Antiepileptic and Antidepressive Polypharmacy in Patients with Multiple Sclerosis

Objective. Patients with multiple sclerosis (MS) are often suffering from neuropathic pain. Antiepileptic drugs (AEDs) and tricyclic antidepressants (TCAs) are commonly used and are susceptible to be involved in drug interactions. The aim of this retrospective study was to investigate the prevalence of use of antiepileptic and antidepressive drugs in MS patients and to discuss the theoretical potential for interactions.Methods. Review of the medical records from all patients treated at a dedicated MS rehabilitation centre in Norway between 2009 and 2012.Results. In total 1090 patients attended a rehabilitation stay during the study period. Of these, 342 (31%; 249 females) with mean age of 53 (±10) years and EDSS 4.8 (±1.7) used at least one AED (gabapentin 12.7%, pregabalin 7.7%, clonazepam 7.8%, and carbamazepine 2.6%) or amitriptyline (9.7%). Polypharmacy was widespread (mean 5.4 drugs) with 60% using additional CNS-active drugs with a propensity to be involved in interactions. Age, gender, and EDSS scores did not differ significantly between those using and not using AED/amitriptyline.Conclusion. One-third of MS patients attending a rehabilitation stay receive AED/amitriptyline treatment. The high prevalence of polypharmacy and use of CNS-active drugs calls for awareness of especially pharmacodynamic interactions and possible excessive adverse effects.

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Central Neuropathic Pain in a Patient with Multiple Sclerosis Treated Successfully with Topical Amitriptyline

Case Reports in Medicine ◽

10.1155/2012/471835 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 11

Author(s):

David J. Kopsky ◽

Remko Liebregts ◽

Jan M. Keppel Hesselink

Keyword(s):

Multiple Sclerosis ◽

Neuropathic Pain ◽

Adverse Events ◽

Active Compound ◽

Analgesic Effect ◽

Tricyclic Antidepressants ◽

Double Blind ◽

Carryover Effect ◽

Double Blind Placebo ◽

Central Neuropathic Pain

Central neuropathic pain in patients with multiple sclerosis (MS) is a common debilitating symptom, which is mostly treated with tricyclic antidepressants or antiepileptics. Unfortunately, the use of these drugs is often limited due to adverse events. We investigated the analgesic effect of topical amitriptyline 5% and 10% cream in a patient with central neuropathic pain due to MS. The analgesic effect of topical amitriptyline cream on neuropathic pain was dose related. To evaluate whether this analgesic effect is due to the active compound or placebo, we conducted a double-blind placebo-controlled n-of-1 study with amitriptyline 5% cream and placebo. The instruction was to alternate the creams every week following the pattern ABAB, with an escape possibility of amitriptyline 10% cream. The result was a complete pain reduction after application of cream B, while most of the time cream A did not reduce the pain. The patient could correctly unblind both creams, determining B as active. She noted that in the week of using the active cream no allodynia was present, with a carryover effect of one day.

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Retrospective Study of 122 Dogs That Were Treated with the Antifibrinolytic Drug Aminocaproic Acid: 2010–2012

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-6298 ◽

2016 ◽

Vol 52 (3) ◽

pp. 144-148 ◽

Cited By ~ 3

Author(s):

Megan Davis ◽

Kiko Bracker

Keyword(s):

Retrospective Study ◽

Adverse Effects ◽

Blood Cell ◽

Red Blood Cell ◽

Blood Cells ◽

Medical Records ◽

Aminocaproic Acid ◽

Red Blood Cell Transfusion ◽

Antifibrinolytic Drugs ◽

Red Blood Cell Transfusions

ABSTRACT Antifibrinolytic drugs are used to promote hemostasis and decrease the need for red blood cell transfusion. Medical records of 122 dogs that were prescribed either oral or intravenous aminocaproic acid between 2010 and 2012 were evaluated retrospectively. Of the 122 dogs, three experienced possible drug-related adverse effects. No significant differences were identified between dogs that experienced adverse effects and those that did not and the possible adverse effects noted were all minor. All dogs that received packed red blood cell transfusions were evaluated for correlations between baseline packed cell volume or dose of red blood cells and aminocaproic acid dose and no correlation was identified. Dogs that received aminocaproic acid as a treatment for active bleeding were divided by cause of hemorrhage into the following groups: neoplastic, non-neoplastic, and unknown. No significant differences in aminocaproic acid dose or the percentage of patients requiring a blood transfusion were identified between groups.

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Intercostal nerve mononeuropathy: study of 14 cases

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2005000500011 ◽

2005 ◽

Vol 63 (3b) ◽

pp. 776-778 ◽

Cited By ~ 7

Author(s):

Paulo Sergio S. dos Santos ◽

Luiz Antonio Lima Resende ◽

Ronaldo G. Fonseca ◽

L. Lemônica ◽

Raul Lopes Ruiz Jr ◽

...

Keyword(s):

Neuropathic Pain ◽

Retrospective Study ◽

Thoracic Surgery ◽

Tricyclic Antidepressants ◽

Intercostal Nerve ◽

University Hospital ◽

Thoracic Pain ◽

Hospital Medical ◽

Therapeutic Drugs ◽

History Of

This retrospective study describes 14 cases of intercostal nerve mononeuropathy (INM) found in 5,560 electromyography (EMG) exams performed between January 1991 and June 2004 in our University Hospital. Medical charts of all patients with history of thoracic pain and EMG diagnosis of intercostal mononeuropathy were reviewed. INM was detected in 14 patients; etiology was thoracic surgery in 6 (43%), post-herpetic neuropathy in 4 (28%), probable intercostal neuritis in 2 (14%), lung neoplasia in 1 (7%), and radiculopathy in 1 (7%). From this study, trauma and infection were the main etiologies in intercostal neuropathic pain development. Tricyclic antidepressants and anticonvulsants were the most common therapeutic drugs used.

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Prevalence of ENT diseases in Chitradurga district of Karnataka, India

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200155 ◽

2020 ◽

Vol 6 (2) ◽

pp. 380

Author(s):

Amardeep Singh ◽

Manjunath K. ◽

Manjunatha Rao S. V. ◽

Akash Aradhya S.

Keyword(s):

Allergic Rhinitis ◽

Retrospective Study ◽

General Population ◽

Medical Records ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Throat Region ◽

High Prevalence ◽

Nasal Diseases

Background: Study was conducted to observe the magnitude of ENT morbidity in the predominantly rural district of Chitradurga, Karnataka.Methods: It was a retrospective study based on medical records of the patients attending OPD of Otorhino-laryngology department in a tertiary care hospital. Retrieved data was tabulated in terms of frequency and percentage to assess the prevalence of ENT diseases in this region. Results: Study revealed high prevalence of ear diseases (40.4%) followed by throat problems (28.5%). Among ear group, majority of patients (19.7%) had otitis media. In throat region, there was high prevalence of pharyngitis (12.8%) and tonsillitis (8.0%). Nasal diseases reflected allergic rhinitis (7.0%) and symptomatic DNS (6.5%) as the major contributors to ENT pathologies.Conclusions: Results of the present study reveal that ear and throat diseases form the largest component of ENT problems. Most of these are infectious and preventable. Health education of general population will play a major role in curtailing the related morbidity.

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SYMPTOMS OF TUBERCULOSIS IN HIV POSITIVE CHILDREN AND THE IMPACT OF PREVENTION ON THE DEVELOPMENT AND COURSE OF THE DISEASE

Tuberculosis and lung diseases ◽

10.21292/2075-1230-2019-97-3-35-39 ◽

2019 ◽

Vol 97 (3) ◽

pp. 35-39

Author(s):

E. Yu. Zorkaltseva ◽

L. V. Zaritskaya ◽

S. V. Pugacheva

Keyword(s):

Retrospective Study ◽

Medical Records ◽

Inpatient Treatment ◽

Hiv Positive ◽

X Ray ◽

High Prevalence ◽

Severe Intoxication ◽

Tuberculosis Therapy ◽

The Impact ◽

Hiv Negative

The objective of the study: to compare the clinical and X-ray signs of tuberculosis in HIV positive and HIV negative children, to identify factors that are more common in HIV infected children in the region with a high prevalence of both infections. Subjects and methods. 264 children with tuberculosis, and 41 children with HIV infection and tuberculosis undergoing inpatient treatment were enrolled in the study, which was the retrospective study of medical records. The patients underwent standard clinical and X-ray examinations, and microbiological tests. Results. Disseminated forms of tuberculosis (39.1%), tuberculous meningoencephalitis (4.9%) were more frequent in the HIV positive children, while in HIV negative children, it made 1.9 and 0.4% respectively. Among HIV positive children, 34% had several sites of tuberculosis, and 19.5% suffered from generalized forms. In HIV positive children, tuberculosis was more often detected in the infiltration phase, it was accompanied by severe intoxication symptoms, while when taking anti-tuberculosis therapy in combination with ART, they had more rapid positive changes.

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Review of antidepressants in the treatment of neuropathic pain

Mental Health Clinician ◽

10.9740/mhc.2015.05.123 ◽

2015 ◽

Vol 5 (3) ◽

pp. 123-133 ◽

Cited By ~ 9

Author(s):

Elizabeth P. Baltenberger ◽

Whitney M. Buterbaugh ◽

B. Shane Martin ◽

Christopher J. Thomas

Keyword(s):

Neuropathic Pain ◽

Adverse Effects ◽

Tricyclic Antidepressants ◽

Randomized Clinical Trials ◽

Treatment Options ◽

Comparable Efficacy ◽

Chemotherapy Treatment ◽

Pubmed Search ◽

Pathological Pain ◽

Meta Analyses

Abstract Introduction Neuropathy is a pathological pain disorder characterized by burning, stabbing, and cramping sensations. There are multiple etiologies for this pain such as diabetes, vascular disorders, and chemotherapy treatment. Neurotransmitters, such as norepinephrine and serotonin, are thought to play a part in the modulation of this pain. The objective of this review is to summarize the current literature to support the efficacy and impact of adverse events of the various classes of antidepressants utilized in the treatment of neuropathic pain. Methods A Medline/Pubmed search was conducted to identify randomized clinical trials within the last 12 years examining the efficacy and safety of antidepressants for the treatment of neuropathy. Systematic reviews and meta-analyses were also included. Results Antidepressants are commonly used in the treatment of neuropathy, with meta-analyses supporting the use of tricyclic antidepressants and selective norepinephrine serotonin reuptake inhibitors. Trials indicate that venlafaxine, duloxetine, and tricyclic antidepressants (TCAs) have comparable efficacy, but TCAs have a higher incidence of adverse effects. Other antidepressants, such as citalopram, paroxetine, and bupropion have limited evidence supporting their use in neuropathy. Discussion Based on the evidence reviewed, venlafaxine and duloxetine should be used as first-line agents. TCAs should be used as second-line agents, due to higher incidence of adverse effects. Other treatment options include citalopram, paroxetine, and bupropion, but data supporting their efficacy is limited.

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Meropenem Administered via Intravenous Regional Limb Perfusion for Orthopedic Sepsis in Horses: A Clinical Retrospective Study

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.629627 ◽

2021 ◽

Vol 8 ◽

Author(s):

Allison P. Mosichuk ◽

Joseph S. Smith ◽

Dane M. Tatarniuk ◽

Jarrod R. Troy ◽

Amanda J. Kreuder

Keyword(s):

Antimicrobial Activity ◽

Overall Survival ◽

Retrospective Study ◽

Adverse Effects ◽

Medical Records ◽

Human Medicine ◽

Bacterial Isolates ◽

Demographic Information ◽

Limb Perfusion ◽

Carbapenem Antibiotic

Septic synovitis is a critical orthopedic condition in horses. Early intervention is key, with antibiotic therapy typically initiated prior to culture and susceptibility reports becoming available. The pharmacokinetics of several antibiotics have been studied in horses for use in intravenous regional limb perfusion (IVRLP) for septic synovitis, including the carbapenem antibiotic, meropenem. For a variety of factors, some veterinary clinicians may select IVRLP meropenem as therapy for these cases. Meropenem is a vital antibiotic in human medicine, making veterinary use divisive. However, verifying the efficacy of meropenem contrasted to other IVRLP antibiotics is essential for appropriate antimicrobial stewardship. To investigate this, equine patient medical records at a single veterinary teaching hospital were examined. Cases treated with meropenem or gentamicin via IVRLP for septic synovitis were retrospectively analyzed for demographics, diagnostics, treatments, outcomes, and adverse effects. Twenty-three meropenem and 37 gentamicin treated horses were analyzed; demographic information was similar between groups. In the meropenem group, nine horses received meropenem only; the remainder received another antibiotic initially then changed to meropenem. Structures infected included joints (meropenem = 13, gentamicin = 17), tendon sheaths (meropenem = 5, gentamicin = 8) and navicular bursae (meropenem = 2, gentamicin = 6). Overall survival to discharge was 86% (52/60), with meropenem 91% (21/23) and gentamicin 84% (31/37), with no statistically significant differences noted between meropenem or gentamicin groups for overall survival to discharge or outcome after discharge. Twenty-four of 26 bacterial isolates obtained from culture were reported as sensitive to imipenem, a carbapenem antibiotic similar to meropenem. Reported susceptibility to other antibiotics such as ceftiofur (n = 22/26), ampicillin (n = 18/26), amikacin (n = 15/26), or gentamicin (n = 12/26) was also frequently present. In the population of this study, antimicrobial activity augmented with IVRLP using either meropenem or gentamicin both appear to be an effective treatment for septic synovial structures, therefore, less critical antimicrobials may be a viable and more judicious treatment option.

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The Impact of Tobacco Smoking Upon Chronic/Recurrent Tonsillitis and Post Tonsillectomy Bleeding

International Archives of Otorhinolaryngology ◽

10.1055/s-0036-1593835 ◽

2016 ◽

Vol 21 (02) ◽

pp. 165-170 ◽

Cited By ~ 7

Author(s):

Udi Cinamon ◽

Abraham Goldfarb ◽

Tal Marom

Keyword(s):

Smoking Cessation ◽

Retrospective Study ◽

General Population ◽

Adverse Effects ◽

Tobacco Smoking ◽

Medical Records ◽

Chronic Tonsillitis ◽

Entire Group ◽

Recurrent Tonsillitis ◽

The Impact

Introduction Smoking has many adverse effects on the oral and pharyngeal mucosa. Outcomes may be developing tonsillar infections and predisposing for post tonsillectomy bleeding (PTB). Objective The objective of our study was to determine whether smokers have more chronic/recurrent tonsillitis indicating for tonsillectomy or develop more PTB episodes. Methods We conducted a retrospective study on two groups of adults (age ≥18 years). Cohort 1: Smoking among patients who underwent tonsillectomy for recurrent/chronic tonsillitis. Cohort 2: Smoking among patients requiring control of PTB that were operated primarily for recurrent/chronic tonsillitis. Cohort 1 served as a population-reference for the second. We retrieved the data from medical records. Results Cohort 1: 206 adults aged 18–50 years (mean 26 ± 7.6). 28% (57 patients) were smokers, versus 24% and 20% in the general population (in the years 2000 and 2010; p = 0.5, p = 0.18, respectively). Cohort 2: 114 adults aged 18–73 years (mean 26 ± 7.6). 43% were smokers, double the incidence in the general population (p = 0.004, p = 0.0004, in 2000 and 2010, respectively), and 1.5 times cohort 1 (p = 0.02). Smoking rates among bleeders on post-operative days 8–10 and later than day 10 were 53% and 60% (p = 0.0005 and p < 0.0001, respectively). Five of ten patients presenting a second PTB were smokers. Timing of re-bleedings was similar to their first PTB and dated similarly as first PTB of the entire group, mean 5.6 days (SD ± 3.2). Conclusion Smokers may encounter more chronic/recurrent tonsillitis episodes, indicating tonsillectomy and significantly are more prone for PTB. Smoking cessation may perhaps diminish recurrent/chronic tonsillitis. Whether pre-operative abstinence or its length would reduce PTB incidence is yet to be determined.

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Percutaneous sclerotherapy for spongiform venous malformations – analysis of patient-evaluated outcome and satisfaction

VASA ◽

10.1024/0301-1526/a000650 ◽

2017 ◽

Vol 46 (6) ◽

pp. 477-483

Author(s):

Robert Karl Clemens ◽

Frederic Baumann ◽

Marc Husmann ◽

Thomas Oleg Meier ◽

Christoph Thalhammer ◽

...

Keyword(s):

Retrospective Study ◽

Medical Records ◽

Venous Malformation ◽

Primary Treatment ◽

Venous Malformations ◽

Treated Area ◽

Item Questionnaire ◽

Percutaneous Sclerotherapy ◽

Multiple Treatments ◽

Pain Improvement

Abstract. Background: Congenital venous malformations are frequently treated with sclerotherapy. Primary treatment goal is to control the often size-related symptoms. Functional impairment and aesthetical aspects as well as satisfaction have rarely been evaluated. Patients and methods: Medical records of patients who underwent sclerotherapy of spongiform venous malformations were reviewed and included in this retrospective study. The outcome of sclerotherapy as self-reported by patients was assessed in a 21 item questionnaire. Results: Questionnaires were sent to 166 patients with a total of 327 procedures. Seventy-seven patients (48 %) with a total of 159 procedures (50 %) responded to the survey. Fifty-seven percent of patients were male. The age ranged from 1 to 38.1 years with a median age of 16.4 years. The lower extremities were the most common treated area. Limitations caused by the venous malformation improved in the majority of patients (e.g. pain improvement 87 %, improvement of swelling 83 %) but also worsening of symptoms occurred in a minority of cases. Seventy-seven per cent would undergo sclerotherapy again. Conclusions: Sclerotherapy for treatment of venous malformations results in significant reduction of symptoms. Multiple treatments are often needed, but patients are willing to undergo them.

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