Posts Tagged pharmacological

[Poster] Effectiveness of Phenytoin and Levetiracetam for Seizure Prophylaxis Among a Traumatic Brain Injury Population: A Systematic Review

To examine the effectiveness of levetiracetam and phenytoin for seizure prophylaxis following brain injury.

Source: Effectiveness of Phenytoin and Levetiracetam for Seizure Prophylaxis Among a Traumatic Brain Injury Population: A Systematic Review – Archives of Physical Medicine and Rehabilitation

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[Abstract] Cannabis and other illicit drug use in epilepsy patients – Hamerle – 2013 – European Journal of Neurology.

Abstract

Background and purpose

This study aimed to assess the prevalence of illicit drug use among epilepsy patients and its effects on the disease.

Methods

We systematically interviewed epilepsy outpatients at a tertiary epilepsy clinic. Predictors for active cannabis use were analysed with a logistic regression model.

Results

Overall, 310 subjects were enrolled; 63 (20.3%) reported consuming cannabis after epilepsy was diagnosed, and 16 (5.2%) used other illicit drugs. Active cannabis use was predicted by sex (male) [odds ratio (OR) 5.342, 95% confidence interval (95% CI) 1.416–20.153] and age (OR 0.956, 95% CI 0.919–0.994). Cannabis consumption mostly did not affect epilepsy (84.1%). Seizure worsening was observed with frequent illicit (non-cannabis) drug use in 80% of cases.

Conclusions

Cannabis use does not seem to affect epilepsy; however, frequent use of other drugs increases seizure risk.

Source: Cannabis and other illicit drug use in epilepsy patients – Hamerle – 2013 – European Journal of Neurology – Wiley Online Library

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[ARTICLE] Fewer specialists support using medical marijuana and CBD in treating epilepsy patients compared with other medical professionals and patients: Result of Epilepsia’s survey – Full Text

EpilepsiaSummary

Objective

From May 20 to September 1 2014, Epilepsia conducted an online survey seeking opinions about the use of medical marijuana and cannabidiol (CBD) for people with epilepsy. This study reports the findings of that poll.

Methods

The survey consisted of eight questions. Four questions asked if there were sufficient safety and efficacy data, whether responders would advise trying medical marijuana in cases of severe refractory epilepsy, and if pharmacologic grade compounds containing CBD should be available. Four questions addressed occupation, geographic region of residence, if responders had read the paper, and if they were International League Against Epilepsy/International Bureau for Epilepsy (ILAE/IBE) members.

Results

Of 776 who started or completed the survey, 58% were patients from North America, and 22% were epileptologists and general neurologists from Europe and North America. A minority of epileptologists and general neurologists said that there were sufficient safety (34%) and efficacy (28%) data, and 48% would advise using medical marijuana in severe cases of epilepsy. By comparison, nearly all patients and the public said there were sufficient safety (96%) and efficacy (95%) data, and 98% would recommend medical marijuana in cases of severe epilepsy. General physicians, basic researchers, nurses, and allied health professions sided more with patients, saying that there were sufficient safety (70%) and efficacy (71%) data, and 83% would advise using marijuana in severe cases. A majority (78%) said there should be pharmacologic grade compounds containing CBD, and there were no differences between specialists, general medical personal, and patients and the public.

Significance

This survey indicates that there is a wide disparity in opinion on the use of medical marijuana and CBD in the treatment of people with epilepsy, which varied substantially, with fewer medical specialists supporting its use compared with general medical personal, and patients and the public.

Continue —> Fewer specialists support using medical marijuana and CBD in treating epilepsy patients compared with other medical professionals and patients: Result of Epilepsia’s survey – Mathern – 2014 – Epilepsia – Wiley Online Library

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[Research Reports] Pharmacotherapy for chronic cognitive impairment in traumatic brain injury.

BACKGROUND: Traumatic brain injury (TBI) is a major cause of chronic disability. Worldwide, it is the leading cause of disability in the under 40s, resulting in severe disability in some 150 to 200 million people per annum. In addition to mood and behavioural problems, cognition-particularly memory, attention and executive function-are commonly impaired by TBI. Cognitive problems following TBI are one of the most important factors in determining people’s subjective well-being and their quality of life. Drugs are widely used in an attempt to improve cognitive functions. Whilst cholinergic agents in TBI have been reviewed, there has not yet been a systematic review or meta-analysis of the effect on chronic cognitive problems of all centrally acting pharmacological agents.
OBJECTIVES: To assess the effects of centrally acting pharmacological agents for treatment of chronic cognitive impairment subsequent to traumatic brain injury in adults.
SEARCH METHODS: We searched ALOIS-the Cochrane Dementia and Cognitive Improvement Group’s Specialised Register-on 16 November 2013, 23 February 2013, 20 January 2014, and 30 December 2014 using the terms: traumatic OR TBI OR “brain injury” OR “brain injuries” OR TBIs OR “axonal injury” OR “axonal injuries”. ALOIS contains records of clinical trials identified from monthly searches of a number of major healthcare databases, numerous trial registries and grey literature sources. Supplementary searches were also performed in MEDLINE, EMBASE, PsycINFO, The Cochrane Library, CINAHL, LILACs, ClinicalTrials.gov, the World Health Organization (WHO) Portal (ICTRP) and Web of Science with conference proceedings.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) assessing the effectiveness of any one centrally acting pharmacological agent that affects one or more of the main neurotransmitter systems in people with chronic traumatic brain injury; and there had to be a minimum of 12 months between the injury and entry into the trial.
DATA COLLECTION AND ANALYSIS: Two review authors examined titles and abstracts of citations obtained from the search. Relevant articles were retrieved for further assessment. A bibliographic search of relevant papers was conducted. We extracted data using a standardised tool, which included data on the incidence of adverse effects. Where necessary we requested additional unpublished data from study
authors. Risk of bias was assessed by a single author.
MAIN RESULTS: Only four studies met the criteria for inclusion, with a total of 274 participants. Four pharmacological agents were investigated: modafinil (51 participants); (-)-OSU6162, a monoamine stabiliser (12 participants of which six had a TBI); atomoxetine (60 participants); and rivastigmine (157 participants). A meta-analysis could not be performed due to the small number and heterogeneity of the studies.All studies examined cognitive performance, with the majority of the psychometric sub-tests showing no difference between treatment and placebo (n =
274, very low quality evidence). For (-)-OSU6162 modest superiority over placebo was demonstrated on three measures, but markedly inferior performance on another. Rivastigmine was better than placebo on one primary measure, and a single cognitive outcome in a secondary analysis of a subgroup with more severe memory impairment at baseline. The study of modafinil assessed clinical global improvement (n = 51, low quality evidence), and did not find any difference between treatment and placebo. Safety, as measured by adverse events, was reported by all studies (n = 274, very low quality evidence), with significantly
more nausea reported by participants who received rivastigmine compared to placebo. There were no other differences in safety between treatment and placebo. No studies reported any deaths.
AUTHORS’ CONCLUSIONS: There is insufficient evidence to determine whether pharmacological treatment is effective in chronic cognitive impairment in TBI. Whilst there is a positive finding for rivastigmine on one primary measure, all other primary measures were not better than placebo. The positive findings for (-)-OSU6162 are interpreted cautiously as the study was small (n = 6). For modafinil and atomoxetine no positive effects were found. All four drugs appear to be relatively well tolerated, although evidence is sparse.

Source: Traumatic Brain Injury Resource Guide – Research Reports – Pharmacotherapy for chronic cognitive impairment in traumatic brain injury

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[ARTICLE] Selective serotonin reuptake inhibitors to improve outcome in acute ischemic stroke: possible mechanisms and clinical evidence – Full Text HTML

Abstract

Background: Several clinical studies have indicated that selective serotonin reuptake inhibitors (SSRIs) administered in patients after acute ischemic stroke can improve clinical recovery independently of depression. Due to small sample sizes and heterogeneous study designs interpretability was limited in these studies. The mechanisms of action whereby SSRI might improve recovery from acute ischemic stroke are not fully elucidated.

Methods: We searched MEDLINE using the PubMed interface to identify evidence of SSRI mediated improvement of recovery from acute ischemic stroke and reviewed the literature on the potential underlying mechanisms of action.

Results: Among identified clinical studies, a well-designed randomized, double-blind, and placebo-controlled study (FLAME – fluoxetine for motor recovery after acute ischemic stroke) demonstrated improved recovery of motor function in stroke patients receiving fluoxetine. The positive effects of SSRIs on stroke recovery were further supported by a meta-analysis of 52 trials in a total of 4060 participants published by the Cochrane collaboration. Based on animal models, the mechanisms whereby SSRIs might ameliorate functional and structural ischemic-brain damage were suggested to include stimulation of neurogenesis with migration of newly generated cells toward ischemic-brain regions, anti-inflammatory neuroprotection, improved regulation of cerebral blood flow, and modulation of the adrenergic neurohormonal system. However, to date, it remains speculative if and to what degree these mechanisms convert into humans and randomized controlled trials in large populations of stroke patients comparing different SSRIs are still lacking.

Conclusion: In addition to the need of comprehensive-clinical evidence, further elucidation of the beneficial mechanisms whereby SSRIs may improve structural and functional recovery from ischemic-brain damage is needed to form a basis for translation into clinical practice.

Continue —> Selective serotonin reuptake inhibitors to improve outcome in acute ischemic stroke: possible mechanisms and clinical evidence – Siepmann – 2015 – Brain and Behavior – Wiley Online Library

 

Possible mechanisms of action. The figure illustrates three possible mechanisms whereby SSRIs might improve structural-brain tissue recovery from ischemia: stimulation of neurogenesis in the subependymal zone and hippocampal dentate gyrus, inhibition of microglia- and neutrophile-induced inflammation mediated by cytotoxic inflammatory molecules, and improvement of cerebral vascular autoregulation (HO-1, heme oxygenase-1; VEGF, vascular endothelial growth factor).

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[ARTICLE] Pharmacological interventions other than for spasticity after stroke – Full Text HTML

Abstract

This is the protocol for a review and there is no abstract. The objectives are as follows:

Primary

To determine if pharmacological interventions for spasticity are more effective than no intervention, normal practice or control at improving function following stroke.

Secondary

To determine if pharmacological interventions for spasticity after stroke are more effective than no intervention, normal practice or control at:

  1. preventing secondary complications such as pain and contractures;
  2. decreasing spasticity at an impairment level.
  3. To determine if global antispasmodic interventions are more effective than local treatments at improving function after stroke.
  4. To determine if early administration of pharmacological interventions for spasticity (before six months) are more effective than late administration (after six months) of pharmacological intervention at improving function after stroke
  5. To determine the side effects of the use of pharmacological interventions against placebo
  6. To determine whether there is a difference between using pharmacological interventions for spasticity compared with no intervention, normal practice or control at improving function of the arm or leg following stroke.
    1. preventing secondary complications such as pain and contractures;
    2. decreasing spasticity at an impairment level.

Full Text HTML –>  Pharmacological interventions other than botulinum toxin for spasticity after stroke – Lindsay – 2013 – Cochrane Database of Systematic Reviews – Wiley Online Library.

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[ARTICLE] The neuroprotective potential of low-dose methamphetamine in preclinical models of stroke and traumatic brain injury – Full Text HTML

Highlights

  • When administered acutely (within 12 hours after injury) low-dose methamphetamine significantly improves cognition and functional behavior.
  • The neuroprotective potential of methamphetamine is highly dose dependent.
  • Methamphetamine mediates dose dependent neuroprotection when administered within 12 h after severe TBI or stroke.

Abstract

Methamphetamine is a psychostimulant that was initially synthesized in 1920. Since then it has been used to treat attention deficit hyperactive disorder (ADHD), obesity and narcolepsy. However, methamphetamine has also become a major drug of abuse worldwide. Under conditions of abuse, which involve the administration of high repetitive doses, methamphetamine can produce considerable neurotoxic effects. However, recent evidence from our laboratory indicates that low doses of methamphetamine can produce robust neuroprotection when administered within 12 h after severe traumatic brain injury (TBI) in rodents. Thus, it appears that methamphetamine under certain circumstances and correct dosing can produce a neuroprotective effect. This review addresses the neuroprotective potential of methamphetamine and focuses on the potential beneficial application for TBI.

Continue –>  The neuroprotective potential of low-dose methamphetamine in preclinical models of stroke and traumatic brain injury.

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[WEB SITE] Tranexamic Acid May Improve Traumatic Brain Injury Outcome

…Lead investigator in Houston, Dr. Bryan Cotton, is a professor at the Department of Surgery at the University of Texas Health Science Center (UTHealth) Medical School. He and his team will evaluate the potential benefits of administering TXA immediately in the event of a TBI, and whether it leads to improved mental recovery. Participating in this study are several Level 1 trauma care centers in the US, including Memorial Hermann-Texas Medical Center…

via Tranexamic Acid May Improve Traumatic Brain Injury Outcome.

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[REVIEW] Pharmacological Therapies for Motor Recovery After Stroke

…Stroke is the most common serious neurological disorder. To date, the focus for research and trials has been on prevention and acute care. Many patients are left with serious neurological impairments and limitations in activity and participation after stroke. Recent preliminary research and trials suggest that the brain is ‘plastic’ and that the natural history of stroke recovery can be improved by physical therapy and pharmacotherapy. Motor weakness and the ability to walk have been the primary targets for testing interventions that may improve recovery after stroke. Physical therapeutic interventions enhance recovery after stroke; however, the timing, duration and type of intervention require clarification and further trials. Pharmacotherapy, in particular with dopaminergic and selective serotonin-reuptake inhibitors, shows promise in enhancing motor recovery after stroke; however, further large-scale trials are required…

via Pharmacological Therapies for Motor Recovery After Stroke.

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[WEB SITE] Neuren Pharmaceuticals gains increased funding for brain injury drug trials – Proactiveinvestors (AU)

…Neuren Pharmaceuticals (ASX:NEU) has revealed the grant awarded for supporting its collaboration with the US Army on the development of potential therapies for traumatic brain injury has been increased by US$3 million and extended to 31 December 2015…

via Neuren Pharmaceuticals gains increased funding for brain injury drug trials – Proactiveinvestors (AU).

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