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Intrathecal Drug Delivery

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https://www.readbyqxmd.com/read/28431428/computational-and-in-vitro-experimental-investigation-of-intrathecal-drug-distribution-parametric-study-of-the-effect-of-injection-volume-cerebrospinal-fluid-pulsatility-and-drug-uptake
#1
Kevin M Tangen, Roxanne Leval, Ankit I Mehta, Andreas A Linninger
BACKGROUND: Intrathecal drug delivery is an attractive option to circumvent the blood-brain barrier for pain management through its increased efficacy of pain relief, reduction in adverse side effects, and cost-effectiveness. Unfortunately, there are limited guidelines for physicians to choose infusion or drug pump settings to administer therapeutic doses to specific regions of the spine or the brain. Although empiric trialing of intrathecal drugs is critical to determine the sustained side effects, currently there is no inexpensive in vitro method to guide the selection of spinal drug delivery parameters...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28426576/personalized-intrathecal-drug-delivery-models-targets-and-approaches
#2
Jonathan P Wanderer, Naveen Nathan
No abstract text is available yet for this article.
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28393436/intrathecal-pump-refills-pocket-fills-and-symptoms-of-drug-overdose-a-prospective-observational-study-comparing-the-injected-drug-volume-vs-the-drug-volume-effectively-measured-inside-the-pump
#3
Paolo Maino, Roberto S G M Perez, Eva Koetsier
OBJECTIVES: One complication associated with the refill procedure of intrathecal drug delivery systems (IDDSs) include a "pocket fill," which is the inadvertent injection of the drug into the subcutaneous space surrounding the pump. The purpose of our study was to assess the mean volume discrepancy between the injected and the effective drug volume inside the IDDS reservoir after refills that did not lead to signs of overdose and to record at which volume discrepancy symptoms of overdose were noticed...
April 10, 2017: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/28381927/the-effects-of-minocycline-on-spinal-root-avulsion-injury-in-rat-model
#4
Tan Yew Chin, Sim Sze Kiat, Hizal Ghazali Faizul, Wutian Wu, Jafri Malin Abdullah
BACKGROUND: The neuroprotective role of minocycline in the treatment of brachial plexus injury is controversial. OBJECTIVE: To study the neuroprotective effect of minocycline via different routes in adult Sprague Dawley rats with brachial plexus injury. METHODS: The C7 nerve roots of the animals were avulsed via an anterior extravertebral approach. Traction force was used to transect the ventral motor nerve roots at the preganglionic level...
March 2017: Malaysian Journal of Medical Sciences: MJMS
https://www.readbyqxmd.com/read/28340041/bleeding-complications-in-patients-undergoing-intrathecal-drug-delivery-system-implantation
#5
Nafisseh S Warner, Markus A Bendel, Matthew A Warner, Jacob J Strand, Halena M Gazelka, Bryan C Hoelzer, William D Mauck, Tim J Lamer, Daryl J Kor, Susan M Moeschler
Introduction.:  Intrathecal drug delivery systems (IDDSs) have dramatically improved analgesia and the functional status of cancer patients and those with chronic pain states. However, given the close proximity to the neuraxis and frequent concomitant use of antiplatelet or anticoagulant medications, this intervention is not without risk. The goal of this investigation was to determine the incidence of bleeding complications following IDDS placement. Methods.:  This is a retrospective review from 2005 through 2014 of adult patients undergoing IDDS implantation or revision at a tertiary care center...
March 3, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28339319/intrathecal-magnetic-drug-targeting-for-localized-delivery-of-therapeutics-in-the-cns
#6
Indu Venugopal, Nazia Habib, Andreas Linninger
AIM: The challenge in treating neurological diseases is not lack of drug potency, but ineffective targeting techniques. We propose a technique called intrathecal magnetic drug targeting (IT-MDT), in which intrathecally injected magnetic nanoparticles (MNPs) are targeted to specific sites using external magnets. MATERIALS & METHODS: MRI and histology confirmed localization of MNPs via IT-MDT at target sites along the spine of Sprague-Dawley rats. RESULTS: MRI results confirmed greater MNP localization when the duration of magnet application was extended...
March 24, 2017: Nanomedicine
https://www.readbyqxmd.com/read/28336783/three-dimensional-dosimetry-for-radiation-safety-estimates-from-intrathecal-administration
#7
Jacob Hesterman, Susan Kost, Robert Holt, Howard Dobson, Ajay Verma, P David Mozley
Intrathecal (IT) administration is of growing interest for drug delivery and its utility is being increasingly investigated through imaging. In this work, the three-dimensional (3D) Voxel-Based Internal Dosimetry Application (VIDA) and 4D Extended Cardiac Torso Phantom (XCAT) were extended to provide radiation safety estimates specific to intrathecal administration. Methods: The 3D VIDA dosimetry application Monte Carlo simulation was run using a modified XCAT phantom with additional and edited cerebrospinal fluid (CSF) regions to produce voxel-level absorbed dose per unit cumulated activity maps for nine selected source regions...
March 23, 2017: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
https://www.readbyqxmd.com/read/28326946/polyamidoamine-dendrimer-conjugated-triamcinolone-acetonide-attenuates-nerve-injury-induced-spinal-cord-microglia-activation-and-mechanical-allodynia
#8
Hwisung Kim, Boomin Choi, Hyoungsub Lim, Hyunjung Min, Jae Hoon Oh, Sunghyun Choi, Joung Goo Cho, Jong-Sang Park, Sung Joong Lee
Background Accumulating evidence on the causal role of spinal cord microglia activation in the development of neuropathic pain after peripheral nerve injury suggests that microglial activation inhibitors might be useful analgesics for neuropathic pain. Studies also have shown that polyamidoamine dendrimer may function as a drug delivery vehicle to microglia in the central nervous system. In this regard, we developed polyamidoamine dendrimer-conjugated triamcinolone acetonide, a previously identified microglial activation inhibitor, and tested its analgesic efficacy in a mouse peripheral nerve injury model...
January 2017: Molecular Pain
https://www.readbyqxmd.com/read/28320042/calcium-channel-modulation-as-a-target-in-chronic-pain-control
#9
REVIEW
Ryan Patel, Carlota Montagut-Bordas, Anthony H Dickenson
Neuropathic pain remains poorly treated for large numbers of patients and little progress has been made in developing novel classes of analgesics. To redress this issue, ziconotide (Prialt(TM) ) was developed and approved as a first in class synthetic version of ω-conotoxin MVIIA, a Cav 2.2 peptide blocker. Unfortunately, the impracticalities of intrathecal delivery, low therapeutic index and severe neurological side effects associated with ziconotide has restricted its use to exceptional circumstances. Ziconotide exhibits no state or use dependent block of Cav 2...
March 20, 2017: British Journal of Pharmacology
https://www.readbyqxmd.com/read/28319551/a-contemporary-medicolegal-analysis-of-implanted-devices-for-chronic-pain-management
#10
Christopher R Abrecht, Penny Greenberg, Ellen Song, Richard D Urman, James P Rathmell
BACKGROUND: Analysis of closed malpractice claims allows the study of rare but serious complications and likely results in improved patient safety by raising awareness of such complications. Clinical studies and closed claims analyses have previously reported on the common complications associated with intrathecal drug delivery systems (IDDS) and spinal cord stimulators (SCS). This study provides a contemporary analysis of claims from within the past 10 years. METHODS: We performed a closed claims analysis for a period January 1, 2009 to December 31, 2013 for cases with pain medicine as the primary service...
April 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28296953/a-numerical-investigation-of-intrathecal-isobaric-drug-dispersion-within-the-cervical-subarachnoid-space
#11
Per Thomas Haga, Giulia Pizzichelli, Mikael Mortensen, Miroslav Kuchta, Soroush Heidari Pahlavian, Edoardo Sinibaldi, Bryn A Martin, Kent-Andre Mardal
Intrathecal drug and gene vector delivery is a procedure to release a solute within the cerebrospinal fluid. This procedure is currently used in clinical practice and shows promise for treatment of several central nervous system pathologies. However, intrathecal delivery protocols and systems are not yet optimized. The aim of this study was to investigate the effects of injection parameters on solute distribution within the cervical subarachnoid space using a numerical platform. We developed a numerical model based on a patient-specific three dimensional geometry of the cervical subarachnoid space with idealized dorsal and ventral nerve roots and denticulate ligament anatomy...
2017: PloS One
https://www.readbyqxmd.com/read/28296770/evaluation-of-intrathecal-drug-delivery-system-for-intractable-pain-in-advanced-malignancies-a-prospective-cohort-study
#12
Shuyue Zheng, Liangliang He, Xiaohui Yang, Xiuhua Li, Zhanmin Yang
Pain is prevalent in advanced malignancies; however, some patients cannot get adequate pain relief by conservative routes of analgesic administration or experience serious side effects related to high dose of opioids. For those who have exhausted multimodal conservative analgesic, intrathecal drug delivery is an alternative intervention for truly effective pain management. The objective of this study was to evaluate the clinical efficacy and safety of intrathecal drug delivery system (IDDS) for the treatment of intractable pain in advanced cancer patients...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28265859/new-cancer-pain-treatment-options
#13
REVIEW
Kenneth D Candido, Teresa M Kusper, Nebojsa Nick Knezevic
PURPOSE OF REVIEW: Cancer pain is often incapacitating and discouraging to patients; is demoralizing to family members and care takers; and is taxing and difficult to subdue for the pain specialists. The consequences of implementing suboptimal treatment are far-reaching; therefore, effective treatment methods are in a great demand. The face of cancer pain management has changed in considerable ways, and interventional procedures have become an integral part of providing multimodal analgesia in cancer pain treatment...
February 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/28212183/cxcl12-cxcr4-signaling-contributes-to-the-pathogenesis-of-opioid-tolerance-a-translational-study
#14
Chih-Peng Lin, Kai-Hsiang Kang, Huang-Ju Tu, Ming-Yueh Wu, Tzu-Hung Lin, Houng-Chi Liou, Wei-Zen Sun, Wen-Mei Fu
BACKGROUND: Long-term opioid therapy for chronic pain may lead to analgesic tolerance, especially when administered intrathecally, thus preventing adequate pain relief. Discovering drug targets to treat opioid tolerance using a mechanism-based approach targeting opioid-induced neuroinflammation provides new therapeutic opportunities. In this study, we provide translational evidence that CXCL12/CXCR4 signaling contributes to the pathogenesis of opioid tolerance. METHODS: The CXCL12 levels in the cerebrospinal fluid of opioid-tolerant patients were compared with those of opioid-naive subjects...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28195861/perioperative-management-of-a-patient-with-an-intrathecal-drug-delivery-device-infusing-ziconotide-a-case-report
#15
Sephalie Patel, Osama Hafez, Wade J Sexton, David A Edwards
Intrathecal ziconotide is used for the treatment of chronic pain and is delivered by an implanted drug delivery device. Anesthesiologists should be familiar with the perioperative management of the pump as well as the potential adverse events related to continued ziconotide infusion during general anesthesia. A case is presented demonstrating the perioperative management of an intrathecal drug delivery device infusing ziconotide in a patient presenting for radical cystectomy with pelvic lymphadenectomy and ileal conduit diversion...
February 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28156637/complications-of-intrathecal-pump-therapy-in-malignancy-related-pain
#16
Egidio Del Fabbro
102 Background: Intrathecal pumps (ITP) are used to manage severe malignancy related pain by delivering analgesics directly into the cerebrospinal fluid, in theory allowing for a reduced opioid dose and fewer complications. Although there is literature to support efficacy in patients with cancer, including improved survival, this mode of drug delivery also carries a risk of serious complications. Reports of complications in non-malignant pain suggest the risks and mortality related to ITP may be under-appreciated and that injury and liability occur with both ITP placement and ITP maintenance...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28095795/intrathecal-magnesium-sulfate-does-not-reduce-the-ed50-of-intrathecal-hyperbaric-bupivacaine-for-cesarean-delivery-in-healthy-parturients-a-prospective-double-blinded-randomized-dose-response-trial-using-the-sequential-allocation-method
#17
Fei Xiao, Wenping Xu, Ying Feng, Feng Fu, Xiaomin Zhang, Yinfa Zhang, Lizhong Wang, Xinzhong Chen
BACKGROUND: Addition of intrathecal magnesium sulfate to local anesthetics has been reported to potentiate spinal anesthesia and prolong analgesia in parturients. The current study was to determine whether intrathecal magnesium sulfate would reduce the dose of hyperbaric bupivacaine in spinal anesthesia with bupivacaine and sufentanil for cesarean delivery. METHODS: Sixty healthy parturients undergoing scheduled cesarean delivery were randomly assigned to receive spinal anesthesia with 0...
January 17, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28089765/intracerebroventricular-delivery-as-a-safe-long-term-route-of-administration
#18
REVIEW
Jessica L Cohen-Pfeffer, Sridharan Gururangan, Thomas Lester, Daniel A Lim, Adam J Shaywitz, Manfred Westphal, Irene Slavc
Intrathecal delivery methods have been used for many decades to treat a broad range of central nervous system disorders. A literature review demonstrated that intracerebroventricular route is an established and well-tolerated method for prolonged central nervous system drug delivery in pediatric and adult populations. Intracerebroventricular devices were present in patients from one to 7156 days. The number of punctures per device ranged from 2 to 280. Noninfectious complication rates per patient (range, 1...
November 10, 2016: Pediatric Neurology
https://www.readbyqxmd.com/read/28063958/prevention-of-chronic-post-thoracotomy-pain-in-rats-by-intrathecal-resolvin-d1-and-d2-effectiveness-of-perioperative-and-delayed-drug-delivery
#19
Jeffery Chi-Fei Wang, Gary R Strichartz
Thoracotomy results in a high frequency of chronic postoperative pain. Resolvins are endogenous molecules, synthesized and released by activated immune cells, effective against inflammatory and neuropathic pain. Different resolvins have differential actions on selective neuronal and glial receptors and enzymes. This article examines the ability of intrathecal resolvin D1 and resolvin D2 to reduce chronic post-thoracotomy pain in rats. Thoracotomy, involving intercostal incision and rib retraction, resulted in a decrease in the mechanical force threshold to induce nocifensive behavior, an enlargement of the pain-sensitive area, and an increase in the fraction of rats showing nocifensive behavior, all for at least 5 weeks...
January 4, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28042914/the-polyanalgesic-consensus-conference-pacc-recommendations-for-intrathecal-drug-delivery-guidance-for-improving-safety-and-mitigating-risks
#20
REVIEW
Timothy R Deer, Jason E Pope, Salim M Hayek, Tim J Lamer, Ilir Elias Veizi, Michael Erdek, Mark S Wallace, Jay S Grider, Robert M Levy, Joshua Prager, Steven M Rosen, Michael Saulino, Tony L Yaksh, Jose A De Andrés, David Abejon Gonzalez, Jan Vesper, Stefan Schu, Brian Simpson, Nagy Mekhail
INTRODUCTION: Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease states. The use of this option is a viable treatment strategy, but it is inherent for pain physicians to understand risk assessment and mitigation. In this manuscript, we explore evidence and mitigating strategies to improve safety with intrathecal therapy. METHODS: A robust literature search was performed covering January 2011 to October 9, 2016, in PubMed, Embase, MEDLINE, Biomed Central, Google Scholar, Current Contents Connect, and International Pharmaceutical Abstracts...
February 2017: Neuromodulation: Journal of the International Neuromodulation Society
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