丙戊酸钠静脉滴注治疗偏头痛持续状态

目的评估丙戊酸钠治疗偏头痛持续状态的有效性和安全性。方法我们前瞻性地用静脉滴注丙戊酸钠来治疗偏头痛持续状态,然后比较患者治疗前与出院时视觉模拟评分(VAS)。并比较各种因素(一般情况,累计的丙戊酸钠剂量,合并用药)与治疗之间的关系。结果首次治疗中,26次(74.3%)治疗时患者VAS评分较治疗前减少50%或50%以上。所有治疗中,37次(82.2%)治疗使患者VAS评分较治疗前减少50%或50%以上。患者的性别与治疗反应无关。所有治疗中,合并用药(强痛定,索密通,散粒痛和达宁)和治疗时间与治疗反应呈负相关。仅3例(8.6%)出现短暂性眩晕。结论丙戊酸钠静滴是快速,有效和安全的止痛治疗。它对偏头痛持续状态有效。     

Cancer risk in people with epilepsy using valproate-sodium

Singh G, Bell GS, Hernáiz‐Driever P, Sander JW. Cancer risk in people with epilepsy using valproate‐sodium.
Acta Neurol Scand: 2012: 125: 234–240.
© 2011 John Wiley & Sons A/S. Objectives – Based on reports of antitumour properties of sodium‐valproate, we hypothesised that valproate has a cancer‐protective effect in people with epilepsy. We aimed to determine cancer risk in people with epilepsy using sodium‐valproate. Materials and methods – Continuous data for 2997 people with epilepsy who had been prescribed valproate for at least two years, and for 11,988 unexposed people were provided by the UK General Practice Research Database. Hazard ratios (HRs) for all cancers and individual cancers between the exposed and unexposed groups, with smoking and alcohol consumption and age as covariates, were calculated using the Cox proportional hazards method. Results – Exposure to valproate had no influence on the incidence of the composite of all cancers [HR: 1.19, 95% CI: 0.97–1.47, P = 0.10]; there was, however, a significant excess of colon cancers [HR: 3.95, 95% CI: 1.97–7.92, P = 0.001] and a trend towards an excess of prostate neoplasms [HR: 2.15, 95% CI: 0.92–5.02, P = 0.08] and in addition, a trend towards reduced incidence of breast cancer [HR: 0.40, 95% CI: 0.14–1.30, P = 0.08] in the exposed group. Conclusions – The lack of an inverse association between valproate use and hazard ratios for all cancers and several individual cancer sites does not lend support for a cancer‐protective role for valproate.     

Improvement in verbal memory after withdrawal of carbamazepine and valproate in patients with well-controlled epilepsy: a randomized, double-blind study

Hessen E, Lossius MI, Gjerstad L. Improvement in verbal memory after withdrawal of carbamazepine and valproate in patients with well‐controlled epilepsy: A randomized, double‐blind study.
Acta Neurol Scand: 2011: 123: 385–389.
© 2010 John Wiley & Sons A/S. Background – For most major antiepileptic drugs, neuropsychological side effects have been reported. Healthy volunteer studies have found that both carbamazepine and valproate impair aspects of verbal memory. Objective – The aim of this study was to assess the effects of carbamazepine and valproate on verbal memory, in a well‐controlled epilepsy population. Methods – This was carried out with a randomized, double‐blind and placebo‐controlled study of anticonvulsant withdrawal in patients receiving monotherapy. Results – In the carbamazepine group (n = 92), withdrawal significantly improved recall after 30 min (P = 0.03). In the valproate group (n = 32), withdrawal significantly improved performance of immediate word span (P = 0.04). Conclusions – Withdrawal was randomized to placebo, but the choice of medication was not randomized to placebo. This means that the shown differences in neuropsychological outcome cannot with full certainty be attributed to either antiepileptic drug. The improvement of memory, after both carbamazepine and valproate withdrawal, was slight, and the impact on daily life function is uncertain.     

A double-blind, randomized trial of low-dose topiramate vs propranolol in migraine prophylaxis

Objective – To assess the efficacy and safety of low‐dose topiramate in migraine prophylaxis vs propranolol. Patients and methods – A randomized, double‐blind, clinical trial including 62 patients with frequent migraine headaches (≥ 3 attacks per month) was performed for a period of 8 weeks. The patients were randomly divided into two treatment groups – treated by topiramate 50 mg/day and propranolol 80 mg/day, respectively. The patients were assessed at 0, 4, and 8 weeks of the study. Results – The topiramate group showed a reduction in the mean (±SD) of monthly migraine frequency from 6.07 (±1.89) to 1.83 (±1.39) episodes per month, headache intensity from 7.1 (±1.45) to 3.67 (±2.1) based on the Visual Analog Scale, and headache duration from 16.37 (±7.26) to 6.23 (±5.22) hours (P < 0.001). In the patients treated with propranolol, the mean (±SD) of monthly headache frequency declined from 5.83 (±1.98) to 2.2 (±1.67) per month, headache intensity lessened from 6.43 (±1.6) to 4.13 (±1.94) and headache duration decreased from 15.10 (±6.84) to 7.27 (±6.46) h (P < 0.001). Conclusion – This study demonstrated that both low‐dose topiramate and propranolol could significantly reduce migraine headache frequency, intensity, and duration. However, compared with propranolol, low‐dose topiramate showed better results.     

Implementation of a new CSF dynamic device: a multicenter feasibility study in 562 patients

Malm J, Sundström N, Cesarini KG, Edsbagge M, Kristensen B, Leijon G, Eklund A. Implementation of a new CSF dynamic device: a multicenter feasibility study in 562 patients.
Acta Neurol Scand: 2012: 125: 199–205.
© 2011 John Wiley & Sons A/S. Objectives – The cerebrospinal fluid (CSF) infusion test is frequently used when selecting hydrocephalus patients for shunt surgery. Very little has been reported regarding adverse events. We present a prospective feasibility study. Methods – Standardized devices for measuring CSF dynamics were built and 562 patients investigated: Needles were placed by lumbar puncture (LP). An automatic CSF infusion protocol was performed. Course of events during the investigation as well as adverse events were registered. Results – Preoperative evaluation of normal‐pressure hydrocephalus was the most common indication (63%), followed by evaluation of shunt function (23%) and intracranial pressure recordings (14%). The LP was successfully performed in all but nine cases with 24 patients (4.3%) reporting major discomfort. Ringer infusion was performed in 474 investigations, and a valid measurement of the outflow resistance was received in 439 (93%). During the infusion phase, 17 (4%) patients reported severe headache. Infusion volume was significantly higher in patients having subjective symptoms during the infusion phase compared with those without adverse events. During 269 preoperative CSF tap tests, six (2%) patients had severe headache. Post‐investigational headache was reported by 83 (15%) patients at the 24‐h follow‐up. No serious adverse events were observed. Conclusion – Infusion testing was safe and without serious adverse events with a high rate of successful procedures. The investigation was associated with expected mild to moderate discomfort.     

Valproate in children with newly diagnosed idiopathic generalized epilepsy

Holland KD, Monahan S, Morita D, Vartzelis G, Glauser TA. Valproate in children with newly diagnosed idiopathic generalized epilepsy.
Acta Neurol Scand: 2010: 121: 149–153.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives – Sparse information on dose–response characteristics for initial antiepileptic drug monotherapy in children with idiopathic generalized epilepsy (IGE) is available. The aim of this study is to characterize the therapeutic dose of valproate in children with newly diagnosed IGE. Materials and methods – Effect of initial valproate monotherapy and doses associated with seizure freedom were examined in consecutive children with IGE identified from a New Onset Seizure Clinic. Results – Of 84 patients identified, 48 (57%) became seizure‐free on valproate monotherapy and another 10 patients became seizure‐free but discontinued VPA because of adverse effects. The mean dose in seizure‐free children was 15.7 mg/kg/day and over 95% of IGE patients will respond below 25 mg/kg/day. Conclusions – Half of children became seizure‐free on valproate monotherapy and did so at modest doses.     

A relationship between migraine and biliary tract disorders: findings in two Swedish samples of elderly twins

Nilsson S, Edvinsson L, Malmberg B, Johansson B, Linde M. A relationship between migraine and biliary tract disorders: findings in two Swedish samples of elderly twins.
Acta Neurol Scand: 2010: 122: 286–294.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives – To investigate whether there is a relationship between the clinical occurrence of migraine and biliary tract disorders (BTD) and to study whether there is a genetic influence on such an association. Materials and Methods – The near lifetime morbidity for migraine and BTD was examined in two Swedish twin‐samples: OCTO‐Twin (149 MZ and 202 DZ pairs; 234 men, 468 women; 80 years of age or older at inclusion), and the GENDER study (249 unlike‐sex DZ‐pairs; 70–80 years of age at inclusion). The diagnosis of BTD was established by perusal of medical records from the last twenty years. The diagnosis of migraine was based on iterated questionnaires and personal interviews. Results – The odds ratio (OR) of BTD among OCTO‐Twin subjects suffering from migraine was 3.5 (1.9–6.7) in monozygotic pairs and 1.7 (1.0–2.9) in dizygotic pairs The corresponding figures among the GENDER unlike‐sex DZ‐pairs was 2.7 (1.6–4.5). Migraine was associated with female sex and waist circumference. Conclusions – There is a relationship between the occurrence of migraine and BTD, also when controlling for the fact that both disorders are more frequent in women. The association appears to be partly attributable to genetic influences.     

Predictors of good clinical outcome in acute stroke patients treated with intravenous thrombolysis

Šaňák D, Herzig R, Zapletalová J, Horák D, Král M, Školoudík D, Bártková A, Veverka T, Heřman M, Kaňovský P. Predictors of good clinical outcome in acute stroke patients treated with intravenous thrombolysis.
Acta Neurol Scand: 2011: 123: 339–344.
© 2010 John Wiley & Sons A/S. Objectives – Intravenous thrombolysis (IVT) is considered an effective treatment for acute ischemic stroke (IS). However, not all treated patients may achieve good outcome. The aim was to evaluate whether the initial NIHSS and DWI infarct volume could be the predictors for good outcome after IVT. Patients and Methods – The set of 125 patients with consecutive hemispheric IS (78 men; mean age 66.0 ± 12.1 years) treated with IVT within 3 h was analyzed. DWI volume was measured on admission. Good outcome was defined as a score 0‐2 in modified Rankin Scale. Results – Multivariate logistic regression analysis showed initial NIHSS as an independent predictor of good outcome (P = 0.001). ROC curves showed baseline NIHSS ≤13.5 points and DWI volume ≤13.7 ml as cut‐offs related to good outcome. Conclusions – The initial NIHSS and DWI volume might be the predictors for good clinical outcome in acute stroke patients treated with IVT. The initial NIHSS score seems to be more accurate.     

Major depression and bipolar disorders in CADASIL: a study using the DSM-IV semi-structured interview

Valenti R, Pescini F, Antonini S, Castellini G, Poggesi A, Bianchi S, Inzitari D, Pallanti S, Pantoni L. Major depression and bipolar disorders in CADASIL: a study using the DSM‐IV semi‐structured interview.
Acta Neurol Scand: 2011: 124: 390–395.
© 2011 John Wiley & Sons A/S. Objective – Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebral microangiopathy characterized by migraine, cerebrovascular events, and cognitive impairment. Although recognized as a cardinal feature of the disease, psychiatric disturbances have rarely been the object of focused studies. We performed a structured evaluation of mood disorders in CADASIL. Materials and Methods – Twenty‐three patients with CADASIL (five men and 18 women) were assessed by psychiatrists using the Structured Clinical Interview for the DSM‐IV, clinician version. For the quantitative assessment of current mood disorder symptoms, the Hamilton Rating Scale for Depression (HRSD) and the Young Mania Rating Scale (YMRS) were used. Results – A lifetime depressive episode was recorded in 17/23 (73.9%) patients with CADASIL. Six (26.1%) patients with CADASIL reported a current depressive episode. A diagnosis of manic lifetime episode was made in 6 (26.1%) patients with CADASIL. The HRSD mean score in patients with current depression was 9.1 ± SD 8.1. The YMRS mean score was 14.2 ± SD 4.1 for manic CADASIL. Conclusion – This study confirms that mood disorders are frequent in CADASIL. The use of a structured psychiatric interview outlines a frequency of depression higher than that previously reported but also reveals a considerable frequency of bipolar disorders. If confirmed in larger series, these data suggest that a greater attention should be paid to the psychiatric aspects in CADASIL.     

Frequency and severity of headache is worsened by Interferon-β therapy in patients with multiple sclerosis

Patti F, Nicoletti A, Pappalardo A, Castiglione A, Lo Fermo S, Messina S, D’Amico E, Cimino V, Zappia M. Frequency and severity of headache is worsened by Interferon‐β therapy in patients with multiple sclerosis.
Acta Neurol Scand: 2012: 125: 91–95.
© 2011 John Wiley & Sons A/S. Background – The relationship between multiple sclerosis (MS) and headache (HA) is not well known. It was reported that interferon‐beta (IFNβ) could induce or worsen HA. Objective – To evaluate the impact of IFNβ treatment on HA and the relationship between HA and the various commercial preparations of IFNβ in mildly disabled patients with MS. Methods – A specific questionnaire was administered to 357 relapsing‐remitting MS patients. Characteristics of HAs were considered, including the temporal relationships with IFNβ administration. Results – One hundred and seventeen patients were treated with weekly intramuscular injections of interferon IFNβ‐1a (Avonex^®), 84 with subcutaneous injections of IFNβ‐1b (Betaferon^®) every other day, 48 and 108 with three times weekly subcutaneous injections of IFNβ‐1a (Rebif^®) 22 mcg or IFNβ‐1a (Rebif^®) 44 mcg, respectively. Three hundred and fourteen patients were affected by HA, and among them, 219 patients suffered of pre‐existing HA. In this latter group, 121 subjects (55%) noted a worsening of their HA after starting IFNβ therapy; this was more frequently reported by patients treated with Avonex^® and Rebif^® 44. Ninety‐five patients experienced new HA. Conclusion – IFNβ treatment could worsen HA in patients with pre‐existing HA or cause the appearance of new HA. Among different IFNβ preparations, Rebif^® 44 and Avonex^® seemed to be more cephalalgic than the other drugs.     

Impact of duration of symptoms on CSF dynamics in idiopathic normal pressure hydrocephalus

Czosnyka Z, Owler B, Keong N, Santarius T, Baledent O, Pickard JD, Czosnyka M. Impact of duration of symptoms on CSF dynamics in idiopathic normal pressure hydrocephalus.
Acta Neurol Scand: 2011: 123: 414–418.
© 2010 John Wiley & Sons A/S. Objective – Cerebrospinal fluid (CSF) pressure–volume compensation may change over time as part of normal ageing, where the resistance to CSF outflow increases and the formation of CSF decreases with age. Is CSF compensation dependent on duration of symptoms in idiopathic normal pressure hydrocephalus (iNPH)? Methods – We investigated 92 patients presenting with iNPH. Mean age was 73 (range 47–86). There were 60 men and 32 women. They all presented with gait disturbance and ventricular dilatation. Memory deficit occurred in 72% and urinary incontinence in 52% of patients. All patients underwent computerized CSF infusion tests. Sixty‐four shunted patients were available for follow‐up, and their improvement was expressed using the NPH score. Results – Mean intracranial pressure (ICP) was 10.1 ± 5.1 mmHg, and mean resistance to CSF outflow was 17.3 ± 5.2 mmHg/(ml/min). Mean duration of symptoms was 24 ± 19 months (range from 2 weeks to 86 months). Baseline ICP, magnitude of ICP pulse waveform, brain compliance and improvement after shunting (72% of patients improved) did not exhibit any dependency on the duration of symptoms. The resistance to CSF outflow showed a strong tendency to decrease in time with the duration of symptoms beyond 2 years (R = −0.702; P < 0.005). Conclusion – This is a preliminary observation, and it suggests that for patients with duration of symptoms longer than 2–3 years, the threshold for normal resistance to CSF outflow should be duration‐adjusted.     

Intravenous sodium valproate for acute migraine in the emergency department: A meta-analysis

The role of intravenous sodium valproate (iVPA) in acute migraine attack has not been completely established. The aim of this updated review was to evaluate the efficacy and safety of iVPA in patients with acute migraine in the emergency department. We searched the PubMed, Web of Science, and Cochrane Library databases for relevant randomized controlled trials (RCTs). The primary outcome was improvement of headache intensity and headache relief. The need for rescue therapy, recurrence of headache, and number of adverse events was also assessed. Seven double-blinded RCTs involving 682 patients were analyzed. Overall, patients receiving iVPA had less improvement of headache intensity (SMD: −0.39, 95% CI: −0.73 to −0.06, P = .02) and lower rate of headache relief (OR: 0.51, 95% CI: 0.33 to 0.77, P = .002) than those receiving other active comparators. In addition, iVPA increased the odds of rescue therapy compared with other active drugs (OR: 3.76; 95% CI: 1.96 to 7.20, P < .0001). Subgroup analysis showed that iVPA was comparable to dexamethasone, with similar improvement of headache intensity, and recurrence of headache. For migraine without aura, we found no significant difference in headache intensity improvement when iVPA was compared with active comparators (SMD: −0.00, 95% CI: −0.54 to 0.54, P = 1.00). iVPA was inferior to the studied comparators and was comparable to dexamethasone for aborting migraine attack. Based on the available evidence, iVPA may be a reasonable alternative or salvage therapy. In particular, iVPA might be a promising agent for migraine with aura and migraine status.     

Efficacy and safety of intravenous lacosamide in refractory nonconvulsive status epilepticus

Koubeissi MZ, Mayor CL, Estephan B, Rashid S, Azar NJ. Efficacy and safety of intravenous lacosamide in refractory nonconvulsive status epilepticus.
Acta Neurol Scand: 2011: 123: 142–146.
© 2010 John Wiley & Sons A/S. Background – Lacosamide (LCM) is a novel antiepileptic drug (AED) recently approved as an adjunctive therapy in the treatment of partial seizures in adults. LCM is available in oral and intravenous formulations, has linear pharmacokinetics and a unique mechanism of action. The aim of this study – To evaluate the safety and efficacy of intravenous LCM in the treatment of nonconvulsive status epilepticus (NCSE) after failure of conventional therapy. Methods – We retrospectively reviewed all patients with NCSE treated with LCM. We reviewed the clinical and electrographic changes before and after LCM administration. We also noted any reported side effects including electrocardiographic changes. Results – We report four cases of NCSE that were refractory to conventional treatment, but readily responsive to LCM. No side effects attributable to LCM were identified. Conclusions – Intravenous LCM may be safe and efficacious as an add‐on AED for the treatment of NCSE when standard therapy fails.     

Is there progressive cognitive dysfunction in Sjögren Syndrome? A preliminary study

Martínez S, Cáceres C, Mataró M, Escudero D, Latorre P, Dávalos A. Is there progressive cognitive dysfunction in Sjögren Syndrome? A preliminary study.
Acta Neurol Scand: 122: 182–188.
© 2010 The Authors Journal compilation © 2010 Blackwell Munksgaard. Objective – The aim of this study was to determine the progression of cognitive dysfunction in primary Sjögren Syndrome (SS). Methods – Twelve subjects with SS were compared with ten subjects with migraine and ten healthy controls on neuropsychological, mood and fatigue tests at baseline and 8 years later. Results – At follow‐up, SS subjects performed below subjects with migraine on the Continuous Performance Test (CPT) but did not differ on other tasks. Compared with controls, both clinical groups obtained lower scores on simple reaction time, patients with SS obtained lower scores on the Wisconsin Card Sorting Test (WCST) and patients with migraine performed below controls on the Benton’s Judgment of Line Orientation Test (JOLO). Clinical groups did not differ on cognitive changes over time, except that migraine subjects improved on verbal fluency. Compared with baseline, both SS and migraine patients were more impaired on simple reaction time, Trail Making Test part B, Stroop and JOLO. However, they showed higher scores on verbal and visual memory, WCST and CPT reaction time. SS also showed higher levels of depression and fatigue than migraine and controls, with no significant changes over time. Discussion – Preliminary evidence indicates some cognitive deficits in both SS and migraine following a pattern of fronto‐subcortical dysfunction without a significant cognitive decline over time.     

The effect of prophylactic therapy with valproate sodium and phenobarbital in two patients with cyclic vomiting syndrome

Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent, stereotypic episodes of incapacitating nausea, vomiting, and other symptoms, separated by intervals of comparative wellness. Associated symptoms include nausea, abdominal pain, headache, and motion sickness. Recently, CVS was categorized as a migraine. Case 1 was a girl aged 4 years and 11 months, who had frequent and severe episodes of vomiting since she was 3 years old. The diagnosis of CVS was established on the basis of clinical symptoms and laboratory data. Her electroencephalogram was normal. Prophylactic therapy using a single drug such as amitriptyline, carbamazepine, phenytoin, cyproheptadine, valproate sodium or phenobarbital was not effective. However, her recurring vomiting disappeared with prophylactic therapy using valproate sodium and phenobarbital. Case 2 was a boy aged 10 years and 7 months, who had frequent episodes of vomiting since he was 1 year and 10 months old. He had been receiving intravenous hyperalimentation therapy at home since infancy because of frequent vomiting and failure to thrive. His electroencephalogram showed no abnormality. Prophylactic therapy using a single drug such as diazepam, phenytoin, valproate sodium or phenobarbital was not effective. However, his recurring vomiting disappeared with prophylactic therapy using valproate sodium and phenobarbital. There were no adverse effects in both patients. The combination therapy with valproate sodium (20 - 26 mg/kg/day) and phenobarbital (4 - 5 mg/kg/day) was effective as a prophylactic therapy in these two patients. The combination therapy with valproate sodium and phanobarbital for prophylaxis of vomiting may be helpful in patients with intractable CVS.     

The Creutzfeldt-Jakob disease (CJD) neurological status scale: a new tool for evaluation of disease severity and progression

Cohen OS, Prohovnik I, Korczyn AD, Ephraty L, Nitsan Z, Tsabari R, Appel S, Rosenmann H, Kahana E, Chapman J. The Creutzfeldt–Jakob disease (CJD) neurological status scale: a new tool for evaluation of disease severity and progression.
Acta Neurol Scand: 2011: 124: 368–374.
© 2011 John Wiley & Sons A/S. Objectives – To develop a scale sensitive for the neurological manifestations of Creutzfeldt–Jakob disease (CJD). Methods – A 26‐item CJD neurological status scale (CJD‐NS) was created based on characteristic disease manifestations. Each sign was assigned to one of eight neurological systems to calculate a total scale score (TSS) and a system involvement score (SIS). The scale was administered to 37 CJD patients, 101 healthy first‐degree relatives of the patients and 14 elderly patients with Parkinson’s disease (PD). Results – The mean TSS (±SD) was significantly higher in patients with CJD (13.19 ± 5.63) compared with normal controls (0.41 ± 0.78) and PD patients (9.71 ± 3.05). The mean SIS was also significantly different between the CJD (5.19 ± 1.22) and PD (2.78 ± 1.18 P ≤ 0.01) groups reflecting the disseminated nature of neurological involvement in CJD. Using a cutoff of TSS > 4 yielded a sensitivity of 97% for CJD, and specificity of 100% against healthy controls. All individual items showed excellent specificity against healthy subjects, but sensitivity was highly variable. Repeat assessments of CJD patients over 3–9 months revealed a time‐dependent increase in both the TSS and the SIS reflecting the scale’s ability to track disease progression. Conclusions – The CJD‐NS scale is sensitive to neurological signs and their progression in CJD patients.     

Intravenous lacosamide for treatment of status epilepticus

Kellinghaus C, Berning S, Immisch I, Larch J, Rosenow F, Rossetti AO, Tilz C, Trinka E. Intravenous lacosamide for treatment of status epilepticus.
Acta Neurol Scand: 2011: 123: 137–141.
© 2010 John Wiley & Sons A/S. Objectives – Treatment of established status epilepticus (SE) requires immediate intravenous anticonvulsant therapy. Currently used first‐line drugs may cause potentially hazardous side effects. We aimed to assess the efficacy and safety of intravenous lacosamide (LCM) in SE after failure of standard treatment. Methods – We retrospectively analyzed 39 patients (21 women, 18 men, median age 62 years) from the hospital databases of five neurological departments in Germany, Austria and Switzerland between September 2008 and January 2010 who were admitted in SE and received at least one dose of intravenous LCM. Results – Types of SE were generalized convulsive (n = 6), complex partial (n = 17) and simple partial (n = 16). LCM was administered after failure of benzodiazepins or other standard drugs in all but one case. Median bolus dose of LCM was 400 mg (range 200–400 mg), which was administered at 40–80 mg/min in those patients where infusion rate was documented. SE stopped after LCM in 17 patients, while 22 patients needed further anticonvulsant treatment. The success rate in patients receiving LCM as first or second drug was 3/5, as third drug 11/19, and as fourth or later drug 3/15. In five subjects, SE could not be terminated at all. No serious adverse events attributed to LCM were documented. Conclusions – Intravenous LCM may be an alternative treatment for established SE after failure of standard therapy, or when standard agents are considered unsuitable.     

High prevalence of neuropathies in patients with end‐stage liver disease

Cocito D, Maule S, Paolasso I, Castelli L, Ciaramitaro P, Poglio F, Ottobrelli A, Grimaldi S. High prevalence of neuropathies in patients with end‐stage liver disease.
Acta Neurol Scand: 2010: 122: 36–40.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives – Peripheral neuropathy has been reported in association with end‐stage liver disease, but there is only a limited number of reports on the incidence and features of these neuropathies. Materials and methods – In this study, 83 patients awaiting liver transplantation were evaluated for the presence of peripheral and autonomic neuropathy. Results – Sixty‐five percent of the patients had evidence of neuropathy, in agreement with peripheral NCS or cardiovascular autonomic function test. The neuropathy was more frequent in patients with advanced hepatic failure, evaluated with the MELD score. The most frequent abnormalities in nerve conduction studies were sensory‐motor neuropathies and sensory neuropathies, with a length‐dependent pattern. Conclusion – Peripheral neuropathy and autonomic neuropathy are common in patients with end‐stage liver disease with different etiology and correlate with the severity of the liver disease.     

A double-blind, randomized, placebo-controlled, single-dose study of the cyclooxygenase-2 inhibitor, GW406381, as a treatment for acute migraine

The objective of the present study was to explore the clinical efficacy and tolerability of GW406381, a cyclooxygenase-2 (COX-2) inhibitor with relatively high CNS penetration, in acute migraine. This was a double-blind, single-dose study of GW406381 compared with placebo and naproxen sodium compared with placebo (protocol number CXA20008). Three hundred and thirty-seven subjects were randomized 1:1:1 to GW406381 (70 mg), naproxen sodium (825 mg), or placebo for the treatment of one migraine headache of moderate or severe intensity in a potential 8-week period. The primary end-point was the proportion of subjects with headache relief [reduction in headache severity score from pre-dose 2 (moderate) or 3 (severe) to 0 (no pain) or 1 (mild)] at 2 h post-dose for GW406381 compared with placebo. Significantly higher proportions of subjects treated with GW406381 (50%, P  = 0.032) or naproxen sodium (56%, P  = 0.005) than with placebo (35%) reported headache relief at 2 h post-dose. Additional significant benefits were observed on many secondary outcomes, including proportions of subjects pain-free, for both GW406381 and naproxen sodium treatment compared with placebo. Both active treatments were well tolerated. Single-dose GW406381 (70 mg) and naproxen sodium (825 mg) were effective and well tolerated in the treatment of acute migraine.     

Intravenous recombinant tissue plasminogen activator for acute stroke in Poland: an analysis based on the Safe Implementation of Thrombolysis in Stroke (SITS) Registry

Kobayashi A, Czlonkowska A, Ahmed N, Romanowicz S, Glonek M, Nyka WM, Opala G, Wahlgren N, for the SITS Poland Collaborative Group. Intravenous recombinant tissue plasminogen activator for acute stroke in Poland: an analysis based on the Safe Implementation of Thrombolysis in Stroke (SITS) Registry.
Acta Neurol Scand: 2010: 122: 229–236.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives – Intravenous thrombolysis was conditionally approved in the European Union (EU) in 2002, under the requirement of entering all patients into Safe Implementation of Thrombolysis in Stroke – Monitoring Study (SITS‐MOST). Countries not belonging to the EU by 2002, i.e. Poland were invited to enter data into the SITS International Stroke Thrombolysis Registry (SITS‐ISTR). The aim of this study is to compare the safety and efficacy of thrombolysis in the Polish SITS‐ISTR stroke patient population with patients registered in SITS‐MOST. Methods – 481 patients in Poland were reported between 2003 and 2007. Baseline and outcome data of Polish patients were compared with SITS‐MOST. Results – Most of the baseline characteristics did not differ between the groups. The most important was the onset‐to‐needle and door‐to‐needle times were significantly longer in Polish patients, 150 vs 136 min and 82 vs 68 min, respectively (P < 0.001). The symptomatic intracranial haemorrhage and independence rates at 3 months were similar in both populations. Polish patients had a significantly higher 3‐month mortality rate, 18.6% vs 11.3% (P < 0.001). Conclusions – Because of higher mortality the study implies the need to improve the organization of thrombolysis services and provides the rationale to continue the monitoring of treatment in Poland.