摘要:

Advances in surgical, radiation and chemotherapeutic techniques for the treatment of tumours of the CNS have not improved the prognosis of this type of cancer. Furthermore, the CNS represents a unique challenge to traditional chemotherapy because of the blood-brain barrier, the variety of tumours present within the CNS and heterogeneity within a given tumour type. Monoclonal antibody technology has provided a variety of new agents to explore as possible therapies for cancers. The use of antibodies to target isotopes, toxins, drugs or enzymes to brain tumours is currently being investigated.A number of phenomena may affect the ability of these immunoconjugates to reach the target and their efficacy once at the target site. These include tumour susceptibility and accessibility, target antigen expression, the immune response of the patient and tumour heterogeneity. We conclude, based on our research and that of others, that immunoconjugates are effective against compartmentalised tumours in the CNS, and their primary role may be in the treatment of residual disease or in combined therapeutic regimens.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

During the last 20 years, there has been intensive and fruitful neurochemical research into the neuromodulator adenosine. Adenosine receptors have been classified, and their distribution and function thoroughly examined in the mammalian brain. However, no adenosinergic drugs are presently marketed for the treatment of CNS disorders.Hypothetically, several disorders including major depression, schizophrenia and Alzheimer's disease might be positively influenced by adenosinergic drugs. Two potent adenosine receptor antagonists, caffeine and theophylline, have been commonly used for centuries. The action of these agents in the CNS, including their relationship to psychiatric disorders, provides information that assists in understanding the behavioural function of the adenosinergic system in humans.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

Although the pathophysiology of Gilles de la Tourette's syndrome is still unknown, effective symptomatic therapies are available. Antipsychotic drugs are the most effective agents for suppressing motor and vocal tics. Haloperidol is the most widely used drug, but pimozide - a closely related drug - is our drug of first choice. Other groups prefer clonidine as the initial treatment. We found a good clinical effect in 81% of patients treated with either pimozide alone or in combination with tetrabenazine. Clonidine or sulpiride have also been used in combination with pimozide with beneficial effect in some patients.In patients with associated behavioural disturbances, we use serotonin reuptake inhibitors, most often in combination with pimozide. Alternatively, clonidine or methylphenidate can be combined with pimozide. In patients who fail to respond to treatment, several other agents with different mechanisms of action can be tried. By combining 2 or 3 drugs which have different sites of action, a more lasting effect can be obtained with lower doses of each drug than with any of the drugs alone. The use of lower dosages is an advantage in long term treatment.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

Cluster headache is a distinct clinical and epidemiological entity. The International Headache Society criteria for the diagnosis of cluster headache requires at least 5 attacks of severe, unilateral, orbital, supraorbital and/or temporal pain lasting 15 to 180 minutes. Attacks should occur at a frequency ranging from 1 every other day to 8 per day. The pain should be associated with at least 1 of the following: conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis or eyelid oedema. Cluster headache can be divided into 2 clinical entities: episodic cluster headache and chronic cluster headache.Pharmacological treatment for cluster headache can be abortive (for acute attacks), prophylactic (preventive) or a combination of both methods. In acute attacks, the fastest relief is afforded by oxygen inhalation, subcutaneous sumatriptan or dihydroergotamine mesylate. Most patients with cluster headache require prophylactic therapy. Medications with proven efficacy as prophylactic treatments include ergotamine, methysergide, corticosteroids, verapamil and lithium. Other agents that may be effective include indomethacin and valproic acid (sodium valproate).Patients with episodic cluster headache may become resistant to a previously successful prophylactic medication. Indeed, approximately 10% of patients with cluster headaches do not respond to prophylactic pharmacotherapy or have significant contraindications to effective prophylactic agents. These patients are candidates for surgical intervention.Patients with chronic cluster headache may require polypharmacy and eventually an ablative neurosurgical procedure. Dihydroergotamine mesylate given intravenously every 8 hours in an inpatient setting is an effective treatment for intractable cluster headache.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

Panic disorder is characterised by the recurrence of acute, unpredictable panic attacks, with associated fear and physiological arousal. The disorder is very common among the general population and has a high rate of associated morbidity and mortality when not treated.Both pharmacological and psychological treatment approaches are effective in alleviating symptoms of panic attacks. Various psychological treatment approaches have been advocated, with cognitive-behavioural treatment the most systematically studied and applied. A wide range of pharmacological agents are useful in treating attacks, and differ primarily in adverse effect profile, latency of onset and potential for abuse or addiction. Available agents include tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors and benzodiazepines. We consider long term use of SSRIs, in conjunction with benzodiazepines for the short term relief of symptoms, to be the optimum pharmacological management of panic disorder.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

CNS nicotinic acetylcholine receptors are a family of ligand-gated cation channels that allow the passage of calcium ions. They are structurally and functionally distinct from nicotinic receptors at the neuromuscular junction. CNS nicotinic receptors show a variation in distribution and pharmacology.The number of these receptors is reduced with normal aging, and a further reduction in number occurs in dementing conditions that are common in elderly individuals. A comparison of receptor loss in the substantia nigra of patients with Parkinson's disease and Lewy body dementia indicates that this process may occur early in the disease and precede cell loss. In addition, nicotine binding sites in humans are concentrated in the entorhinal cortex and subicular formation, areas that are affected early in the course of Alzheimer-type disease.The number of nicotine binding sites is high in human neonatal brain, at which stage exposure to nicotine and tobacco smoke is deleterious. Conversely, epidemiological evidence suggests that later in life tobacco smoking may offer some protection against Parkinson's and Alzheimer's diseases. Exposure to nicotinic agonists and tobacco smoke increases the number of brain nicotinic receptors both in humans and experimental animals, although the functional significance of this and its precise relationship to receptor desensitisation is not completely understood. Acute exposure to nicotine and nicotinic antagonists has beneficial and adverse effects, respectively, on cognitive function. Subcutaneous administration of nicotine to patients with Alzheimer's disease improves discriminative sensitivity and reaction times. Available nicotinic agonists appear to induce diverse functional responses, and models for the testing of such novel compounds are needed.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

In 1980, buspirone was found to have anxiolytic potential. This finding initiated the development of the azapirones - highly serotonin 5-HT1Aagonists. The balance of evidence suggests that the azapirones act as partial agonists postsynaptically, but as full agonists presynaptically in the dorsal raphé. This review focuses mainly on agents for which there are published clinical trial data.Numerous studies have shown that buspirone, gepirone and ipsapirone are as effective as the benzodiazepines in the treatment of generalised anxiety. However, they have a slower onset of action. The azapirones have a completely different adverse reaction profile (dizziness and gastric complaints) compared with the benzodiazepines (sedation, memory loss and withdrawal dependency).Several controlled studies have shown that the azapirones are effective in depression, particularly of the melancholic type. They have an adverse effects profile similar to, but less severe than, the selective serotonin reuptake inhibitors and different to that of the tricyclic antidepressants.Buspirone has not yet proven to be effective in panic disorder. However, gepirone, ipsapirone and other azapirones may be more effective in this disorder. Early studies indicate promising results for buspirone in the treatment of obsessive-compulsive disorder. Clinical trials in alcoholism are equivocal. Further studies of this class of drugs in the treatment of social phobia, post-traumatic stress disorder, premenstrual syndrome, and compulsive and aggressive disorders are in progress.A principle drawback with this class of drug is their short half-life. However, sustained release preparations are being developed.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS