Usefulness of Gabapentin as an Alternative/Adjunct Therapy for Delirium: A Retrospective Observational Study.

BACKGROUND: Antipsychotics are commonly used to treat delirium but can adversely affect the extrapyramidal and cardiac conduction systems. Antipsychotic use has also been reported to be associated with increased mortality in older adults. Therefore, alternative and adjunct medications for delirium are necessary. We retrospectively assessed the efficacy and safety of gabapentin (GBP) as an alternative and adjunct medication for delirium. METHODS: We retrospectively investigated the records of patients with delirium treated with GBP (71 patients; median age, 81 years; interquartile range, 76-87.5 years; 54.9% males) at a general hospital. We examined duration to delirium improvement, as assessed by the Intensive Care Delirium Screening Checklist (ICDSC) and DSM-5 criteria, as well as adverse events. RESULTS: The median (interquartile range) GBP dose was 200 mg (150-350 mg) /day. A total of 71.8% and 85.9% of the patients failed to meet the diagnostic criteria for delirium at 2 days and 5 days after initial administration, respectively (p<0.05). In subgroup analysis, patients with a history of epilepsy or cerebrovascular disease responded better to GBP than did those without such histories, suggesting that patients with abnormal/borderline neuronal activity respond to GBP even though they do not exhibit seizures. GBP did not induce extrapyramidal symptoms, cardiac conduction disturbances, hyperglycemia, or epilepsy but caused sleepiness and myoclonus. CONCLUSIONS: GBP may improve delirium with fewer adverse effects and may be a safe alternative or adjunct treatment for delirium. Dosage adjustment may be necessary to prevent sleepiness.

Fractalkine (FRK) levels in amniotic fluid and its production during pregnancy.

Fractalkine is a new CX(3)C chemokine that has chemoattractant activity for T cells, monocytes and natural killer (NK) cells. Western blot analysis revealed that fractalkine protein was detected as a 95 kDa band in both the amniotic fluid and the amnion during the second and third trimesters. Immunohistochemistry using an anti-fractalkine polyclonal antibody revealed positive staining of epithelial cells in amnion and trophoblasts in both the second and third trimesters. Neonatal urine also contained detectable amounts of fractalkine. RT-PCR detected fractalkine mRNA transcripts in the amnion. To determine whether fractalkine receptor (CX(3)CR1)-positive cells were present in amniotic fluid and amnion, we performed RT-PCR using specific primers for CX(3)CR1. CX(3)CR1-positive cells had migrated into the amniotic fluid and the amnion. The present findings suggest that fractalkine found in amniotic fluid may contribute to the immunodefence mechanism during pregnancy.