Expert review of neurotherapeutics
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Expert Rev Neurother · Mar 2011
ReviewThe limited demyelinating diseases: the voyage of optic neuritis and transverse myelitis to multiple sclerosis and neuromyelitis.
The spectrum of idiopathic inflammatory-demyelinating disorders of the CNS is classified based on clinical symptoms and signs, clinical severity, lesion distribution, neuroimaging features and cerebrospinal fluid characteristics. There is a wide variety of conditions in this broad spectrum. ⋯ Clinical, MRI, cerebrospinal fluid and neuropathological features show that NMO could be considered as a distinct disease rather than as a variant of multiple sclerosis. Accurate and early diagnosis is critical to facilitate initiation of immunosuppressive and/or immunomodulatory therapy to prevent attacks and disability progression.
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Evaluation of: Ruts L, Drenthen J, Jongen JL et al. Pain in Guillain-Barré syndrome: a long-term follow-up study. Neurology 75, 1439-1447 (2010). ⋯ It correlates with sensory loss, severity of the GBS at its nadir and the presence of diarrhea. In the recovery/chronic stages it correlates with weakness, disability and fatigue. Up to a third of patients have pain at 1 year.
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Expert Rev Neurother · Feb 2011
Randomized Controlled Trial Multicenter StudyEfficacy and safety of ramelteon in Japanese adults with chronic insomnia: a randomized, double-blind, placebo-controlled study.
This randomized, double-blind, placebo-controlled study assessed the efficacy and safety of ramelteon 4 and 8 mg in Japanese adults with chronic insomnia. A secondary objective was to evaluate efficacy and safety when doses were uptitrated from placebo, ramelteon 4 and 8 mg to 4, 8 and 16 mg, respectively. Patient-reported sleep data were collected using sleep diaries. ⋯ Significant improvement was observed in the change in subjective total sleep time with ramelteon 8 mg at week 1. In post hoc analyses, ramelteon 8 mg reduced sSL in individuals with smaller fluctuations (within ±30 min) of sSL at baseline, in those with a shorter (<1 year) history of insomnia and in individuals who had not used benzodiazepines. Ramelteon up to 16 mg nightly was safe and well tolerated.
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Expert Rev Neurother · Feb 2011
ReviewSugammadex: a novel approach to reversal of neuromuscular blockade.
Sugammadex is the first in a new class of medications termed selective relaxant binding agents. This medication acts to encapsulate free circulating steroidal nondepolarizing neuromuscular blocking agents. ⋯ Currently approved for clinical use in over 50 countries, sugammadex was not approved by the US FDA in 2008 due to concerns over potential hypersensitivity reactions. It is hoped that further study and clinical experience will help to better define the risk associated with sugammadex and eventually lead to the approval of this novel medication in the USA.
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Expert Rev Neurother · Feb 2011
ReviewReno-cerebrovascular disease: linking the nephron and neuron.
Chronic kidney disease (CKD), a growing public health concern, carries a substantial burden and is a well-known independent predictor of coronary artery disease outcomes. In the last few years, attention has been focused on various CKD indices and their prognostic impact among individuals with, or at risk for, cerebrovascular disease. Mounting evidence suggests that the presence of CKD in various forms (filtration rate and barrier impairments), and even at mild stages, is associated with surrogate cerebrovascular disease markers, confers higher future risk of ischemic and hemorrhagic cerebrovascular events, and predicts poor clinical outcomes after an index stroke. ⋯ Additional investigation is also warranted to clarify whether CKD indices can usefully enhance cerebrovascular disease stratification beyond traditional risk factors. In the meantime, with several recent systematic reviews of published evidence supporting a robust and independent association of CKD with subsequent cerebrovascular disease risk, optimal implementation of established stroke risk reduction strategies in individuals with CKD might improve stroke outcomes. This article summarizes the compelling epidemiological and clinical evidence relating CKD to stroke, and presents the rationale for conducting future studies to assess the role of CKD as a risk marker or potential therapeutic target in individuals with, or at risk for, stroke.