Neuropsych Dis Treat
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Neuropsych Dis Treat · Dec 2007
What is the impact of physician communication and patient understanding in the management of headache?
Migraine is a common and debilitating condition. Despite the burden of disease and increasing availability of effective treatment, migraine management is unsatisfactory. Evidence in other chronic conditions indicates that effective physician communication results in better patient understanding and health outcomes. ⋯ Twelve published papers met the revised criteria. The findings from the limited evidence available suggests, but does not prove, that improvements in physician-patient communication could result in a significant decrease in the burden of suffering and health care resource utilization associated with migraine. More research is needed to assess the explicit role of physician-patient communication in the management of migraine.
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Neuropsych Dis Treat · Feb 2007
Ziconotide: a review of its pharmacology and use in the treatment of pain.
Ziconotide is a powerful analgesic drug that has a unique mechanism of action involving potent and selective block of N-type calcium channels, which control neurotransmission at many synapses. The analgesic efficacy of ziconotide likely results from its ability to interrupt pain signaling at the level of the spinal cord. ⋯ The current review discusses the various studies that have addressed the in vitro biochemical and electrophysiological actions of ziconotide as well as the numerous pre-clinical studies that were conducted to elucidate its antinociceptive mechanism of action in animals. In addition, this review considers the pivotal Phase 3 (and other) clinical trials that were conducted in support of ziconotide's approval for the treatment of severe chronic pain and tries to offer some insights regarding the future discovery and development of newer analgesic drugs that would act by a similar mechanism to ziconotide but which might offer improved safety, tolerability and ease of use.
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Neuropsych Dis Treat · Jan 2007
Update on the management of neuromuscular block: focus on sugammadex.
Steroidal neuromuscular blocking agents (NMBAs), such as rocuronium, are widely used in clinical anesthesia and emergency medicine to facilitate endotracheal intubation and artificial ventilation and to allow surgical access to body cavities. Reversal of neuromuscular blockade is important for the acceleration of patient recovery and prevention of postoperative residual neuromuscular blockade and reduces the incidence of severe morbidity and mortality associated with anesthesia management. Sugammadex is the first selective relaxant binding agent (SRBA) and has been designed to reverse the steroidal neuromuscular blocking drug rocuronium. ⋯ This promotes the liberation of acetylcholine receptors, and muscle activity reappears. This new concept of reversal of neuromuscular block induced by rocuronium (or vecuronium) led to impressive results in animal and phase 1 and 2 studies. Sugammadex is currently in phase 3 clinical studies and may be commercially available by 2008.
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Neuropsych Dis Treat · Jan 2007
Dementia with Lewy bodies: Definition, diagnosis, and pathogenic relationship to Alzheimer's disease.
Clinical dementia associated with the appearance of Lewy bodies in the cerebral cortex has been recognized for over 40 years. Until the 1990s, however, cortical Lewy body disease was thought to be a rare cause of dementia. At that time, the advent of sensitive and specific immunohistochemical techniques for highlighting these elusive structures led to the recognition of cortical Lewy body disease as a common substrate for clinical dementia. ⋯ The two diseases share several genetic and environmental risk factors that have in common increased inflammatory states associated with increased disease risk. Moreover, pathological and experimental work has implicated the involvement of activated microglia and of microglia-derived interleukin-1 in the pathogenesis of the pathognomonic lesions of both diseases. Such neuroinflammatory processes may be the common link driving progression in both diseases and explaining the frequent overlap between the two diseases.
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Dopaminergic agents, anticonvulsants, benzodiazepines, opiates, and iron supplementation comprise the classes of medications commonly used to treat restless legs syndrome (RLS), which is a disorder that is estimated to affect about 1 in 10 individuals worldwide and impacts an affected patient's sleep, mood, daytime function, and quality of life. RLS is characterized by an urge to move the legs that is worse at bedtime and at rest; the symptoms are temporarily relieved by leg movement. ⋯ Ropinirole (Requip((R)), GlaxoSmithKline) is a dopamine agonist that was the first medication approved by the US Food and Drug Administration (FDA) for the treatment of moderate-to-severe primary RLS. Based on several large-scale clinical trials and open-label clinical series, this medication has been demonstrated to be effective and safe in treating the motor symptoms of RLS and improving sleep quality.