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The therapeutic dose for any given patient must be determined, to some extent, by trial and error and by measurement of serum levels, as described below. Not uncommonly a drug is discarded as being ineffective, when a slight increase in dosage would have led to suppression of the attacks. It is, however, also an error to administer a drug to the point where the patient is so dull and stupe ed that the toxic effects are more incapacitating than the seizures. It is highly doubtful that prolonged administration of anticonvulsant medication is a factor in the development of the mental deterioration that occurs in a small percentage of patients with convulsive seizures. In fact, improvement in mentation more often occurs following control of the seizures by the proper dosage of appropriate antiepileptic drugs. The management of seizures with drugs is greatly facilitated by having patients chart their daily medication and the number, time, and circumstances of seizures. Some patients nd it helpful to use a dispenser that is lled on Sunday, for example, with suf cient medication to last the week. This indicates to the patient whether a dose had been missed and whether the supply of medications is running low. The proper use of anticonvulsant drugs is considerably enhanced by the measurement of their serum levels. The concentrations of almost all the commonly used drugs can be measured on a single specimen by immunoassay or by the older gas-liquid chromatography method. These measurements are helpful in regulating dosage, detecting irregular drug intake, identifying the toxic agent in patients taking more than one drug, and assuring patient compliance. Blood for serum levels is ideally drawn in the morning before breakfast and the rst ingestion of anticonvulsants ( trough levels ), a practice that introduces consistency in the measurement of drug concentrations. The effective serum levels for each of the commonly used anticonvulsant drugs are indicated in Table 16-5. The upper and lower levels of the therapeutic range are not to be regarded as immutable limits within which the serum values must t. In some patients, seizures are controlled at serum levels below the therapeutic range; in others, the seizures continue despite serum values within this range. In the latter patients, seizures are sometimes controlled by raising levels above the therapeutic range but not to the point of producing clinical toxicity. In general, higher serum concentrations of drugs are necessary for the control of simple or complex partial seizures than for the control of tonic-clonic seizures alone. It is to be noted that the blood level is not a precise measure of the amount of drug entering the brain, because in the case of the most widely used anticonvulsants the larger proportion of effects to transmit any information such as data from an atomic clock.) We can say that the speed of light is the speed of time. Distance and time are inextricably related. Bockground. Linear algebraicequationscan arise when modeling distributed systems. For example,Fig.9.7 shows a long, thin rod positionedbetweentwo walls that are held at constant temperatures.Heat flows through the rod as well as between the rod and the surrounding air. For the steady-state case,a differential equation basedon heat conservation can be written for such a system as d2T ax- Once You Cast an Image, It Is Difficult to Change Client Side
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