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Metoclopramide vs maxolon ium) were administered to groups of six. Four the six patients did not respond to treatment (two had a dose of 75 to 80 mg/day and two with a dose of 90 mg/day) but six the patients had a stable or decreasing rate of decrease in their seizure burden and did respond to treatment. Three of the six patients with response did get the full course but none of the three patients with response did fully respond and we saw no changes. Our patient did not get a dose and in our practice we do not give doses. However from reading the literature average dose of propranolol (in the first year of age) is 15 mg with 2 to 3 in the second year infants, but with the highest dose being 150 mg for the first 4 months and then decreasing to 30 50 mg per day by 6 months (or 30 to 50 mg per week) and then 50 mg to 80 per day thereafter. There are no safety warnings or recommendations for patients given doses less than 30 mg. The other five or six doses were 25 mcg to 50 mcg, and they were given once every 1 to 5 days in a 2 to 5 day schedule. I believe some patients may respond within 48 hours of starting the dose, but that has been found too. For our patient there was no response to propranolol within 48 hours. We followed the parents and patient throughout their treatment regimen, with the patient in clinic for 6 months following their first dose. As it turned out they were not continuing the propranolol dosage. They did see a nurse twice week and they took their medication during the day but they had taken no medications when we saw them. The father a nurse as needed and I saw them after school. The mother was not on anti-seizure medications, only used anti-epileptic drugs (clonazepam hydrochloride or phenylpropanolamine) for her epilepsy and she had not needed any anti-seizure medications in their practice at the time of presenting. Our patient did get seizure relief and got a control dose week and half before we started on the propranolol. My patient did not get a seizure control dose as he did not have a treatment-resistant seizure before the first dose. I believe this may be a result of difference in dose from propranolol versus maximum therapy. They had been taking propranolol to an extremely high dose and I believe they may not have been able to tolerate this dosage. The study from Journal of American Academy Neurology, published in December of 2013, was similar to ours in the type of patient they studied with a seizure burden of 80 days or less. In their study of patients with epilepsy, the dose they used was 75 to 80 mg/day with a total dose during their first year Cheap generic zoloft of life 3 Order gabapentin overnight to 4 mg total, but during another year they reduced the total dose to 2 or 3 mg. Their results do not apply to my patient. We have reviewed and looked for the same types of study in the literature, and we have only been able to find two randomized, placebo-controlled, placebo-controlled trial studies (where patients were given either a "dummy" dose containing the actual active or placebo) and two case series (where they used a low dose to see if the higher doses had Can i buy promethazine with codeine online some benefit). We did not find any studies using a high dosage (over 80 mg total dose) and so we have no idea of how much it might have affected our patient's seizure burden or control in their first two years of life. What do we have to show for our patient's treatment? We had no seizures. He two seizure exacerbations which were all refractory to anti-seizure medications (but he did have anti-epileptics). Our seizure threshold for epilepsy in an infant is 20 to 20-22. We only had one seizure in over two years of his life (and that was from the same seizure). I believe we have shown him significant decrease in that seizure burden. So, I find there are a great number of studies with small sample sizes, short duration (3 to 18 months), non placebo controlled, and in general with patients under 12 years of age and there are a number of other reasons which may explain why we have only been able to find one study with a high dosage. Are there any additional issues you can discuss? Well they used an in utero (first 12 weeks of life) dose vs the whole-time dose, so it's possible a child would develop tolerance even in the first year. use of 12 weeks could be because of other drugs (as a result of not being on them earlier) or the fact they may want drug working faster than later years to give children the best chance in life.
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