Expert review of neurotherapeutics
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Pregnancy and the puerperium have been recognized to increase the risk of stroke, particularly from late pregnancy and through the puerperium. The reported incidences of stroke during pregnancy and the puerperium varied widely, ranging from 5 to 67 per 100,000 deliveries or pregnancies. Important causes of stroke during pregnancy and the puerperium include preeclampsia and eclampsia, cardioembolism, rupture of cerebral vascular anomaly, peripartum or postpartum cerebral angiopathy and cerebral venous thrombosis. ⋯ Anticoagulation during pregnancy is indicated for current arterial or venous thromboembolism, prior venous thromboembolism on long-term anticoagulation, antiphospholipid syndrome with prior venous thromboembolism and patients with a mechanical heart valve. Data from thrombolytic therapy for pregnant women with acute ischemic stroke are limited. It is critical that the risks and benefits of thrombolytic therapy for pregnant women and fetuses are considered cautiously.
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Expert Rev Neurother · Jan 2010
Review Historical ArticleDrug interactions involving the new second- and third-generation antiepileptic drugs.
During the period 1989-2009, 14 new antiepileptic drugs (AEDs) were licensed for clinical use and these can be subdivided into new second- and third-generation AEDs. The second-generation AEDs comprise felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, rufinamide, stiripentol, tiagabine, topiramate, vigabatrin and zonisamide. The third-generation AEDs comprise eslicarbazepine acetate and lacosamide. ⋯ Noteworthy is the fact that only five new AEDs (eslicarbazepine, felbamate, oxcarbazepine, rufinamide and topiramate) interact with oral contraceptives and compromise contraception control. The most clinically significant pharmacodynamic interaction is that relating to the synergism of valproate and lamotrigine for complex partial seizures. Compared with the first-generation AEDs, the new second- and third-generation AEDs are less interacting, and this is a desirable development because it allows ease of prescribing by the physician and less complicated therapeutic outcomes and complications for patients.
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Expert Rev Neurother · Dec 2009
ReviewEpilepsy, sex hormones and antiepileptic drugs in female patients.
Women with epilepsy have a higher incidence of reproductive endocrine disorders than the general female population. These alterations include polycystic ovary syndrome, hyperandrogenemia, infertility, hypothalamic amenorrhea and hyperprolactinemia. Reproductive dysfunction is attributed both to epilepsy itself and to antiepileptic drugs (AEDs). ⋯ Hepatic enzyme-inducing AEDs, such as carbamazepine and phenytoin, may be most clearly linked to altered metabolism of sex steroid hormones, but valproic acid, an enzyme inhibitor, has also been associated with a frequent occurrence of polycystic ovary syndrome and hyperandrogenism in women with epilepsy. Therefore, treatment of epilepsy and selection of AEDs are important for reproductive health in female patients. The aim of the present review is to critically evaluate the recently published data concerning the interactions between sex hormones, epilepsy and AEDs.
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Expert Rev Neurother · Dec 2009
ReviewBotulinum toxin type A for upper limb spasticity after stroke.
Spasticity is involuntary overactivity of muscles that occurs following upper motor neuron damage to the brain or spinal cord. Upper limb spasticity is common after stroke and can cause deformity, pain and reduced function. ⋯ Randomized controlled trials have shown that botulinum toxin type A can decrease upper limb spasticity and improve the ease of performing basic upper limb functional activities, such as cleaning the hand or dressing a sleeve. This article will review the pharmacology of botulinum toxin type A and its clinical efficacy when used to treat upper limb spasticity after stroke.
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Expert Rev Neurother · Nov 2009
ReviewRegional anesthesia for acute traumatic injuries in the emergency room.
Since the introduction of cocaine in 1884, regional nerve block procedures have been used in anesthesia practice for over 100 years. While almost all medical specialties use simple regional anesthesia techniques, anesthesia providers use a wider variety of more specific nerve block techniques than any other speciality. Anesthesiologists have assumed a vital role in recent military conflicts and, together with surgeons and emergency physicians, have introduced regional anesthesia techniques for the treatment and transport of injured soldiers. While such techniques have only been applied to a limited extent in civilian emergency settings, it is likely that current military experience will enhance future use of regional anesthesia techniques for the care of trauma patients in the civilian prehospital and emergency room settings.