摘要:

Following injury to the CNS, highly reactive free radicals may produce secondary or delayed tissue damage via peroxidation of lipids in cellular membranes. This extensive generation of free radicals appears to overwhelm natural defence mechanisms, dramatically reducing the levels of endogenous antioxidant compounds.In numerous studies utilising models of CNS injury, treatment with a synthetic antioxidant, the nonglucocorticoid 21-aminosteroid (lazaroid) tirilazad, has been shown to maintain the level of endogenous antioxidants, improve neurological outcome, decrease cell loss, reduce cerebral oedema formation and improve survival.As a result of these encouraging results, clinical trials have been initiated to evaluate the utility of tirilazad in the treatment of subarachnoid haemorrhage, spinal cord injury, traumatic brain injury and stroke.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

Migraine is a prevalent and often debilitating condition. Because of this, effective prophylaxis to prevent the recurrence of attacks is an advantageous approach to therapy for some patients.Five main classes of prophylactic agents are currently employed: &bgr;-blockers, calcium antagonists, serotonin (5-hydroxytryptamine; 5-HT) modulators, nonsteroidal anti-inflammatory drugs and ergot alkaloids. Many variables influence the choice of therapy, including the different characteristics of the available drugs and of each patient. Although &bgr;-blockers and flunarizine are generally the most effective prophylactic agents, there is no drug of first-choice and the agent chosen must be carefully tailored to the needs of the individual patient.Status migrainosus - prolonged unresponsive migraine attacks - requires, in most patients, a specific administration protocol consisting of dihydroergotamine, steroids and phenothiazines.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

Tuberous sclerosis complex (TSC) is one of the most commonly occurring and recognised neurocutaneous syndromes, with a prevalence of approximately 1 in 30 000 and a birth incidence of 1 in 10 000. It is a multi-system disorder affecting predominantly the CNS and skin. The underlying genetic defect and pathophysiology in TSC is unclear, but is thought to involve an impairment of normal cell migration resulting in dysplastic and dysfunctional organ systems.Involvement of the CNS is responsible for much of the mortality and morbidity that is associated with TSC. Epilepsy and learning difficulties (mental retardation) are the most frequent CNS manifestations. This combination of symptoms are reflected in the historical alternative, but inappropriately pejorative, name ‘epiloia’, a conjoint description of epilepsy and anoia (meaning ‘mindlessness’).The state of knowledge, understanding and, to a lesser extent, treatment of TSC has progressed significantly in the 100 years since the initial description of the condition. Unfortunately, TSC is largely nonpreventable and patients with the disorder cannot be cured. Attention has therefore focused on the attempted suppression or control of symptoms, usually by pharmacotherapy and educational/psychological support and rarely by surgical procedures. These approaches have had varying success.Epilepsy is the most common and, in many ways, the most frustrating neurological symptom. Seizure control is frequently difficult and occasionally impossible, but has benefited from the advent of the new antiepileptic drugs including vigabatrin and lamotrigine. Learning disabilities, autism and other neuropsychiatric manifestations of TSC are generally not amenable to drug therapy and are reliant more on specific educational and behavioural manipulation. Disturbed sleep is common in children with TSC, and for their caregivers this is often the most distressing and medically neglected manifestation of the disease. The use of melatonin in treating dysfunctional sleep has offered some real hope for this specific neurological symptom of TSC.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

Dystonia is a syndrome of sustained muscle contractions, frequently causing twisting and repetitive movements or abnormal postures. Primary and secondary dystonias are distinguishable and both can be classified by the extent of body involvement as generalised, focal, segmental, multifocal and hemidystonic. The treatment of primary dystonias involves the exclusion of secondary causes such as drug-induced (particularly common with dopamine blocking agents) and Wilson's disease. This should be followed by a trial of levodopa, especially in cases of onset in the first 3 decades of life.Symptomatic oral pharmacotherapy includes anticholinergic agents, baclofen, clonazepam and carbamazepine. The use of intrathecal baclofen infused by a surgically implanted pump has been advocated for intractable axial dystonia. Botulinum toxin A injections have become the treatment of choice of many focal dystonias (e.g. blepharospasm, cervical dystonia, jaw closure dystonia, hyperadduction laryngeal dystonia). Jaw opening dystonia, writer's cramp and more complex limb dystonias may also benefit from botulinum toxin A. Paroxysmal kinesigenic dystonias are responsive to phenytoin, carbamazepine, phenobarbital (phenobarbitone), primidone and diazepam. Paroxysmal nonkinesigenic dystonias do not respond as well to these agents and may warrant a trial of other agents such as acetazolamide, clonazepam, oxazepam, baclofen or anticholinergic agents.Surgical interventions include stereotactic thalamotomy for severe generalised dystonia unresponsive to intensive pharmacological trials, and ‘peripheral’ surgeries designed to address specific types of focal dystonia that are unresponsive to botulinum toxin (e.g. orbital myectomy for blepharospasm and cervical ramisectomy for cervical dystonia). Orthotic devices for limb dystonia, and writing aid devices and other physical therapy measures can provide assistance in selected patients.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

In approximately 70% of patients with newly diagnosed epilepsy, initial treatment with a single antiepileptic drug leads to complete seizure control without intolerable adverse effects. Unfortunately, monotherapy fails, even at maximal tolerated doses, in an important minority of patients. These patients usually have symptomatic epilepsies. For patients with refractory seizures, alternative monotherapy with a second-line agent is a very effective and well tolerated treatment policy. Approximately 40% of patients with partial epilepsy that is refractory to one agent will benefit from alternative monotherapy.If alternative monotherapy fails, polytherapy with a combination of 2 drugs may be helpful in a small minority of patients. However, this efficacy is usually at the expense of added toxicity unless the daily dose of the first drug is reduced. When 3 antiepileptic drugs fail either in sequential monotherapy or combination therapy, diagnostic re-evaluation is required. If surgery is not suitable, monotherapy with the individually best tolerated drug at the lowest effective dose is recommended until more effective antiepileptic drugs become available.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

Melatonin is the major hormone produced by the pineal gland. The concentration of the hormone in blood is increased during the hours of darkness, while a low concentration occurs during daylight. Its secretion is controlled by an endogenous rhythm-generating system that is entrained by light. Melatonin has a role in cueing circadian rhythms (notably the sleep-wake rhythm) and promoting sleep and contributes significantly to the circadian rhythm in body temperature.Administration of melatonin or bright light treatment has established therapeutic actions in circadian rhythm sleep disorders, including disorders associated with jet lag, shift work, delayed phase sleep disorder, periodic sleep disorder in blindness, and sleep and behavioural disorders in children with multiple brain damage. The effects of bright light or melatonin treatment follow a phaseresponse curve. Evening bright light treatment causes a phase delay in the sleepwake cycle and morning light causes a phase advance. Melatonin treatment produces effects that are nearly the mirror image of those caused by bright light.Few clinical trials have been done in insomnias that are not associated with circadian rhythm disorders. Large doses of melatonin may have a therapeutic effect in chronic insomnia. Insomnia that coincides with diminished melatonin secretion occurs in aging and following treatment with &bgr;-adrenoceptor blockers. Trials of melatonin treatment for these sleep disorders have yet to be published.A decrease in melatonin concentration has been reported in most studies of depressed patients. Treatment with drugs that enhance noradrenergic transmission or with tryptophan or 5-methoxypsoralen cause both a therapeutic response and an increase in melatonin secretion; however, no treatment trials of melatonin have been reported in depressed patients.Treatment studies of disorders that are associated with diminished nocturnal melatonin secretion require a therapeutic formulation of the hormone that would reproduce the normal nocturnal increase in melatonin concentration. Although some formulations have been reported, they have yet to be used in treatment studies.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

While tobacco use has declined in many industrialised nations, it remains a leading cause of preventable illness and death worldwide. Nicotine replacement therapy can play a role in assisting tobacco users to terminate their addiction. To this end, 4 different nicotine replacement therapies have been developed: (i) nicotine chewing gum (polacrilex); (ii) transdermal nicotine systems (patch); (iii) nicotine nasal spray; and (iv) nicotine inhalers.The efficacies of these therapies have been evaluated in terms of their ability to aid smoking cessation efforts and to minimise aversive withdrawal symptoms. Tolerability has been evaluated in terms of adverse effect profiles and abuse liability. While more research evaluating the nasal spray and inhalers is needed, transdermal nicotine appears to offer the best combination of efficacy, withdrawal suppression, adverse effects and abuse liability. It has proven efficacy when used in combination with different levels of behavioural therapy.Directions for future research include combination therapies, the most appropriate concentration of nicotine and treatment individualisation.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS