Estimulación de nervio periférico en el tratamiento de diferentes tipo de cefaleas / Peripheral nerve stimulation in the treatment of various types of headache

Introducción. La cefalea constituye una enfermedad con gran impacto en la calidad de vida y la economía de los países industriales. Una de las teorías fisiopatológicas se encuentra la activación de las fibras aferentes cervicales de los nervios C2-C3. La neuroestimulación periférica aferente de C2-C3, que se provoca en la estimulación del nervio occipital, parece aliviar la cefalea a través de las conexiones trigeminocervicales, y ser una de las causas principales de su eficacia. Material y métodos. Estudio multicéntrico retrospectivo entre abril 2005 y mayo 2009. Se incluyó a los pacientes con cefalea crónica mayor que fueron tratados con neuroestimulación. En todos los pacientes se valoró el tipo de cefalea, el grado de dolor mediante una escala numérica simple, tratamiento médico y episodios de cefalea. Se analizó el porcentaje de test negativos. En los portadores del generador definitivo se valoró la eficacia de la técnica mediante el análisis de la escala numérica simple y el análisis del porcentaje de mejoría subjetiva de los pacientes al mes, 3 meses, 6 meses y 12 meses. Se analizó el grado de cobertura, la satisfacción, la disminución de los episodios y la medicación y las complicaciones. Resultados. Se incluyeron 31 pacientes. El resultado del test fue positivo en el 87%. Existió una disminución significativa (p < 0,001) del dolor desde el momento basal con una mejoría mayor del 50% sostenido del 85,2% y un descenso en la puntuación de la escala numérica simple > 2 puntos en un 96,3% de los casos. Todos los pacientes estaban satisfechos durante el estudio. El 56% de la muestra no tuvo episodios de cefaleas tras el año de estudio y el 47% dejo de tomar medicación. La complicación más frecuente fue la migración del electrodo (AU)

Background and objective. Headache has a great impact on patients quality of life and in industrialized countries there is economic impact as well. One of the pathophysiologic theories to explain headache is activation of afferent C2-C3 nerve fibers. Afferent peripheral nerve stimulation by occipital nerve provocation at C2-C3 seems to alleviate headache by acting on the trigeminocervical complex, which would largely explain the effectiveness of this modality. The aim of this study was to describe peripheral nerve stimulation as an alternative therapy in patients who do not respond to other headache treatments. Material and methods. Multicenter retrospective study between April 2005 and May 2009, analyzing cases of patients treated with nerve stimulation for severe chronic headache. In all patients the medical history included type of headache, intensity of pain on a numerical scale, medical treatment used, and number of headache episodes. We recorded the percentage of patients with negative tests. Patients implanted with a generator assessed effectiveness on the numerical scale; we analyzed the percentage of perceived improvement at 1, 3, 6, and 12 months. We also analyzed the extent of coverage provided by the electrodes, patient satisfaction, reduction in the number of episodes and medication, and complications. Results. Of 31 patients, 87% had positive results, with a significant decrease in pain from baseline (P <. 001); 85.2% reported sustained improvement of >50%, and 96.3% reported a decrease of > 2 points on the pain scale. All patients expressed satisfaction during the period of follow-up. Fifty-six percent had no headaches after a year and 47% had stopped taking medication. The most frequent complication was electrode migration (AU)

[Pharmacological treatment of diabetic neuropathy in the elderly]. / Tratamiento farmacológico de la neuropatía diabética dolorosa en el anciano.

Diabetic neuropathy is the third most common complication of diabetes mellitus. When this neuropathy is accompanied by pain, it requires a specific treatment. In the elderly patient, the pain has an enormous impact on quality of life, as it is associated with anxiety, depression and sleep disorders, leading to a direct impact on the functionality of the patient. Likewise, there are a number of changes at the central and peripheral nervous system, which contribute to the chronicity of painful processes, and eventually also affect and impact on the quality of life of elderly patients. It is fundamental before initiating treatment, to know of all aspects related to drug pharmacokinetics and pharmacodynamics, especially those related to aging, because this will allow you to select the best drug for each patient. This article aims to review the pathophysiological concepts related to diabetic neuropathy in the elderly and the best treatment options.

Dose-independent pharmacokinetics of a candidate for diabetic neuropathy, SR-4668, after intravenous and oral administration to rats: Intestinal first-pass effect.

Dose-independent pharmacokinetic parameters of SR-4668 were observed after intravenous (i.v.) administrations at doses of 25, 50, and 75 mg/kg and oral administrations at doses of 50, 100, and 150 mg/kg to rats. The hepatic, gastric, and intestinal first-pass effects of SR-4668 were also measured after i.v., intraportal (i.p.), intraduodenal (i.d.), and intragastric (i.g.) administrations at a dose of 50 mg/kg to rats. Although a considerable amount of orally administered SR-4668 was absorbed, the F was low--only 33%. This indicates considerable first-pass (gastric, intestinal, and/or hepatic) effects of SR-4668 in rats. After i.v. administrations, the total body clearances of SR-4668 were considerably slower than the reported cardiac output in rats, suggesting that the first-pass effects of SR-4668 in the lung and heart could be negligible, if any, in rats. The AUCs of SR-4668 were comparable between i.v. and i.p. administrations, suggesting that the hepatic first-pass effect of SR-4668 was not considerable in rats. The AUCs were also comparable between i.d. and i.g. administrations, suggesting that gastric first-pass effect was almost negligible in rats. However, the AUC after an i.d. administration was significantly smaller (approximately 55% decrease) than that after an i.p. administration, suggesting that the intestinal first-pass effect was approximately 55% of oral dose. The rests of the orally administered dose could be mainly due to degradation of SR-4668 in gastric juices; 77.3-95.6% of the spiked amount of SR-4668 were recovered after 4-h incubation in five human gastric juices. The above data suggested that the low F of SR-4668 could be mainly due to considerable intestinal first-pass effect in rats.