Spasticity: revisiting the role and the individual value of several pharmacological treatments.

Though in the last few decades only a few new drugs have come available for the treatment of spasticity, new insights may revise the role and individual value of several pharmacological treatments. Diazepam, baclofen and tizanidine are the most prescribed drugs for the treatment of spasticity. Intrathecal baclofen and local infiltration of botulin toxin are added values in selective patients. Gabapentin is a novelty, and the working mechanism of cannabis has been elucidated. Dantrolene sodium appears to owe its selectivity from the recently discovered ryanodine receptor, with a peripheral effect in muscles. In this review the pathophysiology and epidemiology of spasticity, pharmacology, clinical efficacy and unwanted effects of the different drugs for spasticity are updated.

Educational needs of general practitioners in palliative care: outcome of a focus group study.

BACKGROUND: The objective of this study was to identify the general practitioner's perception of educational needs in palliative care. METHOD: A qualitative study with focus groups was performed. RESULTS: General practitioners estimate palliative care as an important and valuable part of primary care. Nevertheless, they consider their coordinating role as a course with increasing obstacles. Pain, nausea, dysphagia, delirium, insomnia, anxiety, and depression were mentioned frequently as symptoms difficult to deal with in palliative care. Also, psychosocial issues such as communication, bereavement, and defense mechanisms were subject to discussion in the focus groups. Ethical issues such as euthanasia were mentioned as the most complex subject in palliative care. CONCLUSIONS: General practitioners experience difficulties with their coordinating role in palliative care. With more basic knowledge and skills in communication, but also with consultation, their roles as coordinators of palliative care in primary care will improve. Reflection and deepening of ethical values are necessary conditions for an optimal functioning.

Lipopolysaccharide-induced hyperalgesia of intracranial capsaicin sensitive afferents in conscious rats.

Migraineous and non-migraineous headache is reported to be at highest intensity after an infection. This study investigated whether activation of the immune system can induce hyperalgesia in intracranial capsaicin sensitive afferents. The effects of intraperitoneal injected lipopolysaccharides (LPS) on behavior and c-fos expression in the trigeminal nucleus caudalis layer I, II (TNC I,II) elicited by intracisternally applied capsaicin were studied. Low concentrations of LPS potentiated capsaicin-induced immobilization behavior without affecting c-fos expression in the TNC I,II. Large amounts of LPS however increased the number of capsaicin-induced c-fos positive cells in the TNC I,II. These effects of LPS on capsaicin sensitive afferents are probably mediated by cytokines that act at peripheral vagal nerves, central brain regions or via direct actions of cytokines on capsaicin sensitive afferent nerve terminals. The hyperalgesic action of LPS on intracranial trigeminal and possibly other capsaicin sensitive afferents of the head may explain why different types of infections are accompanied by headache and why migraineous and non-migraineous headache is of highest intensity after an infection.