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CNS Drugs

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https://www.readbyqxmd.com/read/28205146/binge-drinking-current-diagnostic-and-therapeutic-issues
#1
Benjamin Rolland, Mickaël Naassila
The concept of binge drinking (BD) refers to patterns of heavy episodic alcohol consumption, with BD primarily occurring among adolescents and young adults. Several official definitions of BD have been proposed, in particular by the World Health Organization, the National Institute on Alcoholism and Alcohol Abuse, and the Substance Abuse and Mental Health Services Administration. Nevertheless, none of these definitions address the psychosocial and medical consequences of the type of alcohol use seen in BD. In practice, BD can thus correspond to either hazardous or harmful use of alcohol (HUA), while the episodic nature of heavy drinking in BD means that it does not meet the criteria for 'alcohol dependence'...
February 15, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28185158/outcome-measures-in-clinical-trials-for-multiple-sclerosis
#2
REVIEW
Caspar E P van Munster, Bernard M J Uitdehaag
Due to the heterogeneous nature of the disease, it is a challenge to capture disease activity of multiple sclerosis (MS) in a reliable and valid way. Therefore, it can be difficult to assess the true efficacy of interventions in clinical trials. In phase III trials in MS, the traditionally used primary clinical outcome measures are the Expanded Disability Status Scale and the relapse rate. Secondary outcome measures in these trials are the number or volume of T2 hyperintense lesions and gadolinium-enhancing T1 lesions on magnetic resonance imaging (MRI) of the brain...
February 9, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28110399/safinamide-a-review-in-parkinson-s-disease
#3
Hannah A Blair, Sohita Dhillon
Safinamide (Xadago(®)) is an orally active, selective, reversible monoamine oxidase-B inhibitor with both dopaminergic and non-dopaminergic (glutamatergic) properties. In the EU, safinamide is approved for the treatment of mid- to late-stage fluctuating Parkinson's disease (PD) as add-on therapy to a stable dose of levodopa alone or in combination with other PD medications. Safinamide 50-100 mg/day administered as a fixed or flexible dose significantly increased daily 'on' time without dyskinesia (primary endpoint) in patients with mid- to late-stage PD with motor fluctuations in 24-week, placebo-controlled clinical trials...
January 21, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28105588/nogo-a-antibodies-for-progressive-multiple-sclerosis
#4
Benjamin V Ineichen, Patricia S Plattner, Nicolas Good, Roland Martin, Michael Linnebank, Martin E Schwab
Most of the current therapies, as well as many of the clinical trials, for multiple sclerosis (MS) target the inflammatory autoimmune processes, but less than 20% of all clinical trials investigate potential therapies for the chronic progressive disease stage of MS. The latter is responsible for the steadily increasing disability in many patients, and there is an urgent need for novel therapies that protect nervous system tissue and enhance axonal growth and/or remyelination. As outlined in this review, solid pre-clinical data suggest neutralization of the neurite outgrowth inhibitor Nogo-A as a potential new way to achieve both axonal and myelin repair...
January 19, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28101766/crossing-the-blood-brain-barrier-recent-advances-in-drug-delivery-to-the-brain
#5
Mayur M Patel, Bhoomika M Patel
CNS disorders are on the rise despite advancements in our understanding of their pathophysiological mechanisms. A major hurdle to the treatment of these disorders is the blood-brain barrier (BBB), which serves as an arduous janitor to protect the brain. Many drugs are being discovered for CNS disorders, which, however fail to enter the market because of their inability to cross the BBB. This is a pronounced challenge for the pharmaceutical fraternity. Hence, in addition to the discovery of novel entities and drug candidates, scientists are also developing new formulations of existing drugs for brain targeting...
January 18, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28101765/tolerability-and-safety-of-commonly-used-antiepileptic-drugs-in-adolescents-and-adults-a-clinician-s-overview
#6
REVIEW
Martin J Brodie
This paper discusses the issues surrounding the tolerability and safety of the commonly used antiepileptic drugs (AEDs) in adolescents and adults. The content includes dose-related adverse effects, idiosyncratic reactions, behavioural and psychiatric comorbidities, chronic problems, enzyme induction and teratogenesis. Twenty-one AEDs are discussed in chronological order of their introduction into the UK, starting with phenobarbital and ending with brivaracetam. Wherever possible, advice is given on anticipating, recognising and managing these issues and thereby improving the lives of people with epilepsy, most of whom will need to take one or more of these agents for life...
January 18, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28101764/diazepam-in-the-treatment-of-moderate-to-severe-alcohol-withdrawal
#7
Steven J Weintraub
Benzodiazepines ameliorate or prevent the symptoms and complications of moderate to severe alcohol withdrawal, which can include autonomic hyperactivity, agitation, combativeness, hallucinations, seizures, delirium, and death. The benzodiazepines most commonly used for this purpose are lorazepam, chlordiazepoxide, oxazepam, and diazepam. It is widely asserted that no member of this group is superior to the others for treatment of alcohol withdrawal. However, of these, diazepam has the shortest time to peak effect, which facilitates both rapid control of symptoms and accurate titration to avoid over-sedation...
January 18, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28078633/benzodiazepine-use-and-risk-of-developing-alzheimer-s-disease-a-case-control-study-based-on-swiss-claims-data
#8
Fabienne A Biétry, Alena M Pfeil, Oliver Reich, Matthias Schwenkglenks, Christoph R Meier
BACKGROUND: A possible association between benzodiazepine use and Alzheimer's disease (AD) has been hypothesized in previous studies. OBJECTIVES: Using claims data from the Helsana Group, a large Swiss health insurance provider, we examined the association between previous benzodiazepine use and the risk of AD. METHODS: We conducted a matched case-control study and identified 1438 incident AD cases between 2013 and 2014 based on recorded first-time use of drugs used to treat AD [i...
January 11, 2017: CNS Drugs
https://www.readbyqxmd.com/read/27943133/targeting-functional-impairments-in-the-treatment-of-children-and-adolescents-with-adhd
#9
Tyler Sasser, Erin N Schoenfelder, Mark A Stein
The diagnostic criteria for attention-deficit hyperactivity disorder (ADHD) require both symptoms and impairment to be present. Impairment in functioning is commonly the primary reason for referral, and is also a better predictor of long-term outcomes than ADHD symptoms. And yet, only recently has research begun to examine the impact of ADHD treatments on functional impairment using efficient and psychometrically sound outcome measures. In this article, we identify several noteworthy multidimensional measures of functional impairment (ADHD FX, Barkley Functional Impairment Scale [BFIS], Impairment Rating Scale [IRS], Weiss Functional Impairment Rating Scale [WFIRS]) utilized in recent clinical trials for ADHD, and describe their psychometric properties and clinical utility...
December 9, 2016: CNS Drugs
https://www.readbyqxmd.com/read/27943132/new-non-intravenous-routes-for-benzodiazepines-in-epilepsy-a-clinician-perspective
#10
Marco Mula
Benzodiazepines represent the first-line treatment for the acute management of epileptic seizures and status epilepticus. The emergency use of benzodiazepines must be timely, and because most seizures occur outside of the hospital environment, there is a significant need for delivery methods that are easy for nonclinical caregivers to use and administer quickly and safely. In addition, the ideal route of administration should be reliable in terms of absorption. Rectal diazepam is the only licensed formulation in the USA, whereas rectal diazepam and buccal midazolam are currently licensed in the EU...
December 9, 2016: CNS Drugs
https://www.readbyqxmd.com/read/27914038/serotonin-5-ht6-receptor-antagonists-in-alzheimer-s-disease-therapeutic-rationale-and-current-development-status
#11
Hilda Ferrero, Maite Solas, Paul T Francis, Maria J Ramirez
Alzheimer's disease (AD) is the most common cause of dementia in elderly people. Because of the lack of effective treatments for this illness, research focused on identifying compounds that restore cognition and functional impairments in patients with AD is a very active field. Since its discovery in 1993, the serotonin 5-HT6 receptor has received increasing attention, and a growing number of studies supported 5-HT6 receptor antagonism as a target for improving cognitive dysfunction in AD. This article reviews the rationale behind investigations into the targeting of 5-HT6 receptors as a symptomatic treatment for cognitive and/or behavioral symptoms of AD...
December 3, 2016: CNS Drugs
https://www.readbyqxmd.com/read/27896706/anesthetics-and-outcome-in-status-epilepticus-a-matched-two-center-cohort-study
#12
Raoul Sutter, Gian Marco De Marchis, Saskia Semmlack, Peter Fuhr, Stephan Rüegg, Stephan Marsch, Wendy C Ziai, Peter W Kaplan
BACKGROUND: The use of anesthetics has been linked to poor outcome in patients with status epilepticus (SE). This association, however, may be confounded, as anesthetics are mostly administered in patients with more severe SE and critical illnesses. OBJECTIVE: To minimize treatment-selection bias, we assessed the association between continuously administered intravenous anesthetic drugs (IVADs) and outcome in SE patients by a matched two-center study design. METHODS: This cohort study was performed at the Johns Hopkins Bayview Medical Center, Baltimore, MD, USA and the University Hospital Basel, Basel, Switzerland...
November 29, 2016: CNS Drugs
https://www.readbyqxmd.com/read/28130762/new-formulations-of-methylphenidate-for-the-treatment-of-attention-deficit-hyperactivity-disorder-pharmacokinetics-efficacy-and-tolerability
#13
REVIEW
Samuele Cortese, Giulia D'Acunto, Eric Konofal, Gabriele Masi, Benedetto Vitiello
Psychostimulants are the recommended first-line pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD). Methylphenidate is one of the most commonly used psychostimulants worldwide. Given that immediate-release and/or tablet/capsule formulations may decrease adherence to methylphenidate treatment, several drug companies have been developing novel long-acting and/or liquid/chewable formulations that may improve adherence as well as (for long-acting formulations) reduce abuse potential, decrease stigma associated with multiple administrations per day, and decrease the potential for adverse effects related to dosage peak...
February 2017: CNS Drugs
https://www.readbyqxmd.com/read/27995531/effect-on-cognition-of-estroprogestins-combined-with-interferon-beta-in-multiple-sclerosis-analysis-of-secondary-outcomes-from-a-randomised-controlled-trial
#14
Laura De Giglio, Fabiana Marinelli, Valeria T Barletta, Veronica A Pagano, Floriana De Angelis, Fulvia Fanelli, Nikolaos Petsas, Patrizia Pantano, Valentina Tomassini, Carlo Pozzilli
INTRODUCTION: Cognitive impairment is a disabling symptom in multiple sclerosis (MS). While its management remains challenging, beneficial effects on cognition of interferon beta (IFN-β) have been reported and a positive effect from estroprogestins has been hypothesised, suggesting that the combination of the two medications in women with MS could offer a promising treatment strategy. OBJECTIVES: We investigated whether a combination of estroprogestins and IFN-β can improve cognition in women with MS...
February 2017: CNS Drugs
https://www.readbyqxmd.com/read/28004314/pharmacological-treatment-in-%C3%AE-hydroxybutyrate-ghb-and-%C3%AE-butyrolactone-gbl-dependence-detoxification-and-relapse-prevention
#15
REVIEW
Rama M Kamal, Martijn S van Noorden, Wim Wannet, Harmen Beurmanjer, Boukje A G Dijkstra, Arnt Schellekens
The misuse of γ-hydroxybutyrate (GHB) for recreational purposes has resulted in an increase in GHB-related problems such as intoxications, dependence and withdrawal in several countries in Europe, Australia and the US over the last decade. However, prevalence rates of misuse of GHB and its precursor, γ-butyrolactone (GBL), are still relatively low. In this qualitative review paper, after a short introduction on the pharmacology of GHB/GBL, followed by a summary of the epidemiology of GHB abuse, an overview of GHB dependence syndrome and GHB/GBL withdrawal syndrome is provided...
January 2017: CNS Drugs
https://www.readbyqxmd.com/read/27882532/alemtuzumab-use-in-clinical-practice-recommendations-from-european-multiple-sclerosis-experts
#16
Thomas Berger, Irina Elovaara, Sten Fredrikson, Chris McGuigan, Lucia Moiola, Kjell-Morten Myhr, Celia Oreja-Guevara, Igor Stoliarov, Uwe K Zettl
Alemtuzumab (Lemtrada™) is a humanized monoclonal antibody approved in more than 50 countries. Within the European Union, alemtuzumab is indicated for the treatment of adult patients with relapsing-remitting multiple sclerosis (RRMS) with active disease defined by clinical or imaging features; in the USA, the indication states that alemtuzumab should generally be reserved for the treatment of patients with relapsing forms of multiple sclerosis who have had an inadequate response to two or more disease-modifying therapies (DMTs)...
January 2017: CNS Drugs
https://www.readbyqxmd.com/read/27873224/therapeutic-potential-of-transdermal-glyceryl-trinitrate-in-the-management-of-acute-stroke
#17
Jason P Appleton, Nikola Sprigg, Philip M Bath
The nitric oxide donor, glyceryl trinitrate (GTN), is a candidate treatment for the management of acute stroke with haemodynamic and potential reperfusion and neuroprotective effects. When administered as a transdermal patch during the acute and subacute phases after stroke, GTN was safe, lowered blood pressure, maintained cerebral blood flow, and did not induce cerebral steal or alter functional outcome. However, when given within 6 h of stroke onset, GTN reduced death and dependency (odds ratio 0.52; 95% confidence interval 0...
January 2017: CNS Drugs
https://www.readbyqxmd.com/read/27826741/the-porirua-protocol-in-the-treatment-of-clozapine-induced-gastrointestinal-hypomotility-and-constipation-a-pre-and-post-treatment-study
#18
Susanna Every-Palmer, Pete M Ellis, Mike Nowitz, James Stanley, Eve Grant, Mark Huthwaite, Helen Dunn
BACKGROUND: Clozapine, an antipsychotic used in treatment-resistant schizophrenia, causes slow gastrointestinal transit in 50-80% of patients. Clozapine-induced gastrointestinal hypomotility is both common and serious, and potential complications include severe constipation, ileus, bowel obstruction and related complications, with a higher mortality rate than clozapine-related agranulocytosis. Little evidence exists on its prevention and management. METHOD: Using a well-validated radiopaque marker ('Metcalf') method, we compared colonic transit times (CTTs) of clozapine-treated inpatients not receiving laxatives with their transit times when receiving laxatives, with treatment prescribed according to the Porirua Protocol for clozapine-related constipation (docusate and senna augmented by macrogol 3350 in treatment-resistant cases)...
January 2017: CNS Drugs
https://www.readbyqxmd.com/read/27878767/phenobarbital-versus-valproate-for-generalized-convulsive-status-epilepticus-in-adults-a-prospective-randomized-controlled-trial-in-china
#19
Yingying Su, Gang Liu, Fei Tian, Guoping Ren, Mengdi Jiang, Brian Chun, Yunzhou Zhang, Yan Zhang, Hong Ye, Daiquan Gao, Weibi Chen
OBJECTIVE: Although generalized convulsive status epilepticus (GCSE) is a life-threatening emergency, evidence-based data to guide initial drug treatment choices are lacking in the Chinese population. We conducted this prospective, randomized, controlled trial to evaluate the relative efficacy and safety of intravenous phenobarbital and valproate in patients with GCSE. METHODS: After the failure of first-line diazepam treatment, Chinese adult patients with GCSE were randomized to receive either intravenous phenobarbital (standard doses, low rate) or valproate (standard)...
December 2016: CNS Drugs
https://www.readbyqxmd.com/read/27848217/pregabalin-for-the-treatment-of-drug-and-alcohol-withdrawal-symptoms-a-comprehensive-review
#20
REVIEW
Rainer Freynhagen, Miroslav Backonja, Stephan Schug, Gavin Lyndon, Bruce Parsons, Stephen Watt, Regina Behar
Treatments for physical dependence and associated withdrawal symptoms following the abrupt discontinuation of prescription drugs (such as opioids and benzodiazepines), nicotine, alcohol, and cannabinoids are available, but there is still a need for new and more effective therapies. This review examines evidence supporting the potential use of pregabalin, an α2δ voltage-gated calcium channel subunit ligand, for the treatment of physical dependence and associated withdrawal symptoms. A literature search of the MEDLINE and Cochrane Library databases up to and including 11 December 2015 was conducted...
December 2016: CNS Drugs
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