scholarly journals Cannabinoids for the treatment of refractory neuropathic pruritus in amyotrophic lateral sclerosis: A case report

2021 ◽  
pp. 026921632110453
Author(s):  
Kelvin Lou ◽  
Shane Murphy ◽  
Clair Talbot
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Side Effects ◽  
Lessons Learned ◽  
Case Presentation ◽  
Course Of Action ◽  
Research Problems ◽  
Neuropathic Pruritus ◽  
Gastrointestinal Side Effects ◽  
Chronic Pruritus ◽  
Lateral Sclerosis

Background: Neuropathic symptoms have a wide variety of manifestations, ranging from pain to pruritus. Neuropathic pruritus is a type of chronic pruritus related to damaged small fibers. Cannabinoids have evidence to manage neuropathic symptoms. We present a case of refractory neuropathic pruritus that was successfully managed with the use of oral cannabinoids. Case presentation: A 60-year-old male with amyotrophic lateral sclerosis with ongoing pruritus despite the use of standard neuropathic therapies. Possible course of action: Sodium channel and N-methyl-D-aspartate receptor antagonists have evidence for neuropathic symptoms but can cause significant gastrointestinal side effects. Prescription cannabinoids such as nabiximol can be cost prohibitive to use in practice. Synthetic tetrahydrocannabinol products are dose limited by psychoactive side effects. Formulation of a plan: A balanced oral cannabinoid from a licensed producer was preferred as it has evidence for neuropathic symptoms and is generally well tolerated. Outcome: The patient showed improvement to his pruritus score from 7/10 to 3/10. There was initial increased sedation but tolerance developed quickly. Lessons learned from case: Cannabinoids are possibly safe and effective in management of neuropathic pruritus. View on research problems: Additional research is needed to establish efficacy and safety.

scholarly journals Intrathecal Riluzole for the Treatment of Patients With Amyotrophic Lateral Sclerosis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Nicholas M Boulis
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Side Effects ◽  
Oral Administration ◽  
Oral Therapy ◽  
Drug Exposure ◽  
Oral Treatment ◽  
Oral Drug ◽  
Systemic Drug Exposure ◽  
Lateral Sclerosis ◽  
Systemic Drug

Abstract INTRODUCTION Oral riluzole is the only approved treatment known to improve survival in patients with amyotrophic lateral sclerosis (ALS), with modest efficacy and dosing limited by hepatic toxicity and asthenia. We postulated that a continuous intrathecal (IT) delivery of low daily doses of riluzole could elevate spinal cord (SC) concentrations well above those achievable with oral treatment alone, without increasing side-effects. METHODS A 6-wk and a 24-wk GLP study were conducted to evaluate the safety of IT riluzole in purpose-bred hound dogs. Oral riluzole, equivalent to 50 mg BID in humans, was administered in combination with one of 3 IT doses given through continuous infusion. Plasma, SC, and brain concentrations of riluzole were measured, along with assessments of safety and tolerability. RESULTS In the 6-wk study, when combining the oral and IT routes, IT infusion significantly increased SC concentrations well above those achieved with oral drug administration alone, without increasing brain concentrations. All IT doses in combination with oral administration were well tolerated by the animals. In the 6-mo study, the lowest dose used in the 6-wk study was dropped and a higher dose was added. This highest dose of IT riluzole was not tolerated by the dogs and yielded SC and brain concentrations significantly higher than achieved in any of our previous studies. CONCLUSION Continuous IT administration of riluzole when combined with oral administration can increase the SC concentration of riluzole above those achievable with oral therapy, without increasing the risk for adverse events associated with systemic drug exposure or off-target side-effects in the brain. Therefore, IT riluzole infusion when used in conjunction with oral therapy may safely enhance lower motor neuron neuroprotection and improve the survival benefit of the drug through enhanced SC delivery, and, with a careful selection of IT doses, it could be implemented in patients with ALS.

scholarly journals Nightmare and Abnormal Dreams: Rare Side Effects of Metformin?

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Theo Audi Yanto ◽  
Ian Huang ◽  
Felicia Nathania Kosasih ◽  
Nata Pratama Hardjo Lugito
Keyword(s):  
Side Effects ◽  
Extended Release ◽  
Adverse Reactions ◽  
Antidiabetic Agent ◽  
Probability Scale ◽  
Case Presentation ◽  
Gastrointestinal Side Effects ◽  
History Of ◽  
Negative Feelings ◽  
Unpleasant Experience

Background. Metformin is widely known as an antidiabetic agent which has significant gastrointestinal side effects, but nightmares and abnormal dreams as its adverse reactions are not well reported. Case Presentation. Herein we present a case of 56-year-old male patient with no known history of recurrent nightmares and sleep disorder, experiencing nightmare and abnormal dreams directly after consumption of 750 mg extended release metformin. He reported his dream as an unpleasant experience which awakened him at night with negative feelings. The nightmare only lasted for a night, but his dreams every night thereafter seemed abnormal. The dreams were vivid and indescribable. The disappearance and occurrence of abnormal dreams ensued soon after the drug was discontinued and rechallenged. The case was assessed using Naranjo Adverse Drug Reaction (ADR) probability scale and resulted as probable causality. Conclusion. Metformin might be the underlying cause of nightmare and abnormal dreams in this patient. More studies are needed to confirm the association and causality of this findings.

On the Relation of Oxidative Stress to Neuroinflammation: Lessons Learned from the G93A-SOD1 Mouse Model of Amyotrophic Lateral Sclerosis

2006 ◽  
Vol 8 (11-12) ◽  
pp. 2075-2087 ◽  
Author(s):  
Kenneth Hensley ◽  
Molina Mhatre ◽  
Shenyun Mou ◽  
Quentin N. Pye ◽  
Charles Stewart ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Amyotrophic Lateral Sclerosis ◽  
Mouse Model ◽  
Lessons Learned ◽  
G93a Sod1 Mouse ◽  
Sod1 Mouse ◽  
G93a Sod1 ◽  
Lateral Sclerosis

scholarly journals Case presentation: Dental treatment with PAP for ALS patient

2006 ◽  
Vol 32 (1) ◽  
pp. 32-35
Author(s):  
Takeshi Kikutani ◽  
◽  
Fumiyo Tamura ◽  
Keiko Nishiwaki
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Dental Treatment ◽  
Case Presentation ◽  
Lateral Sclerosis

The aim of this study was to evaluate the effect of Palatal Augmentation Prosthesis (PAP) for an Amyotrophic Lateral Sclerosis (ALS) patient. The patient’s palatogram was taken during swallowing to assess her lingual function. A PAP was provided to assist her with feeding and swallowing functions. The patient’s lingual pressure strength showed increases, and she was able to feed well using PAP. This devise was useful for assisting lingual dysfunctions due to various diseases.

scholarly journals Increasing Patient Self-Enrollment in the National Amyotrophic Lateral Sclerosis Registry: Lessons Learned From a Direct to Provider Campaign

2018 ◽  
Vol 7 (1) ◽  
pp. 71-82
Author(s):  
Lindsay Rechtman ◽  
Heather Jordan ◽  
Wendy Kaye ◽  
Maggie Ritsick ◽  
Paul Mehta
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Lessons Learned ◽  
Train The Trainer ◽  
Phone Calls ◽  
Enrollment Rates ◽  
Education Enrollment ◽  
Competing Priorities ◽  
Enrollment Data ◽  
Measure Project ◽  
Lateral Sclerosis

Objective: To conduct educational and promotional outreach activities to general neurologists and to increase self-enrollment of persons with amyotrophic lateral sclerosis (ALS) in the National ALS Registry (Registry). Methods: A multicomponent project to educate neurologists and increase Registry self-enrollment was delivered. Project components consisted of phone calls, mailings, train-the-trainer presentations, and key informant interviews. Project-specific metrics, continuing education enrollment, and Registry self-enrollment data were analyzed to measure project efficacy. Results: Mailings were sent to 1561 neurologists in 6 states during 2015 to 2016. Sixty-five percent of responding neurologists remembered the mailing 3 months after receipt. Of providers who saw patients with ALS in the 3-month period, 60% read the provider guide, 22% distributed a patient guide, and 15% advised a patient to self-enroll. No changes in self-enrollment rates were observed. Conclusion: Targeted mailings to providers can be used to educate them about the Registry; however, most providers did not distribute materials to patients with ALS. Increases in providers receiving Registry material did not lead to increases in patient self-enrollment. Practice Implications: General neurologists have competing priorities, and they see patients with ALS infrequently. Neurologists could be the appropriate channel to distribute Registry information to patients, but they are not the appropriate resource to assist patients with self-enrollment. Engaging the support staff of busy specialists can help increase research response rates and information distribution. The lessons learned from this project can be applied to other rare conditions and disease specialists.

scholarly journals Which Way to Choose for the Treatment of Metastatic Prostate Cancer: A Case Report and Literature Review

2021 ◽  
Vol 11 ◽  
Author(s):  
Xiangwei Yang ◽  
Donggen Jiang ◽  
Yamei Li ◽  
Tianzhi Zhang ◽  
Duanya Xu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
Literature Review ◽  
Specific Antigen ◽  
Metastatic Tumor ◽  
Multiple Organ ◽  
Case Presentation ◽  
Multiple Metastases ◽  
Gastrointestinal Side Effects ◽  
Remarkable Reduction

BackgroundProstate cancer (PCa) is the second most common cancer among males in the world and the majority of patients will eventually progress to the metastatic phase. How to choose an effective way for the treatment of metastatic PCa, especially in the later stage of the disease is still confusing. Herein we reported the case of a patient diagnosed with metastatic PCa and conducted a literature review on this issue.Case PresentationA 57-year-old man with metastatic PCa had been managed by Dr. J.P. since April 2012 when the patient was admitted to the Third Affiliated Hospital of Sun Yat-sen University by aggravating frequent urination and dysuria. The prostate-specific antigen (PSA) concentration was 140 ng/ml, and the diagnosis of PCa was confirmed by prostate biopsy, with Gleason score 4 + 5 = 9. Chest CT and bone scan indicated multiple metastases in the lungs and bones. Triptorelin, bicalutamide, zoledronic acid, and docetaxel were then administered, six cycles later, the metastatic tumors in the lungs disappeared and those in the bones lessened significantly, along with a remarkable reduction in PSA level (< 2 ng/ml). Intermittent androgen deprivation was subsequently conducted until August 2018, when the serum PSA level was found to be 250 ng/ml, again docetaxel 75 mg/m2 was administered immediately but the patient was intolerant this time. Instead, abiraterone was administered until March 2019 because of intolerable gastrointestinal side-effects and increasing PSA level. In October 2019, the patient came to our center, a modified approach of docetaxel (day 1 40 mg/m2 + day 8 35 mg/m2) was administered. Luckily, the PSA level decreased rapidly, the bone pain was greatly relieved, and no obvious side effects occurred. However, four cycles later, docetaxel failed to work anymore, the metastatic tumor in the liver progressed. We proposed several regimens as alternatives, but they were soon denied due to the high prices or unavailability or uncertain effect of the drugs. In addition, the patient’s condition deteriorated speedily and can no longer bear any aggressive treatment. Finally, the patient died of multiple organ failure in August 2020.ConclusionThe experiences of this case provide valuable evidence and reference for the treatment choices of metastatic PCa, in some circumstances modified and advanced regimens may produce unexpected effects.

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