Short-term efficacy and safety of valproate sustained-release formulation in newly diagnosed partial epilepsy [VIPe-study]. a multicenter observational open-label study

To evaluate the efficacy and safety of valproate [VPA] sustained-released in monotherapy across all ages in newly-diagnosed epileptic patients with partial seizures [PS] with or without secondary generalization. This was a multicenter, prospective, observational, open-label, non-comparative study involving the Gulf Cooperation Council [GCC] countries except the Kingdom of Saudi Arabia, and was performed between November 2004 and May 2006. Adults and children [6 years or older with newly diagnosed partial epilepsy [PE]] with or without secondary generalization were enrolled. The primary efficacy parameter was 6 month-remission rate [proportion of seizure-free patients in relation to total number of retained patients]. Secondary efficacy parameters included: 6 month-retention rate, investigator's clinical global impression rating, maximal effective dose and safety profile. Seventy-seven patients were enrolled; 56% adults and 44% children, with average duration of epilepsy of 5 months in the pediatric and 17 months in the adult group. Seizures type distribution: PS with secondary generalization [62%], complex PS [53%] and simple PS [14%]. The majority had idiopathic seizures [48%]. Sixty-six patients completed the study [treatment retention rate 80.5%]. At 6 months, 87% of patients became seizure free with VPA sustained-release monotherapy [average dose 22 mg/kg/day]. Adverse drug reactions [hair loss and tremor] were recorded in <20% of patients, mostly affecting adults. In this population, short-term treatment with VPA sustained-release in monotherapy provides good seizure control and is well tolerated

Central nervous system demyelination associated with etanercept in a 51 years old woman

There are few case reports documenting a new onset of demyelinating processes in patients receiving anti-tumour necrosis factor alpha therapy [anti-TNF alpha] for chronic inflammatory arthropathies. Whether anti-TNF alpha therapy induces new onset demyelination or just exacerbates pre-existing latent multiple sclerosis is not fully understood. We are reporting a 51-year-old woman without a prior history of multiple sclerosis, who developed demyelinating brain lesions three months after starting Etanercept. Her symptoms partially resolved on cessation of the drug. Our case was unusual compared to some previous case reports, as the patient's age at presentation was beyond that for idiopathic multiple sclerosis. This may strengthen the hypothesis of a causal relationship between new onset demyelination and Etanercept; however, exacerbation of pre-existing demyelinating process by Etanercept in this patient still cannot be totally excluded. We recommend doing magnetic resonance imaging [MRI] of the brain before starting patients on anti-TNF alpha therapy to exclude latent demyelination. In addition, new onset demyelination following anti-TNF alpha therapy should be reported and studied thoroughly as this may yield a significant advancement in our understanding of the pathogenesis of multiple sclerosis. Long-term follow-up of these cases is also important to determine the long-term prognosis and the rate of relapse of demyelinating process in this group of patients

Neurogenic stunned myocardium following hemorrhagic cerebral contusion

Neurogenic stunned myocardium [NSM] is a well-known complication of subarachnoidal hemorrhage, but has been reported rarely in association with other central nervous system disorders. A case of NSM is described in a patient with hemorrhagic brain contusion associated with cerebral edema. An 18-year-old man was admitted with severe cranial trauma following a car roll-over. Six days after admission, he developed findings suggestive for NSM. The troponin T and creatine kinase-MB level were elevated and echocardiogram showed apical and inferoposterior hypokinesis and diffuse left ventricular akinesis with severely reduced ejection fraction [18%]. Invasive measurements confirmed low cardiac output. His cardiac function resolved completely within 6 days after decompressive craniotomy. This case supports the presumed unifying role of the increased intracranial pressure, probably triggering a vigorous sympathetic outflow hyperactivity leading to NSM

Neurogenic stunned myocardium following hemorrhagic cerebral contusion

Neurogenic stunned myocardium NSM is a well-known complication of subarachnoidal hemorrhage, but has been reported rarely in association with other central nervous system disorders. A case of NSM is described in a patient with hemorrhagic brain contusion associated with cerebral edema. An 18-year-old man was admitted with severe cranial trauma following a car roll-over. Six days after admission, he developed findings suggestive for NSM. The troponin T and creatine kinase-MB level were elevated and echocardiogram showed apical and inferoposterior hypokinesis and diffuse left ventricular akinesis with severely reduced ejection fraction 18%. Invasive measurements confirmed low cardiac output. His cardiac function resolved completely within 6 days after decompressive craniotomy. This case supports the presumed unifying role of the increased intracranial pressure, probably triggering a vigorous sympathetic outflow hyperactivity leading to NSM

Haematologic disorders and cerebral venous thrombosis

This review focuses on the several coagulation disorders [the so called hypercoagulable states] that are associated with cerebral venous thrombosis. Hypercoagulable states likely explain the high percentage of cases of cryptogenic cerebral infarction in young people. The most common of the hereditary defects appear to be deficiency of antithrombin III, protein C or protein S, activated protein C resistance and prothrombin 20211A mutation. In a large majority of cases activated protein C resistance is due to the presence of factor V Leiden. Antiphospholipid antibodies [lupus anticoagulant and anticardiolipin antibodies] represent an acquired disorder of coagulation. Rare defects include heparin cofactor II [HC II], plasminogen or tissue plasminogen activator deficiency [TPA], elevated plasminogen activator inhibitor-1 [PAI-1] and dysfibrinogenemia. Hyperhomocystinemia is responsible for both arterial and venous thrombosis. A work-up to identify one of the recognizable hypercoagulable states is indicated, especially in younger patients with stroke. Laboratory evaluation for hypercoagulable states may also often be indicated in those patients who do not have other obvious risk factors for their stroke. If from clinical history, family history and/or laboratory studies, a patient is felt to have a hypercoagulable state, the decision for long term chronic anticoagulation needs to be individualized. If a hereditary hypercoagulable state is found, it also may be appropriate to recommend screening of other family members

Hemifacial spasm resulting from vertebral artery dolichoectasia

A 32-year-old man presented with left hemifacial spasm. Neurophysiological findings revealed an absent ipsilateral R1 on blink reflex. An MRI showed a dolichoectatic left vertebral artery impinging on the root exit zone of the left facial nerve. Botulinum toxin infections relieved the manifestations of hemifacial spasm. This case demonstrates that MRI/MRA is an essential part of the work-up for hemifacial spasm, and shows that in accordance with the literature, vertebral dolichoectasia is an uncommon cause of hemifacial spasm

Schwannoma of the vestibulocochlear nerve presenting as isolated paroxysmal vertigo

We report a patient with a schwannoma of the eighth cranial [vestibulocochlear] nerve who presented with isolated episodes of paroxysmal vertigo and positive Dix-Hallpike maneuver, and without the common features of hearing loss, disequilibrium and tinnitus. There are no previous reports of paroxysmal episodes of vertigo as the sole manifestation of schwannoma of the vestibulocochlear nerve. Hence, recurrent paroxysmal vertigo should therefore prompt the physician to rule out schwannoma of the vestibulocochlear nerve as a potential cause even in the presence of normal hearing tests

Hemifacial spasm resulting from vertebral artery dolichoectasia

A 32-year-old man presented with left hemifacial spasm. Neurophysiological findings revealed an absent ipsilateral R1 on blink reflex. An MRI showed a dolichoectatic left vertebral artery impinging on the root exit zone of the left facial nerve. Botulinum toxin infections relieved the manifestations of hemifacial spasm. This case demonstrates that MRI/MRA is an essential part of the work-up for hemifacial spasm, and shows that in accordance with the literature, vertebral dolichoectasia is an uncommon cause of hemifacial spasm

Biomedical publications from the sultanate of Oman medical research during past decade

To perform a retrospective analysis for the number of biomedical and clinical research publications generated from the Sultanate of Oman over the past decade [1990-1999]. Method: Medline was searched with the aid of the Internet provider PubMed. By using the advanced search option, entries were based on the country name, the different institutions and time period considered. In addition, for non-Medline listed journals, a thorough search per journal index was performed for this 10-year period. The number of Medline-listed biomedical research papers generated from the Sultanate of Oman over the past decade totalled 809. Of these, 34% were Medline-listed, the remaining ones appeared in non-Medline listed journals. The most common subject area was pediatrics followed by neurology/neurosurgery and microbiology/ immunology. Taking into account the relatively short history of medical research in the Sultanate of Oman, the data reveal a considerable growth in biomedical and clinical research publications during the nineties

evidence-based review of dopamine receptor agonists in the treatment of Parkinson's disease

Apomorphine and certain ergot alkaloids [bromocriptine, lisuride and pergolide] have been available for several decades; for the last few years, they were joined by newer dopamine agonists [cabergoline, pramipexole and ropinirole] most of them are non-ergolines. Each of these dopamine agonists has its own pharmacological characteristics and occupies a place in the pharmacotherapy of Parkinsons disease. In this evidence-based review, emphasis is put on the clinical efficacy of dopamine agonists in early and advanced Parkinsons disease, and where possible comparative evidence regarding their efficacy and safety is provided. In addition, their clinical pharmacokinetics, adverse effect profiles and most relevant interactions will be summarized

Geographical distribution of biomedical publications from the Gulf Corporation Council countries

It was our purpose to perform a geographical analysis for the number of biomedical and clinical research publications from the six countries of the Gulf Cooperation Council over the past decade [1990-1999]. Medline was searched with the aid of the Internet provider PubMed. By using the advanced search option, entries were based on the country name for each of the Gulf Cooperation Council countries and the time period considered. The number of Medline-listed biomedical research papers published in the Gulf Cooperation Council countries over the last 10 years totaled 6,960 and increased by 14% over the past decade. The Kingdom of Saudi Arabia followed by Kuwait was by far the most prolific and accounted for 67 and 16% of publications. The research output from the United Arab Emirates and Oman grew steadily over the past decade, while it appeared to plateau for both Bahrain and Qatar. Taking into account that Gulf Cooperation Council countries have a relatively short history of research, the data show that the Gulf Cooperation Council countries are very prolific in terms of Medline-indexed biomedical research publications

Guidelines for the prevention of migraine

Treatment of migraine has traditionally been divided into managing acute attacks and prophylactic treatment. Treatment of acute migraine has been the subject of many research papers and review articles in recent literature partly at the cost of prophylactic treatment, which is the focus of this review. The objective of prophylactic therapy is to reduce frequency, duration and severity of attacks in addition to optimize the patient's ability to function normally. Preventive therapy is usually undertaken in patients who have more than two migraine episodes per month or when less frequent have severely disabling headaches resistant to usual treatment. Beta-blocking drugs without intrinsic sympathomimetic activity [e.g. propranolol] are usually the first drugs of choice followed by tricyclic antidepressant agents [e.g. amitriptyline], non-steroidal anti-inflammatory drugs [e.g. naproxen], calcium antagonists [e.g. flunarizine] or valproate. The use of serotonin antagonists [e.g. methysergide] is limited because of their potential serious side effects. Migraine refractory to standard prophylactic therapy is very often the result of overuse of abortive antimigraine drugs. The choice of medication clearly depends on the patient's profile [age, co-morbid medical conditions] and the contraindication and side effect profile of the drug

Functional topography of thalamic syndromes A Case-oriented approach

Thalamic le + - sions can present clinically in various ways. We report, three patients each presenting with a different type of thalamic syndrome: a centromedian syndrome, a paramedian syndrome and a posterolateral syndrome. Neuroanatomical evidence is provided to support the clinical findings in these cases