Expert review of neurotherapeutics
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Expert Rev Neurother · Dec 2007
ReviewTramadol extended-release formulations in the management of pain due to osteoarthritis.
Tramadol is a centrally acting, synthetic analgesic. Its mechanism of action involves weak binding to the mu-opioid receptors and inhibition of reuptake of both norepinephrine and serotonin. It has been used to treat moderate-to-severe pain for 30 years in Europe and more than 10 years in the USA. ⋯ Generally, adverse events are typical of tramadol (constipation, nausea, dizziness and somnolence). Descriptively, a trend to comparable or lower incidence and severity of adverse events seems apparent with the various once-daily formulations. Tramadol once-daily formulations are more effective than placebo and at least as effective and well tolerated as immediate-release formulations in the treatment of pain due to osteoarthritis, and offer a reduced dosing regimen, which is especially valuable in elderly patients.
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Mortality in people with epilepsy is two- to three-times that of the general population. This can be attributed to epilepsy itself (epilepsy-related death) or to the underlying cause of the epilepsy. Sudden unexpected death in epilepsy (SUDEP) is the commonest cause of epilepsy-related death. ⋯ Poor incident case reporting, inaccurate death certification and fewer post-mortem examinations have limited the value of epidemiological data on SUDEP. Here, we review the characteristics of SUDEP, its likely risk factors, mechanisms and differential diagnosis, and consider possible strategies for prevention. We also explore the discussion of SUDEP with patients and the management of relatives of SUDEP patients.
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Neurostimulation therapy involves the use of peripheral or central nerve electrical stimulation approaches for the treatment of medically intractable headache. Currently, for peripheral stimulation the main approach is that of occipital nerve stimulation, while for central stimulation deep-brain approaches with the target of the region of the posterior hypothalamic gray matter have been explored. Target conditions include migraine and the trigeminal autonomic cephalalgias: cluster headache, paroxysmal hemicrania and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/cranial autonomic features (SUNCT/SUNA), as well as hemicrania continua. The initial results are encouraging and given the very significant disability of medically intractable primary headaches, this is a very promising area for patients and physicians alike.