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Some Medical New Points in Neurlogy

   Effect of Modafinil on Subjective Fatigue in Multiple Sclerosis and Stroke Patients


Background: Modafinil has anecdotal response to neurological fatigue, but such an effect may depend on the type and location of cerebral impairment. Objectives: It was the aim of this study to compare fatigue observed in different neurological pathologies, to evaluate the tolerability to modafinil, and to describe changes in subjective fatigue. Methods: We enrolled 14 brainstem or diencephalic stroke (BDS) patients, 9 cortical stroke (CS) patients and 17 multiple sclerosis (MS) patients. The Fatigue Assessment Instrument severity scale was performed at baseline, after 3 months of modafinil and after 1 month of washout. Cognition, mood and somnolence were assessed. A subgroup of 14 patients underwent activity measures before and during treatment. Results: Thirty-one patients completed the study (10 BDS, 9 CS, 12 MS). The responder profile is more frequent in MS than in CS (p = 0.04), and in BDS than in CS patients (p = 0.04). Actiwatch measures showed no changes in activity during, before and after therapy. Conclusion: Modafinil was tolerated in 75% of patients at small doses and seemed to improve the severity of fatigue in the MS and BDS groups but not in the CS group. There was no modification in measured physical activity.

Effects of different postmenopausal hormone therapy regimens on cerebral blood flow and cognitive functionsINTRODUCTION: The purpose of this study was to compare the effects of different postmenopausal hormone therapy regimens, namely conjugated equine estrogens (CEE), CEE plus medroxyprogesterone acetate (MPA), tibolone, and raloxifene on cerebral blood flow and cognitive functions. METHODS: A total of 64 healthy postmenopausal women admitted to the Department of Obstetrics and Gynecology, Cumhuriyet University, Turkey were included in this study. Patients were divided into five groups with respect to the treatment protocols: CEE 0.625 mg/day (n=13); CEE 0.625 mg/day + MPA 2.5 mg/day (n=14); tibolone 2.5 mg/day (n=11); raloxifene 60 mg/day (n=9); and control (n=17). The CEE group included only women with surgical menopause. Those who were on hormonal therapy, who had previously used hormonal therapy, who had neurological disorders, or who did not accept the longterm follow-up were excluded from the study. Demographic and clinic characteristics were recorded. Before starting the therapy regimens, cerebral blood flow was evaluated by internal carotid artery and middle cerebral artery peak systolic velocity, and pulsatility index measurements via Doppler ultrasonography. Cognitive functions were evaluated by the Standardized Mini-Mental Test. The mean follow-up period was 10.9+/-2.4 months, ranging between 8 and 16 months. After the follow-up period, the cerebral blood flow, and cognitive function of each woman was re-evaluated. RESULTS: Demographic and clinical characteristics of the women were not significantly different between the study groups (P>0.05). There were no significant differences between the pretreatment and posttreatment values for cerebral blood flow indices and cognitive function scores in any of the study groups (P>0.05). CONCLUSION: Different postmenopausal hormone therapy regimens have not revealed any significant effects on either cerebral blood flow or cognitive function.

Body mass index changes and chronic neuroleptic drug treatment for Tourette syndrome

A known risk of neuroleptic medications is weight gain, but few studies have estimated long-term effects in childhood. This study evaluated effects of neuroleptics on body mass index for age and sex (body mass index Z scores) in a matched cohort of neuroleptic-treated (n = 16) and nonneuroleptic-treated (n = 29) children and adolescents with Tourette syndrome. Growth parameters were assessed in 45 children, aged 5-15 years, treated for an average of 3 years (range, 1-6) with low doses of pimozide or risperidone. Effects of neuroleptic treatment, age, duration, and treatment x duration interactions on changes in Z score were assessed with regression, and time course of changes was modeled using repeated measures analysis of variance. Although the mean first-year weight gain differed significantly (13.5 kg neuroleptic vs 3.2 kg nonneuroleptic), the longterm Z score changes did not (0.3 vs 0.1; F(4,44) = 0.87, P = 0.49). Repeated measures analysis of Z scores differed significantly by treatment (F(3,77.6) = 6.34, P = 0.0007), related to first-year changes only. In children and adolescents with Tourette syndrome treated for longer than 1 year with neuroleptics, weight gain is not necessarily excessive.

Clinical and pharmacogenetic determinants for the discontinuation of non-ergoline dopamine agonists in Parkinson’s disease

OBJECTIVE: To identify determinants for the discontinuation of non-ergoline dopamine agonist (DA) treatment in patients with Parkinson’s disease (PD) and to identify genetic determinants in genes encoding dopamine receptor (DR)D2 and DRD3 in a exploratory analysis. METHODS: Patients included were first-time users of the non-ergoline DA ropinirole or pramipexole who had been diagnosed with PD before 2005. Treatment discontinuation was defined as a gap of 180 days or more between two refills of the DA. Non-genetic determinants for discontinuation were studied in the overall population, and genetic determinants [DRD2 141C Ins/Del, DRD2 (CA)(n) STR, DRD2 TaqIA, DRD3 MscI single nucleotide polymorphism (SNP) and DRD3 MspI SNP] were studied in a subgroup. Cox proportional hazard analysis was used to estimate the hazard ratios (HR) for the discontinuation of non-ergoline DA treatment. RESULTS: The study population comprised 90 patients. Apomorphine use was associated with non-ergoline DA discontinuation, although the apomorphine group consisted only of three patients [HR 6.26; 95% confidence interval (CI) 1.85-21.2]. Daily levodopa dosages between 500 and 1000 mg were positively associated with discontinuation (HR 2.31; 95% CI 1.08-4.93). Included in the exploratory pharmacogenetic analysis were 38 patients. The absence of a 15x DRD2 CA repeat allele was significantly related with a decreased discontinuation of non-ergoline treatment (HR 0.23; 95% CI 0.07-0.81). The DRD3 MspI polymorphism showed a non-significant allele dose effect, suggestive of a causal relationship. CONCLUSION: This study identified apomorphine use and levodopa dosages between 500 and 1000 mg as non-genetic and the 15x DRD2 CA repeat allele as genetic determinants for the discontinuation of non-ergoline DA treatment in patients with PD. More research is needed to replicate these findings.

Efficacy and tolerability of topiramate in pediatric migraine

About 5-10% of school-age children manifest migraine headaches. Treatment options for pediatric migraine are limited. Topiramate is approved for migraine prophylaxis in adults, but its use in children is limited. We retrospectively reviewed the records of 37 patients, i.e., 22 (60%) girls and 15 (40%) boys (mean age, 14 years; range, 7.3-20.5 years), diagnosed with migraine without aura in 30 (81%), with aura in four (11%), and abdominal, ophthalmoplegic, and catamenial in one each. The mean follow-up was 12 +/- 5 months standard deviation (S.D.). Clinical response was qualified as excellent, good, no change, or worse. Numbers of headaches per month were 15 +/- 7 S.D. prior to treatment and 3 +/- 3.4 S.D. (P<0.001) after treatment. An excellent or good response (>50% migraine reduction) was attained in 28 patients (76%). Ten (27%) patients exhibited adverse effects. Patients taking>2 mg/kg/day were more likely to demonstrate side effects. The mean dose for patients without adverse effects was 1.27 +/- 0.7 mg/kg/day S.D. Those who reported adverse effects were taking a mean dose of 2.8 +/- 1.5 mg/kg/day S.D. This study demonstrated that topiramate is an effective, safe alternative for the prophylaxis of pediatric migraine. An acceptable risk/benefit maintenance dose was< or =2 mg/kg/day.



August 19, 2009 - Posted by | 1

1 Comment »

  1. Great headline. If your cookie has a bite-sized action and your reader completes the action, I think two things happen. Their self-confidence goes up (which feels good) and their trust in you increases.

    Comment by Debt Settlement Program | September 16, 2009 | Reply

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