, a nootropic drug, is used in the therapy of age-related cognitive disturbances and poststroke aphasia. Clinical experience has also shown that at high doses it is effective against cortical myoclonus. LEV is an antiepileptic drug. Clinical trials have confirmed its efficacy in partial seizures and preliminary findings suggest that it is also effective in generalized seizures and myoclonus.

The primary objective of this study was to investigate the economic impact of treatment of acute ischaemic stroke with piracetam vs placebo according to the societal perspective in France. Socio-demographic, clinical and resource utilisation data for piracetam and placebo patients during the acute phase following stroke was obtained from the Piracetam Acute Stroke Study (PASS) clinical trial database. The economic analysis was based on the population defined as being treated within 6 h 59 min following stroke and presenting an initial Orgogozo score of less than 55. Resource utilisation data concerning the rehabilitation phase, outpatient follow-up and institutionalisation was obtained from decision tree analysis. There was a higher percentage of autonomous patients in the piracetam group (27.8%) compared to placebo (22.9%). The mean duration of hospitalisation (autonomous 21.8 days; non-autonomous 30.3 days) and the cost of an autonomous patient was lower than a non-autonomous patient. The total cost per stroke patient receiving piracetam was estimated at 103 KF during the 6-month period, compared to 106 KF per placebo patient. The major cost driver was hospitalisation during the acute phase, representing approximately 50% of the total cost per patient. In patients with moderate to severe stroke treated within 6.59 h, piracetam was cost-effective compared to placebo over the 6-month study period.

Objective: To determine whether piracetam 4.8 g/day together with intensive language therapy improved language function more than language therapy alone., Design: Double-blind, placebo-controlled parallel group study., Setting: Referral speech and language clinic of a university department of neurology., Patients: Sixty-six inpatients with aphasia present between 4 weeks and 36 months., Interventions: Intensive language therapy for 6 weeks in all patients. Thirty-two patients received piracetam 4.8 g daily and 34 patients received placebo., Main Outcome Measure: The Aachen Aphasia Test (AAT), a standardized procedure for evaluating the severity of aphasia, was performed at baseline and after 6 weeks' treatment., Results: In 50 patients evaluated for efficacy, a trend toward improvement in the active group was observed in all subtests of the AAT. This trend was statistically significant for absolute differences in recovery of "written language" and "profile level.", Conclusion: Piracetam appears to have a positive adjuvant effect on the recovery of aphasia in patients receiving intensive language therapy.

Myoclonus is a rare, but disabling symptom, occurring in a number of diseases of different origin. Aetiological and neurophysiological classifications, as well as the current treatment in myoclonus are discussed. An overview of the treatment of myoclonus with piracetam in 62 case reports, 3 open trials and 2 doubleblind trials, covering 171 patients is reported.

Dural sinus thrombosis developed in two young women with paroxysmal nocturnal haemoglobinuria (PNH). The incidence, the clinical presentation, the radiologic findings, the therapy and the pathophysiology of haemolysis and thrombosis are discussed.