摘要:

In the assessment of the efficacy of antiepileptic drugs (AEDs), seizure frequency is often the most common, and usually the only, end-point used. However, the need to consider other important seizure-related variables, including seizure severity and measures of psychological functioning, has been well documented. Recent research has focused on the development of health-related quality-of-life questionnaires for use in clinical trials and clinical practice. Such measures may have the potential for enhancing the assessment of the efficacy of AED treatment. Nevertheless, more substantial evidence is required to demonstrate the usefulness of such measures before they can be established as an integral part of the assessment of the impact of AED treatment.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

Neurosyphilis is a symptom of the tertiary stages of syphilis (a chronic systemic infection ofTreponema pallidumsubspeciespallidum). Classical neurosyphilis has become a rare condition in Western countries because of the use of penicillin for the treatment of early or latent syphilis. Although textbook neurosyphilis is now uncommon, modified neurosyphilis as a consequence of intercurrent antibiotic use for other conditions may be more common. This latter condition is harder to diagnose than classical neurosyphilis because of atypical clinical and cerebrospinal fluid (CSF) findings. The coexistence of HIV infection and syphilis has further complicated the picture.There have been no well controlled trials of treatments for neurosyphilis. Nevertheless, the treatment of choice for established neurosyphilis has been shown to be benzylpenicillin (penicillin G). The drug is administered as an intensive therapy of frequent intravenous high doses or high doses of an intramuscular repository formulation with probenecid. Other agents that can be used include high dose amoxicillin (amoxycillin) with probenecid (but compliance cannot be monitored), tetracyclines, macrolides or ceftriaxone. If the individual is HIV-positive or of unknown serostatus, benzylpenicillin should be used to prevent or treat neurosyphilis. In patients who are allergic to penicillin, rush desensitisation can be used to allow administration of benzylpenicillin. Alternatively, nonpenicillin antibiotics can be used.Much work has been performed to establish the bactericidal concentrations of penicillin and other antibiotics in serum and CSF. However, the significance of these values is uncertain because the causative pathology of neurosyphilis may lie in the perivascular space.Follow-up and counselling of patients with neurosyphilis, and repeat lumbar puncture for analysis of CSF where initially abnormal, are recommended.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

Preventing and treating cerebral ischaemia and secondary brain damage are the most important goals of trauma care in patients with head injury. At present, there are no therapies available for treating cerebral ischaemia and, therefore, the intensive therapy of severe head trauma is based on preventing or protecting against ischaemia and providing optimal conditions for tissue repair processes. This is achieved by the maintenance of an adequate cerebral perfusion pressure. A large number of drugs can be considered and should be used in a stepwise fashion. Relevant monitoring parameters can help in the selection of adequate and effective treatments.An adequate cerebral perfusion pressure is ≥70mm Hg. This is achieved in patients with head injury by restoring to the normal range both intracranial pressure (≤20 to 25mm Hg) and mean arterial blood pressure (≥90mm Hg). All patients with a Glasgow Coma score ≤8 are considered at risk of increased intracranial pressure. Sedation and mechanical ventilation are mandatory for these patients. Normoxia [oxyhaemoglobin saturation recorded using a pulse oximeter (SpO2) ≥95%] and moderate hypocapnia (35 to 38mm Hg) are desirable goals, and hypo-osmolarity and hyperglycaemia must be avoided. A strict control of volaemia is required and in some patients hypervolaemia may be needed to maintain blood pressure. When intracranial pressure starts to increase, treatment includes (in a stepwise fashion): deepening of sedation, hyperventilation in patients with a suspected increase in cerebral blood flow, mannitol or hypertonic saline (7.5%) and, in some patients, continuous infusion of barbiturates. Cerebrospinal fluid removal can be considered in some patients, as well as skull vault removal to decompress widespread and uncontrollable cerebral oedema.Current research for future treatments of cerebral ischaemia has focused on inhibition of lipid peroxidative reactions and the use of glutamate antagonists. Inhibition of free radicals is also under investigation.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

At present, no drug has been proven to be effective in the treatment of acute ischaemic stroke or intraparenchymatous haemorrhage. However, investigations of neuroprotective, antiplatelet, anticoagulation and thrombolytic therapies for acute ischaemic stroke are ongoing. Recent studies have provided evidence of the usefulness of therapies for the primary and secondary prevention of ischaemic stroke. In the primary prevention of ischaemic stroke, warfarin is indicated in all patients with atrial fibrillation and at least 1 risk factor for stroke, and for patients greater than 65 years old with lone atrial fibrillation. Warfarin is also indicated for the secondary prevention of ischaemic stroke in patients with atrial fibrillation. Aspirin (acetylsalicylic acid) and ticlopidine are indicated for the secondary prevention of ischaemic stroke in patients without atrial fibrillation. Carotid endarterectomy is beneficial in patients with high grade stenosis and transient ischaemic attacks or nondisabling stroke.In patients with subarachnoid haemorrhage, the prevention of rebleeding is based on surgical intervention; however, nimodipine is useful in preventing the incidence of delayed cerebral ischaemia.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

Serotonin 5-HT3-receptors are the only monoamine neurotransmitter receptors that are a member of the ligand-gated ion channel receptor superfamily, enabling these receptors to modulate fast synaptic transmission.Over the past 10 years, 5-HT3-receptors have been extensively investigated. Whilst it is generally accepted that 5-HT3-receptor antagonists attenuate emesis induced by a variety of stimuli, an extensive body of evidence indicates that these ligands may also alleviate some of the symptoms associated with various CNS disorders (e.g. psychosis, anxiety, dementia) and also reduce the rewarding properties of and withdrawal symptoms associated with drugs of abuse. In general, however, the clinical potential described for 5-HT3-receptor antagonists has not been substantiated by a number of preclinical and clinical reports.The further unravelling of the mechanisms underlying the actions of 5-HT3-receptor antagonists, and the reasons why they apparently fail to display efficacy in the hands of some experienced investigators, remain major objectives for the future.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

There are important gender differences in the epidemiology of psychiatric disorders and in the effects of drugs used to treat these disorders. Women are major consumers of psychotropic drugs. but they have often been excluded from drug trials that establish tolerability and dose parameters. Because women have a higher proportion of adipose tissue than men, higher plasma drug concentrations and longer elimination half-lives can occur in women.In this review, gender differences are examined for the most prevalent diagnoses with a tradition of pharmacological responsivity. Anxiety disorders are generally more common in women, although social phobia and post-traumatic stress disorder may have an equal gender distribution. Obsessive-compulsive disorder has a slight preponderance in women, while patients with generalised anxiety disorder and panic disorder are predominantly women. Benzodiazepines that undergo conjugation appear to have a longer elimination time in women, and concomitant administration of oral contraceptives can decrease clearance of these drugs.Women are twice as likely to have a major depression and equally likely to have bipolar disorder as men. However, women are overrepresented in the rapid cycling variant of bipolar disorder. Gender data on antidepressant response are mixed, but women are more vulnerable to lithium-induced hypothyroidism. Men and women have equal risk for schizophrenia, but vary in terms of clinical features such as premorbid functioning, age of onset and outcome. Women tend to require lower dosages of antipsychotics, experience a greater improvement in symptoms when receiving these drugs, but are at a higher risk of developing tardive dyskinesia. The incidence of eating disorders (anorexia nervosa and bulimia nervosa) is higher in females than in males.Future attention to gender differences will improve the diagnosis of, allow for more accurate prognosis of, and promote individually designed interventions for psychiatric disorders.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS