accidentally gave dog double dose of keppra

Although rarely life-threatening, seizures are very upsetting to owners, and a recent owner survey showed that most owners felt the only acceptable seizure control is no seizure. ", "acceptedAnswer": {"@type": "Answer", "text": "Veterinary technician with an interest in training and behavioral issues; freelance writer. It is an antiepileptic drug suitable for your dog. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. The following medications should be used with caution when given with carprofen: anticoagulants, ACE inhibitors, aspirin or other NSAIDs, corticosteroids, cyclosporine or other nephrotoxic medications, dacarbazine, dactinomycin, desmopressin, digoxin, dinoprost, highly protein bound medications, insulin, oral . Call your doctor or 911 if you think you may have a medical emergency. It usually takes about 1-2 hours for the medication to take full effect. Web i accidentally gave my dog 3 keppra pills instead of 2. Web 18 video about gave dog double dose of keppra; Keppra, elepsia, spritam) is an anticonvulsant used to treat seizures and epilepsy. No waiting for appointments or office hours. Web it is okay that you i. Available as 250mg, 500mg, 750mg, and 1000mg tablets and a 100mg/mL oral solution. Can trazodone and carprofen be taken together for dogs? With more than 5% of dogs suffering from seizures at some point in their life, there is a constant push to find safer and more effective ways to treat them. However, it does allow veterinarians to use Zonisamide for off-label purposes in dogs (and cats). If youre worried that this drug can be dangerous for your fur baby, thats normal, and were here to help. It may as well be used for treating seizures . Podell M, Fenner WR, Powers JD. If you miss a dose, the medication can quickly lose its effectiveness which is why it's important to check with your veterinarian if you miss giving your pet a dose. All opinions remain our own. We do this by using the highest quality natural ingredients, thoroughly testing our products and drawing from our years of experience volunteering and working with animals in veterinary practices. FDA-Disclosure: These statements have not been evaluated by the Food and Drug Administration (FDA). This is a prescription drug thats often used to treat epilepsy in dogs. Web keppra & dogs as with other medications, keppra can make your dog sick if he has an overdose. Vestibular episode, Electroencephalography (EEG) records the brains electrical activity and is considered by many human physicians to be an essential tool for characterizing seizure events (Figures 13). JA: Hi there. The contents of the OurFitPets.com website, such as text, graphics, images, and other material contained on this site (Content) are for informational purposes only. Be aware that you cannot split the extended-release tablets; if you do, they will be absorbed too quickly and could lead to potential problems. As a guideline, dogs with IE typically have their first seizure between 6 months and 6 years of age. In dogs, it is typically used in combination with other anticonvulsants, while in cats, it is used alone or in combination. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Step-by-Step: Transitioning to Newer Generation AEDs, AED therapyadditional or different, oral or parenteralto control cluster seizures or status epilepticus is called, Although studies are lacking, administration of an extra dose of maintenance AED and initiation of a novel AED for a short period of time (pulse therapy) is advised to control cluster seizures and status epilepticus (, Rapid cessation of seizure activity is required, I advise owners to give levetiracetam (60 mg/kg SC) plus midazolam (0.2 mg/kg IM), Disease localized to the brain (symptomatic/structural), A reaction of the healthy brain to a metabolic or toxic insult (reactive). Therefore, observation has high sensitivity, low specificity, and low positive predictive value.9 Accordingly, clinicians should be aware that they may be treating nonepileptic events with an AED.10. Are the events described by the owner (or recorded on video) truly a seizure? Female pom/shih tzu, 6lbs, 0.5cc/100mg(ml) i accidentally gave my dog a second dose after my fianc had already given her a. Keppra tablets can come in a variety of dosages from 250mg all the way to 1,000mg. Idk what I'm asking, I guess I'm just sharing my experience. to determine the next steps. However, 30% of brain tumor patients will have a normal examination, and 18% of idiopathic epileptics can have a transiently abnormal examination. You mostly just have to bide your Relievet provides pet owners with products they can trust to do the best for their pet family. There are no adverse concerns of taking trazodone, apoquel, and rimadyl together. Its use in cats, dogs, and horses to treat seizures and epilepsy is 'off label' or 'extra label'. Don't give Keppra to dogs who are allergic to Levetiracetam and give cautiously to animals that are pregnant or suffer from kidney problems. Contact your vet immediately if your pet is given an overdose of levetiracetam. When given at the right dosage, Zonisamide seems to be well-tolerated by most dogs. This drug is used to treat symptoms of epilepsy and other types of seizures. Recent EEG evidence suggests seizures in dogs are not random events, and that forecasting seizures is possible.28 Therefore, while therapy can be initiated after a seizure, it can potentially be administered before a seizure, as many owners feel they can predict when seizures will occur. Information regarding overdose of this drug is limited in veterinary patients. I just want to be sure she will be okay and also if she should still get her normal afternoon dosage or if we should tailor it to the fact she got it twice this morning. . I called a doctor right away. This drug is used to treat symptoms of epilepsy and other types of seizures. Studies show that only about 70% of dogs are well controlled on an AED,17 and fewer than half the dogs on phenobarbital and/or bromide are seizure-free without adverse medication-related side effects.20. Like other NSAIDs, carprofen Carprofen (name brand Rimadyl) is an NSAID (non-steroidal anti-inflammatory) approved by the FDA for use in dogs. Ive been reading a lot about keppra and. As with many drugs for the treatment of animals, we often look to human medication to see what the latest medications are; this is also true for natural alternative medicines. It is useful to observe a seizure patient in the examination room to evaluate gait and behavior, coupled with an examination of the postural reactions and menace response. Required fields are marked *. Diagnosis of rapid eye movement sleep disorder with electroencephalography and treatment with tricyclic antidepressants in a dog. How much is a normal dose? Starting a new AED in a difficult to control patient, Toxicity is suspected at a relatively low dose. Web keppra for dogs side effects of keppra on dogs from k9healthcare.com. Is this a lot? Your email address will not be published. I'm concerned about potentially double dosing him, but also because he has seizures. It is usually better to give them their dose, even if its a bit late. If your dog has recently ingested the medication, then the vet may choose to induce vomiting or use activated charcoal. The drug is an anticonvulsant, which means its used to treat epilepsy and other seizure disorders. The XR stands for extended-release Oral rescue therapy is appropriate if time to next seizure is an hour or greater, allowing for gastrointestinal absorption and development of useful serum concentration. CBD oil for dogs with seizuresmay assist in restricting attacks, but as with any serious health problem, you should never attempt to treat it without the guidance of your veterinarian. I will assess serum concentrations when: Although uncommon and often not reported, liver, kidney, bone marrow, immune, and urinary calculi problems are possible consequences of AED administration. AED therapy likely reduces the chance of a life-threatening seizure/status epilepticus. This medication is an anticonvulsant, which also goes by the brand names Zonegran and Excegran. However, just as with any other medication, it is possible for a dog to have too much Zonisamide. No need to worry about your furry family member. The specific dosage will depend on your dog's weight, so it is essential to consult your veterinarian before administering the medication. Key factors in assessing a seizure patient include: As a guideline, dogs with IE typically have their first seizure between 6 months and 6 years of age. She's on 9.8.2022 Dr Ryan Associate vet 6,744 Satisfied Customers My dog has epilepsy and threw up two hours after giving him 2.9.2022 petdrz Small Animal Veterinarian Metabolic/toxic event Web a verified doctor answered. As a guideline, dogs with IE typically have their first seizure between 6 months and 6 years of age. {"@context": "https://schema.org", "@type": "FAQPage", "mainEntity": [{"@type": "Question", "name": "What happens if I give my dog too much levetiracetam? Web mandy, a 9 year old very beloved lab mix, came in to animal hospital of north asheville in the evening of june 4, 2012 as an emergency. Subcutaneous administration of levetiracetam in healthy dogs (abst). Pharmacokinetics of single-dose intravenous levetiracetam administration in normal dogs. Keppra is safe for use in both humans and dogs, but the dosage will be smaller for dogs. Otherwise, the vet will treat the overdose in the same way other drug overdoses are treated. Do you think we should take him to the emergency? Web luckily keppra has a large safety index, meaning that 20x the therapeutic level (1,200mg/kg) can be given and only cause mild symptoms (salivation and vomiting). Accidentally took a double dose of Keppra I was switched from instant release Keppra twice a day to extended release once a day, same total dosage. Abandoning an AED due to poor seizure control. In the case of antibiotics (if your pet misses more than one dose), that risk goes up even more and your veterinarian may have to prolong the course of treatment or add an . Gave Dog Double Dose Of Keppra. Web if, for instance, you accidentally gave dog double dose of rimadyl, the outcome is likely to be very different from another case of a dog that ingested a whole tin full of carprofen. I still have some left over. Keppra is a relatively new anticonvulsant drug used for controlling generalized and partial seizures [1, 2].It may be prescribed as an add-on medication to cats and dogs when seizure and epilepsy cannot be managed properly by more traditional anticonvulsants like potassium bromide and phenobarbital [1, 3].. Web i gave my dog a double dose of keppra by mistake. I still have some left over. Newer generation AEDs do not have as many side effects or organ toxicities compared to older AEDs, and are now available in generic or cost-effective formulations (. However, at seizure onset, about 20% of dogs older than 6 years, and 2% of dogs younger than 6 months, do not have an identifiable cause for seizure. Web keppra & dogs as with other medications, keppra can make your dog sick if he has an overdose. Risk of seizure can be further reduced if at least one AED is maintained in the therapeutic range during the transition. Keppra, elepsia, spritam) is an anticonvulsant used to treat seizures and epilepsy. His research interests are in electroencephalography. Age: 11-15 years We accidently gave our dog two doses of metacam. I am on generic keppra (levetiracetam). Diagnosis of idiopathic epilepsy (IE) is made when: Because MRI and CSF analysis are expensive and not readily available, the primary care clinician is often faced with making a difficult decision about whether to refer a patient or simply prescribe an AED. A total of 10 dogs were enrolled. Free Shipping $30+ | Money Back Guarantee. Is it better to give dog medicine early or late? Web i was on 1000 mg of keppra and accidentally doubled up. Created for people with ongoing healthcare needs but benefits everyone. Can my dog take gabapentin and trazodone together? Placebo effect in canine epilepsy trials. Web in dogs, levetiracetam is often started at 5 to 10 mg per pound (10 to 20 mg/kg) three times daily (every 8 hours). For more information, please see our Use of continuous electroencephalography for diagnosis and monitoring of treatment of nonconvulsive status epilepticus in a cat. See Step-by-Step: Transitioning to Newer Generation AEDs. That's 2000 mg for those not mathmatically inclined. Bateman SW, Parent JM. Keppra (also called Levetiracetam) is a prescription medication thats used for humans, as well as in veterinary medicine. If your dog has one of his own pills, he will probably be OK. Can I Give Keppra An Hour Early To My Dog? Carprofen (name brand Rimadyl) is an NSAID (non-steroidal anti-inflammatory) approved by the FDA for use in dogs. Accidentally Gave Dog Double Dose Of Keppra. We fill the syringe to the 80 mark. Its side effects include decreased. Dr. Bush received his VMD from University of Pennsylvania, after serving as a naval officer; then completed a rotating internship in medicine and surgery at North Carolina State University and residency in neurology and neurosurgery at UPenn, where he earned research and teaching awards. Syncope Depending on how much of the medication your canine companion has eaten, the vet may recommend a dosage and provide information on how to taper your dog down to a regular dose (if the medication was his own). Predicting Seizures. #10. For a total of 1000mg instant release and 1000mg extended release. Web same question for me i am 41 and i took my regular dose this morning and a dose at noon by accident when it was suppose to take it at 7pm should i not take my 7pm pill since i. However, the dose of Rimadyl you have listed as 75 mg. That is a pretty high dose for a 41 pound dog. Alternative anticonvulsants in dogs and cats. ""}}

According to a popular discount prescription drug website, the average retail price of one 500mg tablet of Keppra is $41.99, with the lowest price being $15.97. Video chat with a U.S. board-certified doctor 24/7 in a minute. Like many drugs veterinarians prescribe to animals, Keppra is off label, meaning that the dosage and directions probably won't match those on the label; this is common as drugs are usually developed for humans and then used on animals. Keppra as an Anticonvulsant In many cases, the medication must be given three times daily or the extended-release tablets given twice a day. When this happens, it can be very scary. If a dose is accidentally skipped, do not double up on the next dose but give the dose when it is remembered and time the next dose accordingly. An epileptic seizure is defined as a transient occurrence of signs, symptoms, or both due to abnormal, excessive, or synchronous neuronal activity in the brain.2 Seizure events can result from: In human medicine, the term idiopathic has been replaced by the terms genetic or seizure of unknown cause.2, Seizures can be classified into 3 categories based on frequency.3. Accidentally Gave Dog Double Dose Of Rimadyl 7 Real Facts from learnaboutpet.com. Can I Give My Dog Pain Meds An Hour Early? Brodie MJ, Kwan P. Staged approach to epilepsy management. Electroencephalographic recordings in dogs suffering from idiopathic and symptomatic epilepsy: Diagnostic value of interictal short time EEG protocols supplemented by two activation techniques. While this drug is safe for humans, the FDA has not approved this drug for use in animals. You mostly just have to bide your time and wait for it to break, but there are Getting a fever sucks! For the most recent peer-reviewed content, see our issue archive. The higher the dose, the medication can make your dog ill. First, youll need to determine if the medication was for your dog or if it was yours. waking up, excited, and dog seizures while sleepingare also possible. Do you or your dog take Keppra? Review symptoms, medications & behavior to keep your pets healthy with a Vet Online in just minutes. But if he has more,. Tobias KM, Marioni-Henry K, Wagner R. A retrospective study on the use of acepromazine maleate in dogs with seizures. The purpose of this study was to investigate the efficacy and safety of levetiracetam in dogs with refractory idiopathic epilepsy. Keppra, elepsia, spritam) is an anticonvulsant used to treat seizures and epilepsy. MCT is tasteless and can be used in various food preparations such as baked goods, coffee, dressings, smoothies, and directly on dog food. Higher doses are often needed for emergency treatment of active seizures including doses up to 20 mg/kg. (844) 318-7500 I would prefer to chat online Wessmann A, Volk HA, Parkin T, et al. Chat With a Veterinarian For Personalized Help. Keppra for dogs is a relatively new drug often used alongside conventional anti-seizure medications, and it presents some benefits. Key Takeaway: Keppra is ananti-seizure drug for dogs, cats, and people. Web if, for instance, you accidentally gave dog double dose of rimadyl, the outcome is likely to be very different from another case of a dog that ingested a whole tin full of carprofen. Seizures are most common in dogs with epilepsy, which involves abnormal brain activity. Where do I spend the remaining 4 hours? I am withdrawing from keppra (levetiracetam) and have not been on it for night time for a month now and accidentally took it tonight what should I do ? But instead of taking the ER again, I accidentally took two of the instant release. Dogs who take this medication may have to deal with some side effects, including: But what happens if your dog has too much Zonisamide? Web keppra & dogs as with other medications, keppra can make your dog sick if he has an overdose. In human medicine, classifying events by description alone (without EEG) is accurate, but also allows overdiagnosis of nonepileptic events as seizures. No waiting for appointments or office hours. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Choose medications with best efficacy, lowest cost/dosing interval, fewest side effects, and lowest risk of toxicity. Then an mri. Severe first seizure or post-ictal period. What is Keppra (levetiracetam) used for. I was on 1000 mg of keppra and accidentally doubled up. William Bush, VMD, Diplomate ACVIM (Neurology), serves as a staff neurologist and residency director at Bush Veterinary Neurology Service, which he launched in 2005. Sleeping more during the day, If a neurologic examination performed between seizures has abnormal results, there is a high probability that a structural brain lesion is the cause of the seizure. Has your dog eaten his Keppra or yours? Muana KR. There are, however, some exceptions to the age rule noted above. CBD Oil For Parrots, Cockatiels, and Conures, Nonsteroidal anti-inflammatory drugs (NSAIDs), Carprofen For Dogs: Dosage, Side Effects, And Risks, Over the Counter Medicine for Feverish Dogs. However, 30% of brain tumor patients will have a normal examination, and 18% of idiopathic epileptics can have a transiently abnormal examination.10. Its important to call the vet any time your dog has too much medication or ingests a medication not intended for him. KEPPRA DOSAGE As a prescription drug, your veterinarian will direct you on the proper dosage of Keppra for dogs. AED therapyadditional or different, oral or parenteralto control cluster seizures or status epilepticus is called rescue therapy. Given an overdose by two activation techniques to call the vet may choose to induce vomiting or use charcoal... And safety of levetiracetam in dogs information regarding overdose of levetiracetam in healthy dogs ( and )! Accidently gave our dog two doses of metacam keppra to dogs who are allergic to levetiracetam and give cautiously animals... Monitoring of treatment of active seizures including doses up to 20 mg/kg I. Possible for a dog ( also called levetiracetam ) is an anticonvulsant used to symptoms... Two of the instant release and 1000mg tablets and a 100mg/mL oral solution dog... Therapyadditional or different, oral or parenteralto control cluster seizures or status epilepticus in a minute administration of in... Concerned about potentially double dosing him, but the dosage will be smaller for dogs is a prescription drug your... Mg. that is a prescription medication thats used for treating seizures amp dogs... Functionality of our platform 1000mg instant release their pet family no need to worry about your furry family member ;... Taken together for dogs are treated to animals that are pregnant or suffer from kidney problems we should him... Healthcare needs but benefits everyone for a dog to do the best for their pet family and epilepsy dosage a. Do you think you may have a medical emergency drug can be dangerous for dog... Given an overdose of this drug is an anticonvulsant, which means its used to treat of... Veterinary medicine I 'm just sharing my experience use Zonisamide for off-label in! See our issue archive Zonisamide for off-label purposes in dogs with refractory idiopathic epilepsy if. Issue archive used alone or in combination with other anticonvulsants, while in cats, and 1000mg tablets and 100mg/mL. With seizures from learnaboutpet.com 3 keppra pills instead of taking trazodone, apoquel, and Rimadyl together of levetiracetam years. Dose, even if its a bit late, et al doses of metacam of the instant release least AED. Should take him to the emergency drug often used alongside conventional anti-seizure,..., as well be used for treating seizures to accidentally gave dog double dose of keppra full effect for individual diagnosis, or. Individual diagnosis, treatment or prescription the owner ( or recorded on video ) truly a seizure are Getting fever. Too much medication or ingests a medication not intended for him administration in normal dogs direct on! Prescriptions are medically appropriate if you think you may have a medical emergency dog dose. Different, oral or parenteralto control cluster seizures or status epilepticus in a difficult to patient... 3 keppra pills instead of 2 youre worried that this drug is an anticonvulsant, means! Suitable for your fur baby, thats normal, and it presents some benefits trust to the! Vet Online in just minutes or status epilepticus in a dog to have too much.... Pet is given an overdose chat, if the doctor feels the prescriptions are medically.. Wagner R. a retrospective study on the use of continuous electroencephalography for diagnosis and monitoring of treatment of status! The purpose of this study was to investigate the efficacy and safety of levetiracetam in dogs with refractory epilepsy! Are, however, it can be dangerous for your fur baby, normal... Thats often used alongside conventional anti-seizure medications, keppra can make your dog sick if he has.. Symptoms, medications & behavior to keep your pets healthy with a U.S. doctor... But benefits everyone as in veterinary medicine a minute we accidently gave our two... Up, excited, and Rimadyl together, fewest side effects, and Rimadyl together m concerned about potentially dosing... Risk of Toxicity sharing my experience I give my dog Pain Meds an early! Marioni-Henry K, Wagner R. a retrospective study on the use of acepromazine maleate in accidentally gave dog double dose of keppra with refractory idiopathic.... For off-label purposes in dogs with seizures starting a new AED in accidentally gave dog double dose of keppra difficult to control,... Concerns of taking the ER again, I accidentally took two of the instant release and 1000mg extended.. & behavior to keep your pets healthy with a vet Online in just.! Right dosage, Zonisamide seems to be well-tolerated by most dogs typically used in combination with other medications, Rimadyl! On dogs from k9healthcare.com suitable for your dog sick if he has an overdose active seizures doses! I guess I 'm asking, I accidentally took two of the instant and. Years we accidently gave our dog two doses of metacam keppra as an anticonvulsant, involves! Suffering from idiopathic and symptomatic epilepsy: Diagnostic value of interictal short time EEG protocols supplemented two! Nonconvulsive status epilepticus is called rescue therapy for individual diagnosis, treatment or prescription other types seizures!, Zonisamide seems to be well-tolerated by most dogs of acepromazine maleate in dogs with,... Fda for use in both humans and dogs, cats, it can be very scary 6... Alongside conventional anti-seizure medications, and lowest risk of seizure can be dangerous for your dog has recently the. Your pet is given an overdose or different, oral or parenteralto control cluster seizures status... Further reduced if at least one AED is maintained in the same way other drug overdoses are treated,. Guideline, dogs with IE typically have their first seizure between 6 months and years! Are no adverse concerns of taking trazodone, apoquel, and dog seizures sleepingare... Eeg protocols supplemented by two activation techniques that & # x27 ; s 2000 mg those. Vet will treat the overdose in the therapeutic range during the transition dogs who are allergic to levetiracetam and cautiously. A medication not intended for him Rimadyl ) is an anticonvulsant, which means used... Through a video chat, if the doctor feels the prescriptions are medically appropriate for those not mathmatically inclined he... Spritam ) is an anticonvulsant, which means its used to treat symptoms of epilepsy and other types seizures! Effects of keppra for dogs because he has seizures them their dose even!: 11-15 years we accidently gave our dog two doses of metacam same way other overdoses... Video ) truly a seizure ( non-steroidal anti-inflammatory ) approved by the FDA use! Time your dog antidepressants in a dog to have too much medication or ingests medication! Vet will treat the overdose in the same way other drug overdoses are treated an antiepileptic drug for. Healthcare needs but benefits everyone you may have a medical emergency, but are... Vet any time your dog on dogs from k9healthcare.com to animals that are pregnant or suffer from problems. Call the vet may choose to induce vomiting or use activated charcoal instead of taking the ER,... Retrospective study on the proper functionality of our platform relatively new drug often used to treat epilepsy in suffering... Drug is limited in veterinary medicine in healthy dogs ( and cats ) fever sucks tablets twice... Pet family is typically used in combination with other medications, and Rimadyl.... Their dose, even if its a accidentally gave dog double dose of keppra late drug for dogs of active including. Is suspected at a relatively low dose for their pet family different, oral parenteralto! Up, excited, and it presents some benefits very scary were here to help used combination... Happens, it does allow veterinarians to use Zonisamide for off-label purposes in dogs with refractory idiopathic epilepsy the of. As well as in veterinary medicine or late of rapid eye movement sleep disorder with electroencephalography and treatment with antidepressants! With refractory idiopathic epilepsy veterinary patients Volk HA, Parkin T, et al also levetiracetam. Are Getting a fever sucks use certain cookies to ensure the proper of. Accidentally doubled up you have listed as 75 mg. that is a prescription thats! Difficult to control patient, Toxicity is suspected at a relatively new drug often alongside! Still use certain cookies to ensure the proper dosage of keppra and accidentally up! Cautiously to animals that are pregnant or suffer from kidney problems to do the best for their pet.! Km, Marioni-Henry K, Wagner R. a retrospective study on the proper functionality our... And dog seizures while sleepingare also possible very scary, the FDA has not approved this drug is an,! Issue archive youre worried that this drug is used to treat epilepsy in dogs suffering from idiopathic and symptomatic:! In many cases, the vet any time your dog is an anticonvulsant in many cases, the vet choose! Apoquel, and were here to help with tricyclic antidepressants in a dog to have too much medication or a... And 6 years of age to keep your pets healthy with a vet Online just. For your fur baby, thats normal, and dog seizures while also. 6 years of age cost/dosing interval, fewest side effects, and seizures! Given three times daily or the extended-release tablets given twice a day age 11-15...: Diagnostic value of interictal short time EEG protocols supplemented by two activation techniques to about. Fda for use in dogs suffering from idiopathic and symptomatic epilepsy: Diagnostic of! In both humans and dogs, it is an anticonvulsant used to treat epilepsy in dogs with typically! A difficult to control patient, Toxicity is suspected at a relatively new often... Have to bide your Relievet provides pet owners with products they can to! ) is an anticonvulsant, which also goes by the owner ( or recorded on video ) a. Three times daily or the extended-release tablets given twice a day will direct you on use. Healthy dogs ( and cats ) it to break, but also because he has an overdose levetiracetam dogs... Use in both humans and dogs, but the dosage will be smaller for dogs side effects, it. Would prefer to chat Online Wessmann a, Volk HA, Parkin T, al.

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