This study describes a process technology to maintain or improve the gas barrier property of ethylene vinyl alcohol (EVOH) barrier films after flexing. EVOH and polyethylene-grafted maleic anhydride (PE-g-MA) multi- and microlayer samples with 5, 19, and 35 layers were produced in a coextrusion line. Flexing was performed using a Gelbo flex tester (400 flexes). After flexing, pin hole tests were performed on the film and only those with fewer than two pin holes were re-tested for oxygen transmission rate (OTR). Pin holes decreased after 400 Gelbo flexes as the number of layers increased. The OTR on these films demonstrated that thin EVOH barrier layers can improve film flex crack resistance. This proves that for a given barrier resin total thickness the flex barrier property can be increased dramatically by microlayering.
Summary: Purpose: To define the risk of seizure recurrence (RSR) that families and physicians would accept before discontinuing antiepileptic drugs (AEDs) for children with controlled epilepsy. Methods : A questionnaire was completed by families of 76 children with epilepsy ≥ 3 months seizure‐free and by their attending epilepsy specialist (n = 4). Results: Forty‐two percent of families were unwilling to discontinue AEDs with an RSR of 25%. In contrast, 20% were willing to accept a > 75% RSR. Several factors differentiated the risk acceptable to families: previous seizure frequency (risk adverse with intermediate frequency), multiple seizure types (risk taking), grade or grades repeated in school (risk adverse), and the family's strategy of playing lotteries. Although families and physi‐cians were prepared to accept similar median RSR (35 and 40%, respectively), individual answers did not correlate (r 2 = ‐0.07). Physicians were unable to predict the families response (r 2 = 0.09). Conclusions: Our current practice is to discontinue AEDs after 2 years of seizure‐free results in seizure recurrence of 30–40%. This risk may seem excessive to more than half of families, whereas other families will risk stopping AEDs at higher risks of recurrence. Physicians are poor judges of the degree of risk that is acceptable to a particular family, which may account in part for the anxiety manifested by families at AED discontinuation.
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Summary: Purpose: Lamotrigine (LTG) is an antiepileptic drug (AED) recently released in several countries. It is effective for a variety of seizure types in adults and children both as an add‐on agent and in monotherapy, and is generally well tolerated. This report reviews the apparent risk factors for rash associated with LTG to determine whether and how the risk of serious rash can be minimized in practice. Methods: The panel of experts reviewed all published and unpublished data related to the incidence and risk factors for serious rash with LTG. Results: An allergic skin reaction occurs in ∼10% of patients, usually in the first 8 weeks. Rashes leading to hospitalization, including Stevens—Johnson syndrome and hypersensitivity syndrome, occurred in approximately one of 300 adults and one of 100 children in clinical trials and appeared to be increased with overrapid titration when starting therapy and with concurrent valproate (VPA). Conclusions: Recommendations are made for both minimizing the likelihood of serious rash and for management of rash in patients taking LTG. Risk of serious rash may possibly be lessened by strict adherence to manufacturer's dosing guidelines, particularly in patients who are at higher risk: those on concurrent VPA and in the pediatric population.
