E-free after withdrawal of antiepileptic medication over one year were normal neurological examination and use of carbamazepine prior to withdrawal.94 In the context of NCC, this means that patients with normal neurological examination, those with clearance of NCC lesions and those that were treated with carbamazepine stand a good chance of remaining seizure-free after withdrawal of antiepileptic medication.However, well planned longitudinal studies are necessary to confirm the above assumptions. For withdrawal of antiepileptic medication in patients with NCC that have access to CT scanners various possible scenarios are laid out in Fig. 4 that may guide the clinician as to when withdrawal of antiepileptic medication in patients with epilepsy due to NCC seems justified. In the absence of CT the clinician may attempt to get serial T. solium cysticercosis antigen levels89 or electroencephalogram recordings and if this is not available, he may start slow tapering of antiepileptic medication under close supervision after the patient was seizure-free for at least one year. Factors influencing access to antiepileptic treatment in sub-Saharan Africa Biomedical treatment of people with epilepsy in subSaharan Africa may be affected by important sociocultural factors such as traditional beliefs and/or stigma95 and knowledge of these factors is crucial to make treatment successful. In this context the term `epilepsy treatment gap’ has been coined which represents the number of people with active epilepsy who have not accessed biomedical services or who are not on treatment or are on inadequate treatment.96 This treatment gap has two important components and includes access to health care and adherence to treatment.Table 1 Antiepileptic medication available in sub-Saharan Africa: drug loading, titration, and maintenance doses as well as side effects (in the order of their DactinomycinMedChemExpress Dactinomycin availability) Titration (usual adult maintenance dose) 30?0 mg p.o. every 3 days (long half-life) (y60?180 mg/day)Antiepileptic medicationStarting doseSide effects (list non-exhaustive) Fatigue, pronounced cognitive decline, headaches, ataxia, nystagmus, depression, agitation, aggression, hyperkinesia (children), megaloblastic anaemia,teratogenicity, vitamin K deficiency in new-borns; rapid titration in status: respiratory depressionRoute of administration Oral, i.v., s.c., i.m.Phenobarbitone 1. 30 mg p.o. 2. (rapid) 50 mg i.v., s.c. or i.m. every 6 hours diluted 1 : 10 with inj. water 3. (status) 20 mg/kg i.v. diluted 1 : 10 with inj. water (start with 200?00 mg) (maximum rate: 100 mg/minute) Carbamazepine 200 mg p.o.200 mg p.o. every 3 days (y800?2000 mg/day) 25?0 mg p.o. per day (y200?500 mg/day)Phenytoin1. 300 mg p.o. 2. (rapid) 600 mg p.o. for 3 days 3. (status) 1.5 g i.v. diluted 1 : 10 with inj. water (first 250 mg as bolus, next 500 mg in 0.5 to 6 hours, next 750 mg in 1?4 hours according to clinic) (maximum rate: 20 mg/minute)Vertigo, double vision, nystagmus, Oral ataxia, movement disorders, hyponatraemia, leucopenia, rash, nausea, fatigue, liver failure, teratogenicity Vertigo, double vision, nystagmus, Oral, i.v. (beware tremor, movement disorders, rash, of phlebitis) megaloblastic anaemia, leuco-, thrombopenia, fatigue, acne, PX-478 side effects osteopathy, gingival hyperplasia, liver failure, irreversible cerebellar atrophy, teratogenicity; rapid titration in status: cardiac dysrhythmias, hypotoniaPathogens and Global HealthVOL .NO .WinklerNeurocysticercosis in sub-Saharan AfricaFigure.E-free after withdrawal of antiepileptic medication over one year were normal neurological examination and use of carbamazepine prior to withdrawal.94 In the context of NCC, this means that patients with normal neurological examination, those with clearance of NCC lesions and those that were treated with carbamazepine stand a good chance of remaining seizure-free after withdrawal of antiepileptic medication.However, well planned longitudinal studies are necessary to confirm the above assumptions. For withdrawal of antiepileptic medication in patients with NCC that have access to CT scanners various possible scenarios are laid out in Fig. 4 that may guide the clinician as to when withdrawal of antiepileptic medication in patients with epilepsy due to NCC seems justified. In the absence of CT the clinician may attempt to get serial T. solium cysticercosis antigen levels89 or electroencephalogram recordings and if this is not available, he may start slow tapering of antiepileptic medication under close supervision after the patient was seizure-free for at least one year. Factors influencing access to antiepileptic treatment in sub-Saharan Africa Biomedical treatment of people with epilepsy in subSaharan Africa may be affected by important sociocultural factors such as traditional beliefs and/or stigma95 and knowledge of these factors is crucial to make treatment successful. In this context the term `epilepsy treatment gap’ has been coined which represents the number of people with active epilepsy who have not accessed biomedical services or who are not on treatment or are on inadequate treatment.96 This treatment gap has two important components and includes access to health care and adherence to treatment.Table 1 Antiepileptic medication available in sub-Saharan Africa: drug loading, titration, and maintenance doses as well as side effects (in the order of their availability) Titration (usual adult maintenance dose) 30?0 mg p.o. every 3 days (long half-life) (y60?180 mg/day)Antiepileptic medicationStarting doseSide effects (list non-exhaustive) Fatigue, pronounced cognitive decline, headaches, ataxia, nystagmus, depression, agitation, aggression, hyperkinesia (children), megaloblastic anaemia,teratogenicity, vitamin K deficiency in new-borns; rapid titration in status: respiratory depressionRoute of administration Oral, i.v., s.c., i.m.Phenobarbitone 1. 30 mg p.o. 2. (rapid) 50 mg i.v., s.c. or i.m. every 6 hours diluted 1 : 10 with inj. water 3. (status) 20 mg/kg i.v. diluted 1 : 10 with inj. water (start with 200?00 mg) (maximum rate: 100 mg/minute) Carbamazepine 200 mg p.o.200 mg p.o. every 3 days (y800?2000 mg/day) 25?0 mg p.o. per day (y200?500 mg/day)Phenytoin1. 300 mg p.o. 2. (rapid) 600 mg p.o. for 3 days 3. (status) 1.5 g i.v. diluted 1 : 10 with inj. water (first 250 mg as bolus, next 500 mg in 0.5 to 6 hours, next 750 mg in 1?4 hours according to clinic) (maximum rate: 20 mg/minute)Vertigo, double vision, nystagmus, Oral ataxia, movement disorders, hyponatraemia, leucopenia, rash, nausea, fatigue, liver failure, teratogenicity Vertigo, double vision, nystagmus, Oral, i.v. (beware tremor, movement disorders, rash, of phlebitis) megaloblastic anaemia, leuco-, thrombopenia, fatigue, acne, osteopathy, gingival hyperplasia, liver failure, irreversible cerebellar atrophy, teratogenicity; rapid titration in status: cardiac dysrhythmias, hypotoniaPathogens and Global HealthVOL .NO .WinklerNeurocysticercosis in sub-Saharan AfricaFigure.
