In a randomized, nonblinded clinical trial, 36 consecutive patients with generalized convulsive status epilepticus were treated with either combination diazepam and phenytoin (DZ/DPH) or phenobarbital (PB). Phenytoin was added to the PB regimen if seizures persisted for 10 minutes after beginning therapy. The cumulative convulsion time (total time spent in active convulsive movements) was shorter for the PB group than for the DZ/DPH group (median, 5 versus 9 minutes, p less than 0.06); the response latency (elapsed time from initiation of therapy to the end of the last convulsion) was also shorter for the PB group (median, 5.5 versus 15 minutes, p less than 0.10). The median cumulative convulsion time is between 0 and 14 minutes shorter for the PB regimen than for the DZ/DPH regimen (95% confidence interval). Similarly, the median response latency for the PB regimen is between 1 minute longer and 20 minutes shorter than that for the DZ/DPH regimen (95% confidence interval). The frequencies of intubation, hypotension, and arrhythmias were similar in the two groups. Eleven of 18 patients in the PB group responded to phenobarbital monotherapy. We conclude that the PB regimen is rapidly effective, comparable in safety, and enjoys certain practical advantages in comparison with the DZ/DPH regimen.

No abstract

No abstract

No abstract

SUMMARY Thirty‐five epileptic patients with co‐existent focal and bilaterally synchronous, diffuse paroxysmal electrographic discharges are evaluated and their electrographic features are correlated with clinico‐pathological data. The findings are compared with information derived from a control group of 67 patients with clearly defined and uncomplicated focal epileptiform discharges. Statistically significant differences were found between the control and study groups in regard to the following variables. The mean age of onset of seizures and age at the time of EEG recording of the study group was lower and the mean interval of time between the two events was shorter. The age distributions within the two groups were different in a similar manner. A greater number of patients with frontal foci and fewer with temporal foci were found in the study group. Excessively slow background rhythms occurred more frequently in the study group. Partial, complex seizures with or without secondary generalization were more common in the control group. Focal or lateralizing neurologic signs were more common in the study group. Non‐electrographic evidence of cerebral abnormality extending beyond the temporal lobe in patients with temporal foci was more common in the study group. When the effect of age was minimized by age matching the differences of the variables outlined above remained significant. Patients with electrographic foci consistent with the clinical seizure pattern, abnormal findings on neurological examination and contrast radiography had electro‐graphic evidence suggesting a lesion in areas other than the frontal region. The localizing value of foci in the frontal regions, when associated with bilaterally synchronous discharges, would appear to be questionable: such foci were generally not supported and, in some cases, were actually contradicted by the various clinical data. RÉSUMÉ Trente‐cinq malades épileptiques qui présentent des paroxysmes EEGraphiques focalisés aussi bien que généralisés (bilatéraux synchrones et diffuses) sont étudiés, les données de l'EEG étant corrélées avec le tableau clinico‐pathologique. Les résultats sont comparés avec ceux obtenus dans un groupe (contrôle) de soixante‐sept épileptiques dont l'EEG présente seulement des décharges épileptiformes focales. Des différences statistiquement significatives entre les deux groupes ont été trouvées pour les facteurs suivants. L'âge moyen du début des crises et l'âge moyen au moment du premier enregistrement EEG sont plus bas et l'intervalle de temps moyen entre ces deux événements est plus court dans le groupe étudié que dans le groupe contrôle. Les distributions d'âge dans les deux groupes montrent une différence semblable. Dans le groupe étudié on trouve un plus grand nombre de malades avec un foyer frontal et moins de cas avec un foyer temporal. Les rythmes de base anormalement lents sont observés plus fréquemment dans le groupe étudié. Les crises partielles à séméiologie élaborée sont plus communes dans le groupe de contrôle. ...