Response to beta interferon 1b among Saudi patients with multiple sclerosis

To determine the efficacy and tolerability of subcutaneous beta interferon 1b [B1F1b] among Saudi patients with remitting-relapsing multiple sclerosis [R-R MS]. An open label study held at the Neurology Division of the Armed Forces Hospital, Riyadh from March 1997 until December 2001. Thirty-two consecutive patients below the age of 50 years with clinically definite R-R MS according to Poser's Criteria and expanded disability status scale below 5.5 were enrolled in treatment with subcutaneous B1F1b 8 million IU 3 times a week. The primary outcome measures used were: reduction in annual relapses, proportion of relapse-free patients, and the mean time to the first relapse after treatment was started. The secondary outcome measures used were the time to progression in disability, tolerability and safety of the beta interferon. Only 28 patients were analyzed to assess the outcome measures, the other 4 patients dropped out and were followed-up. Twenty were women and 8 were men [female:male ratio of 2.5:1]. There was a significant reduction in relapse-rate in all patients, 32.5% were relapse-free, while 37.5% showed reduction in the number of relapses. None of our patients showed progression of disability [P<0.0249]. Mild adverse reactions were seen in 38.5%, influenza-like illness occurred in 53.6%, and injection-site reaction in 35.7%. Subcutaneous B1F1b is effective in patients with R-R MS, especially in reducing relapse rate, probable disability, and it is well tolerated. However, longer follow-up is necessary to evaluate the role of B1F1b in preventing disability

Response to beta interferon 1b among Saudi patients with multiple sclerosis

To determine the efficacy and tolerability of subcutaneous beta interferon 1b [B1F1b] among Saudi patients with remitting-relapsing multiple sclerosis [R-R MS]. An open label study held at the Neurology Division of the Armed Forces Hospital, Riyadh from March 1997 until December 2001. Thirty-two consecutive patients below the age of 50 years with clinically definite R-R MS according to Poser's Criteria and expanded disability status scale below 5.5 were enrolled in treatment with subcutaneous B1F1b 8 million IU 3 times a week. The primary outcome measures used were: reduction in annual relapses, proportion of relapse-free patients, and the mean time to the first relapse after treatment was started. The secondary outcome measures used were the time to progression in disability, tolerability and safety of the beta interferon. Only 28 patients were analyzed to assess the outcome measures, the other 4 patients dropped out and were followed-up. Twenty were women and 8 were men [female:male ratio of 2.5:1]. There was a significant reduction in relapse-rate in all patients, 32.5% were relapse-free, while 37.5% showed reduction in the number of relapses. None of our patients showed progression of disability [P<0.0249]. Mild adverse reactions were seen in 38.5%, influenza-like illness occurred in 53.6%, and injection-site reaction in 35.7%. Subcutaneous B1F1b is effective in patients with R-R MS, especially in reducing relapse rate, probable disability, and it is well tolerated. However, longer follow-up is necessary to evaluate the role of B1F1b in preventing disability

New horizons in management of alzheimer's disease

At present there is no definitive treatment or cure for Alzheimer's disease, different pharmacological strategies are being actively investigated. Cholinergic therapy and narcoleptic agents represent the available approaches to symptomatic treatment of Alzheimer's disease. The use of cholinesterase inhibitors constitutes the best cholinergic approach to increase acetylcholine levels. Donazapil and Rivstigmine are effective and safe. Tacrine is less used due to its hepatotoxicity. Other cholinesterase inhibitors are still under investigation. Antioxidant therapy, such as Vitamin E and Selegeline, should disrupt or prevent the free radical beta-amyloid recirulating cascade they can prevent or halt pathological process. Oestrogen replacement therapy in post-menopausal women and non steroidal anti-inflammatoory drugs may play a role in showing or preventing Alzheimer's disease. Nerve growth factor is essential to the health of cholinergic neurons but is not available yet for clinical use. The most promising approaches for the future currently undergoing investigation involve attempts to slow the production of beta-amyloid aggregation. Gene therapy is also under investigation and assessment

New horizons in management of alzheimer's disease

At present there is no definitive treatment or cure for Alzheimer's disease, different pharmacological strategies are being actively investigated. Cholinergic therapy and neuroleptic agents represent the available approaches to symptomatic treatment of Alzheimer's disease. The use of cholinesterase inhibitors constitutes the best cholinergic approach to increase acetylcholine levels. Donazapil and Rivstigmine are effective and safe. Tacrine is less used due to its hepatotoxicity. Other cholinesterase inhibitors are still under investigation. Antioxidant therapy, such as Vitamin E and Selegeline, should disrupt or prevent the free radical beta-amyloid recirculating cascade they can prevent or halt pathological process. Oestrogen replacement therapy in post-menopausal woman and non steroidal anti-inflammatory drugs may play a role in slowing or preventing Alzheimer's disease. Nerve growth factor is essential to the health of cholinergic neurons but is not available yet for clinical use. The most promising approaches for the future currently undergoing investigation involve attempts to slow the production of beta-amyloid aggregation. Gene therapy is also under investigation and assessment

Neurological complications of infective endocarditis

We reviewed the files of 80 successive patients with native and prosthetic valve endocarditis admitted to Riyadh armed forces hospital. Neurological complications [NC] occurred in 28 [35%] patients. The valves involved were mitral in 12 [43%] aortic in eight [29%] combined mitral and aortic lesions in six [21%] and others in two [7%]. The common causative organisms were streptococci in 12 [43%] staphylococcus aureus and staphylococcus epidermides, both occurring in four [14%]. Compared to the 52 infective endocarditis patients with no neurological complications [NNC] the NC occurred more frequently in male patients those with aortic valve lesion those with atrial fibrillation those with delayed therapy and those with causative organisms being streptococci. Eleven patients died [39%], 12 [43%] recovered with motor sequelae, six [21%] had seizure disorder, and five [18%] had full recovery. The frequency of neurological complications and mortality is comparable to those reported in the literature; however the frequency of strokes was higher in our patients

Malignant hyperthermia, neuroleptic malignant syndrome and heat stroke: spectrum of a clinical syndrome

Malignant hyperthermia [MH] is a rare disease which occurs in genetically susceptible subjects after exposure to certain anaesthetics. The triggering anaesthetic agent causes abnormal release or re-uptake of calcium Ca[2+] from the sarcoplasmic reticulum. This interferes with the contraction relaxation process with a progressive increase in heat production and reduction of ATP levels. Neuroleptic malignant syndrome [NMS] is an uncommon disorder and occurs after administration of a neuroleptic agent or acute withdrawal of dopamine therapy. This leads to reduced central dopaminergic drive in the striatum and hypothalamus, so, extrapyramidal muscle rigidity with progressive generation of heat occurs. Heat stroke [HS] is due to the transfer of heat from the environment to the body core. This leads to a major insult to the hypothalamus, the temperature thermostat of the body, so there is a progressive increase in body temperature. There are similarities in the pathogenesis, biochemical changes, clinical pictures, complications and accordingly, the management of these potentially fatal syndromes. Dopaminergic agents and bromocriptine are effective in NMS but of no use in MH or HS. Dantrolene, an inhibitor of calcium release from the sarcoplasmic reticulum is the specific treatment for MH. It has also been used successfully in NMS and HS especially if rhabdomyolysis has occurred

Hypertensive brain diseases: subcortical arteriosclerotic encephalopathy [binswanger's disease]

HYPERTENSION is an important risk factor for many forms of cerebrovascular disease, including cerebral infarction, intracerebral hemorrhage and subarachnoid hemorrhage. Although the statistical importance of hypertension as a risk factor for stroke is well known, the only clinical neurological disorder that is caused solely by elevating the blood pressure is hypertensive encephalopathy. Two other neurological conditions are also linked with hypertension: Binswanger's disease [BD] and lacunar syndromes. Two hundred and twenty lesions were seen in all stroke patients admitted to King Khalid University Hospital during the period of June 1982 to May 1987. Hypertension was invariably present in all patients with Binswanger's disease and in 75% of patients with lacunar syndromes, as compared to 26% to 37% of patients with arterial infarcts, 54% of patients with cerebral hemorrhage and 30% of patients with subarachnoid hemorrhage. In this series, we will review the pathogenesis, clinical characteristics, and the management of these syndromes: Binswanger's disease, lacunar syndromes, and hypertensive encephalopathy