GLG News by Neurologists who Treat Epilepsy (US)

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

Brain stimulation for high blood pressure?

February 6, 2011

Analysis of:Deep brain stimulation relieves refractory hypertension | www.neurology.org

In the past few years there has been a few reports of an anti-hypertensive effect of deep brain stimulation with Medtronic quadripolar electrodes in patients treated for pain syndromes.  Interestingly the antihypertensive effect appears independant of the analgesic effect.  The blood pressure is normalized and all anti-hypertensive medications stopped.  The reduction of blood pressure appears at the time of the surgery and is still present 27 months later.  up. 

Daniel WynnDirector, Clinical ResearchCONSULTANTS IN NEUROLOGY LTD

Central Neuropathic Pain: Cymbalta--- Another Failed Trial

December 29, 2010

Analysis of:Duloxetine in patients with central neuropathic pain caused by spinal cord injury or stroke: A randomized, double-blind, placebo-controlled trial. | www.ncbi.nlm.nih.gov

Treatment of neuropathic pain remains an enigmatic dilemma for most physicians.  Presently there are no drugs FDA approved for central neuropathic pain.  The use of drugs utilized for diabetic peripheral neuropathy and fibromyalgia, most notably Cymbalta (Eli Lilly), Lyrica (Pfizer) and Savella (Forest), as well as generics such as  gabapentin, tricyclic antidepressants and older anticonvulsants remain the mainstay of therapy. 

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

Duloxetine is not for all pains

December 27, 2010

Analysis of:Duloxetine in patients with central neuropathic pain caused by spinal cord injury or stroke: A randomized, double-blind, placebo-controlled trial. | www.ncbi.nlm.nih.gov

When faced with a patient with central pain we use drugs approved for peripheral neuropathy.  Some class I evidence support the use of gabapentin, pregabalin, lamotrigine, and tramadol for central pain. Hence, Vranken and his colleagues tested the analgesic effect on central pain of the mix noradrenergic-serotoninergic antidepressant duloxetine (Cymbalta). Unfortunately, their study confirms previous data showing that a mix noradrenergic-serotoninergic antidepressant is not an effective analgesic for central pain.

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

The first trial of mini spinal cord stimulators in early 2011

December 15, 2010

Analysis of:New miniature smart chip implant to combat chronic pain | www.physorg.com

After much talk in the past years, a new generation of neurostimulators will be tested in 2011 in Australia.  Because of miniaturisation, electrodes and the Implantable Pulse Generator (IPG) are now a single unit that can be directly implanted over the spinal cord or a peripheral nerve.  Now that's would be a prime example of minimally invasive surgery.

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

Botox gets the green light for migraine, but does it work?

November 17, 2010

Analysis of:OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial | cep.sagepub.com

Chronic migraine is a subtype of migraine, which is defined by 15 or more headaches days per month with 8 or more migraine days for at least 3 months.  For the PREEMT2 recruited in 66 sites. 347 patient received Botox and 358 received placebo. The double blind phase lasted 24 weeks, which was followed by an open-label period of 32 weeks.  Botox was injected every 12 weeks. The primary endpoint was the incidence of headache day, was significantly lower in the Botox and placebo group.

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

Spinal cord stimulation (SCS) for Parkinson’s disease? We're not there yet.

November 8, 2010

Analysis of:Spinal cord stimulation failed to relieve akinesia or restore locomotion in Parkinson’s disease | www.ncbi.nlm.nih.gov

Spinal cord stimulation (SCS) in dopamine-depleted mice and rats reverses the akinesia and improves locomotion (see Fuentes et al, Science 2009). Because SCS is much less invasive than deep brain stimulation, it is worth testing in Parkinson’s patients. Thevathasan and colleagues (2010) tested SCS in two patients with Parkinson’s disease.  There findings show no evidence that SCS improves the motor symptoms of Parkinson’s disease.

Daniel WynnDirector, Clinical ResearchCONSULTANTS IN NEUROLOGY LTD

Fampridine-PR -- The First Drug Proven to Help Multiple Sclerosis Patients Walk!

January 19, 2010

Analysis of:Biogen Idec Submits Application in Europe for the Approval of Fampridine-PR Tablets to Improve Walking Ability in People with Multiple Sclerosis | www.pipelinereview.com

Being confined to a wheelchair is the most common fear of patients living with multiple sclerosis (MS) from the time of diagnosis.  Up until now, there have been no therapies demonstrated to improve walking in multiple sclerosis.Fampridine-PR is the first drug application for a product which has clearly shown to improve walking speed in a significant portion of MS patients, and may become the first drug specifically approved for this indication.

Daniel WynnDirector, Clinical ResearchCONSULTANTS IN NEUROLOGY LTD

Acorda's Fampridine: The First FDA Approval to Help MS Patient's Walk

December 14, 2009

Analysis of:FDA Questions Efficacy of Acorda's MS Drug (Fampridine SR) | www.thestreet.com

Fampridine SR improves multiple sclerosis patient's ability to walk.  In demonstrating this, Acorda has successfully demonstrated that a new class of therapeutics, potassium channel blockers, can be effectively employed to address MS symptoms effectively and safely.

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

TRPs as Analgesic Drug Targets: Using HC-030031 to Probe the Role of TRPA1

September 28, 2009

Analysis of:The 3rd Annual Pain Therapeutics Summit | click.bsftransmit1.com

Transient receptor potential cation channel, subfamily A, member 1 (TRPA1) is a cold receptor, somewhat the opposite of the capsaicin receptor (TRPV1), which is a heat receptor. TRPA1 is a chemosensor and it has an abundance of agonists, exogenous (cigarette smoke, etc...) and endogenous (prostaglandins, etc…). All neurons that express TRPA1 also express TRPV1. Stimulating TRPA1 causes pain. Hydra Biosciences is developing TRPA1 antagonists (receptor blocker) to block pain and inflammation.

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

TRPV1 Agonists: 500 Years in Development

September 28, 2009

Analysis of:The 3rd Annual Pain Therapeutics Summit | click.bsftransmit1.com

Qutenza is a flexible film that wraps on the skin and leads to a rapid release of 8% capsaicin. Possible applications: OA, Post-herpetic neuralgia, HIV neuropathy, and diabetic neuropathy. The results show efficacy in both post-herpetic neuralgia and HIV neuropathy as determine by 30% decrease in pain. More trials are being presently conducted. NeurogesX is developing a liquid form is that is works in a much shorter time (5 min instead of the current 30 to 60 min).

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