Efficacy of Erenumab in the Treatment of Trigeminal Neuralgia: A Retrospective Case Series

2021 ◽  
pp. 10.1212/CPJ.0000000000001075
Author(s):  
Eliot Parascandolo ◽  
Kelsey Levinson ◽  
Paul Rizzoli ◽  
Roni Sharon
Keyword(s):  
Monoclonal Antibody ◽  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Rating Scale ◽  
Antibody Therapy ◽  
Case Series ◽  
Primary Objective ◽  
Retrospective Case ◽  
Refractory Pain ◽  
Reduced Frequency

AbstractBackground:Trigeminal neuralgia is a chronic, often refractory, pain condition which adversely impacts the lives of patients. Current treatments are only mildly effective. Anti-CGRP monoclonal antibodies have been successfully studied in the treatment of migraines. CGRP plays a role in both trigeminal neuralgia (TN) and migraine. It is prudent to attempt CGRP monoclonal antibody therapy in TN. Erenumab, a human Anti-CGRP monoclonal antibody medication, modulates CGRP, which is elevated in TN patients. The primary objective of this study was to evaluate the efficacy of erenumab for patients with TN.Methods:Retrospective analysis was performed on data collected from 10 patients diagnosed with TN and treated with erenumab for 6 months. Pain was tracked using a numeric pain rating scale (NPRS) from 0 to 10. The effect of erenumab on NPRS after 6 months’ time was the primary endpoint. Secondary endpoints included side effects to therapy, improvement in headache frequency in those with comorbid migraine, evaluating mood following therapy, and global mood improvement using scale (worse, no change, improved).Results:Nine out of ten patients (90.0%) reported improvement in pain severity and in global mood improvement. Three patients reported resolution of anxiety, and/or depression. Side effects were minimal with three patients reporting constipation, injection site reactions or both.Conclusions:Based on these results, erenumab appears to be an efficacious treatment option for patients with refractory trigeminal neuralgia. Patients experienced improvement in pain, reduced frequency of headache, and improvement in mood. Treatment was well tolerated with only mild side effects reported.Classification of Evidence:This study provides class IV evidence that Erenumab increase the probability of improved pain control in patients with medication resistant trigeminal neuralgia.

scholarly journals Cerliponase Alfa for the Treatment of Atypical Phenotypes of CLN2 Disease: A Retrospective Case Series

2020 ◽  
pp. 088307382097799
Author(s):  
Eva Wibbeler ◽  
Raymond Wang ◽  
Emily de los Reyes ◽  
Nicola Specchio ◽  
Paul Gissen ◽  
...  
Keyword(s):  
Treatment Duration ◽  
Chart Review ◽  
Rating Scale ◽  
Neuronal Ceroid Lipofuscinosis ◽  
Case Series ◽  
Language Function ◽  
Retrospective Case ◽  
Function Loss ◽  
Clinical Rating Scale

Background: The classic phenotype of CLN2 disease (neuronal ceroid lipofuscinosis type 2) typically manifests between ages 2 and 4 years with a predictable clinical course marked by epilepsy, language developmental delay, and rapid psychomotor decline. Atypical phenotypes exhibit variable time of onset, symptomatology, and/or progression. Intracerebroventricular-administered cerliponase alfa (rhTPP1 enzyme) has been shown to stabilize motor and language function loss in patients with classic CLN2 disease, but its impact on individuals with atypical phenotypes has not been described. Methods: A chart review was conducted of 14 patients (8 male, 6 female) with atypical CLN2 phenotypes who received cerliponase alfa. Pre- and posttreatment CLN2 Clinical Rating Scale Motor and Language (ML) domain scores were compared. Results: Median age at first presenting symptom was 5.9 years. First reported symptoms were language abnormalities (6 [43%] patients), seizures (4 [29%]), ataxia/language abnormalities (3 [21%]), and ataxia alone (1 [7%]). Median age at diagnosis was 10.8 years. ML score declined before treatment in 13 (93%) patients. Median age at treatment initiation was 11.7 years; treatment duration ranged from 11 to 58 months. From treatment start, ML score remained stable in 11 patients (treatment duration 11-43 months), improved 1 point in 1 patient after 13 months, and declined 1 point in 2 patients after 15 and 58 months, respectively. There were 13 device-related infections in 8 patients (57%) and 10 hypersensitivity reactions in 6 (43%). Conclusions: Cerliponase alfa is well tolerated and has the potential to stabilize motor and language function in patients with atypical phenotypes of CLN2 disease.

scholarly journals Off-licence use of clozapine in patients with emotionally unstable personality disorder: a case series analysis

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S116-S116
Author(s):  
Declan Hyland ◽  
Alex Walmsley ◽  
Victoria Simpson
Keyword(s):  
Side Effects ◽  
Personality Disorder ◽  
Suicide Attempts ◽  
Symptom Control ◽  
Case Series ◽  
Community Support ◽  
Retrospective Case ◽  
Psychotherapeutic Treatment ◽  
Self Harm ◽  
Emotionally Unstable Personality Disorder

ObjectiveThis retrospective case series followed emotionally unstable personality disorder (EUPD) patients following initiation of clozapine on an off-licence basis, aiming to examine tolerance by determining side effect prevalence and treatment cessation frequency, as well as examining efficacy, by investigating number of hospital re-admissions and symptom control.Case reportThis case series captured the experiences of 11 EUPD patients under the care of Mersey Care NHS Foundation Trust, all of whom had, at some time in the past five years, been initiated on clozapine. All patients were white British females, with a median age of 31. The median daily dose of clozapine was 300 mg. Most patients had significant psychiatric comorbidities, as well as illicit substance and / or alcohol misuse.Whilst prescribed clozapine, patients were only admitted to hospital once on average and this was commonly for clozapine re-titration. Whilst in hospital, rates of self-harm were low, but ligaturing and suicide attempts showed higher prevalence. Patients still demonstrated self-harming behaviour out of hospital leading to A and E presentations. In the community, contacts with the police were minimal, with only two patients undergoing Section 136 assessments or arrests.All patients reported side effects from clozapine - usually hypersalivation, over-sedation and constipation. All 11 patients experienced sinus tachycardia. Eight patients temporarily ceased taking clozapine at some point. In three patients, discontinuation of clozapine was as a result of intolerable side effects. Three patients experienced neutropenia, which subsequently resolved. Only two patients had a body mass index within healthy range.DiscussionDespite patients reporting clozapine to provide symptomatic benefit for their EUPD, and improved their engagement with mental health services, prevalence of self-harm and of A and E presentations remained high, indicating the importance of community support and concomitant psychotherapeutic treatment. Patients with more robust community support showed greater adherence to clozapine.High prevalence of side effects and obesity in these patients, in addition to risk of developing neutropenia, highlights the importance of rigorous monitoring after initiating clozapine. It is reassuring that, despite development of neutropenia in some patients, this recovered quickly, and clozapine treatment could resume.ConclusionClozapine may be an effective pharmacological treatment for enabling EUPD patients to engage more therapeutically with services. Clozapine may be of greater benefit to those with more stable, less chaotic lives. Although diminished, patients still show self-harming behaviour and need for A and E admissions and re-hospitalisation. Side effects of clozapine are common and regular monitoring is required.

scholarly journals Relationship between Drug-Induced Sleep Endoscopy Findings, Tonsil Size, and Polysomnographic Outcomes of Adenotonsillectomy in Children

2019 ◽  
Vol 161 (3) ◽  
pp. 507-513 ◽  
Author(s):  
Derek J. Lam ◽  
Natalie A. Krane ◽  
Ron B. Mitchell
Keyword(s):  
Rating Scale ◽  
Tertiary Care ◽  
Case Series ◽  
Apnea Hypopnea Index ◽  
Strongly Correlated ◽  
Sleep Endoscopy ◽  
Retrospective Case ◽  
Drug Induced ◽  
Failure Assessment ◽  
The Relationship

Objective (1) Determine the correlation of awake tonsil scores and preadenotonsillectomy (pre-AT) sleep endoscopy findings. (2) Assess the relationship between polysomnographic AT outcomes with awake tonsil scores and sleep endoscopy ratings of tonsil and adenoid obstruction. Study Design Retrospective case series with chart review. Setting Tertiary care children’s hospital. Subjects and Methods Children aged 1 to 18 years who underwent sleep endoscopy and AT from January 1, 2013, to August 30, 2016, were included. Pre-AT sleep endoscopy findings were scored with the Sleep Endoscopy Rating Scale. Awake tonsil scores and sleep endoscopy ratings were compared with Spearman correlation. Associations between changes in pre- and post-AT polysomnography parameters and (1) awake tonsil scoring and (2) sleep endoscopy scoring were assessed with 1-way analysis of variance and linear regression. Results Participants included 36 children (mean ± SD age, 6.8 ± 4.3 years; 68% male, 44% obese). Awake tonsil scores and sleep endoscopy ratings were strongly correlated ( R = 0.58, P = .003). Awake tonsil scores were not associated with changes in any polysomnography parameters after AT (all P > .05), while sleep endoscopy ratings of adenotonsillar obstruction were significantly associated (all P < .05, R2 = 0.16-0.35). Patients with minimal adenotonsillar obstruction during sleep endoscopy had less improvement than those with partial or complete obstruction (mean obstructive apnea-hypopnea index change: −8.2 ± 11.5 vs −15.9 ± 14.3, and −46.8 ± 31.3, respectively; P < .001). Conclusions In children at risk for AT failure, assessment of dynamic collapse with sleep endoscopy may better predict the outcome of AT than awake tonsil size assessment, thus helping to inform surgical expectations.

Pramipexole: Augmentation in the Treatment of Depressive Symptoms

CNS Spectrums ◽  
2006 ◽  
Vol 11 (3) ◽  
pp. 172-175 ◽  
Author(s):  
Sanjay Gupta ◽  
Jennifer L. Vincent ◽  
Bradford Frank
Keyword(s):  
Depressive Symptoms ◽  
Treatment Regimen ◽  
Rating Scale ◽  
Bipolar Depression ◽  
Case Series ◽  
Unipolar Depression ◽  
Off Label Use ◽  
Retrospective Case ◽  
Off Label ◽  
Hamilton Rating Scale

ABSTRACTWe describe a retrospective case series of three patients, two with bipolar depression and one with unipolar depression. Pramipexole is a Food and Drug Administration-approved antiparkinsonian agent, which, when used to augment antidepressants, would be considered an off-label use and should be discussed with the patient. These patients had robust responses to pramipexole augmentation of their treatment regimen. All three patients had been taking an atypical antipsychotic. The depressive symptoms were evaluated using the Hamilton Rating Scale for Depression.

Levetiracetam monotherapy for treatment of structural epilepsy in dogs: 19 cases (2010–2015)

2017 ◽  
Vol 181 (15) ◽  
pp. 401-401 ◽  
Author(s):  
Darren Kelly ◽  
Francesca Raimondi ◽  
Nadia Shihab
Keyword(s):  
Side Effects ◽  
Seizure Control ◽  
Case Series ◽  
Poor Response ◽  
Response To Treatment ◽  
Seizure Freedom ◽  
Retrospective Case ◽  
Cluster Seizures ◽  
Structural Epilepsy

To evaluate the efficacy and tolerability of levetiracetam monotherapy in dogs with structural epilepsy. Retrospective case series. Nineteen client-owned dogs with structural epilepsy. Seizure frequencies after initiation of treatment were used to evaluate the efficacy of levetiracetam monotherapy. Seizure control was considered good if no seizures occurred within three months of starting treatment or poor if seizures returned within one month of starting treatment. Tolerability was evaluated by considering the occurrence and severity of any reported side effects. Ten of the 19 dogs were considered to have a good response to treatment with 7 achieving complete seizure freedom. Nine dogs were considered to have poor response to treatment. There was a statistically significant reduction in the percentage of patients experiencing cluster seizures from 68.4% to 15.8% (p=0.002). Side effects were noted in 8 of the 19 dogs but were considered mild in all cases. Follow-up times ranged from 12 days to 426 days. When used in conjunction with other appropriate therapies, levetiracetam may be an efficacious option for monotherapy in dogs with structural epilepsy. Its tolerability makes it a suitable option for use in a wide variety of patients.

scholarly journals Attenuated androgen discontinuation in patients with hereditary angioedema: a commented case series

2022 ◽  
Vol 18 (1) ◽  
Author(s):  
Marcus Maurer ◽  
Markus Magerl ◽  
Emel Aygören-Pürsün ◽  
Konrad Bork ◽  
Henriette Farkas ◽  
...  
Keyword(s):  
Side Effects ◽  
Hereditary Angioedema ◽  
Treatment Strategies ◽  
Case Series ◽  
Additional Patient ◽  
Type I ◽  
Retrospective Case ◽  
Androgen Withdrawal ◽  
Life Threatening ◽  
Attenuated Androgen

Abstract Background Hereditary angioedema (HAE) is characterized by potentially severe and life-threatening attacks of localized swelling. Prophylactic therapies are available, including attenuated androgens. Efficacy of attenuated androgens has not been assessed in large, randomized, placebo-controlled trials and can be associated with frequent, and sometimes severe, side effects. As better tolerated targeted therapies become available, attenuated androgen withdrawal is increasingly considered by physicians and their patients with HAE. Attenuated androgens withdrawal has not been systematically studied in HAE, although examination of other disorders indicates that attenuated androgen withdrawal may result in mood disturbances and flu-like symptoms. Standardized protocols for attenuated androgen discontinuation that continue to provide control of attacks while limiting potential attenuated androgen withdrawal symptoms are not established as the outcomes of different withdrawal strategies have not been compared. We aim to describe the challenges of attenuated androgen discontinuation in patients with HAE and how these may continue into the post-androgen period. Case presentation We present a retrospective case series of 10 patients with confirmed type I HAE who have discontinued prophylactic treatment with attenuated androgens. The most common reason for attenuated androgen discontinuation was side effects. Attenuated androgens were either immediately withdrawn, tapered and/or overlapped with another treatment. The major challenge of discontinuation was the management of an increased frequency and severity of HAE attacks in some patients. Conclusions Healthcare teams need to undertake careful planning and monitoring after attenuated androgens discontinuation, and modify treatment strategies if HAE control is destabilized with an increased number of attacks. Discontinuation of attenuated androgens is definitively an option in an evolving HAE treatment landscape, and outcomes can be favourable with additional patient support and education.

Dysphagia characteristics in Huntington’s disease patients: insights from the Fiberoptic Endoscopic Evaluation of Swallowing and the Swallowing Disturbances Questionnaire

CNS Spectrums ◽  
2018 ◽  
Vol 24 (04) ◽  
pp. 413-418 ◽  
Author(s):  
Yael Manor ◽  
Yael Oestreicher-Kedem ◽  
Alona Gad ◽  
Jennifer Zitser ◽  
Achinoam Faust-Socher ◽  
...  
Keyword(s):  
Huntington's Disease ◽  
Huntington’S Disease ◽  
Rating Scale ◽  
Oropharyngeal Dysphagia ◽  
Case Series ◽  
Solid Food ◽  
Self Report ◽  
Endoscopic Evaluation ◽  
Retrospective Case ◽  
Tertiary Referral Center

BackgroundHuntington’s disease (HD) is a neurodegenerative disease characterized by increasing dysphagia as the disease progresses. Specific characteristics of the HD dysphagia are not well defined.ObjectiveTo characterize the swallowing disturbances of HD patients, to evaluate the feasibility of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in assessing dysphagia in HD patients, and to discern the relation between FEES findings and patients’ self-report on dysphagia symptoms and swallowing related quality of life (SWAL-QOL).MethodA retrospective case series in a tertiary referral center. All recruited HD patients underwent Bed Side Swallowing Evaluation (BSE), FEES, the Unified Huntington’s Disease Rating Scale (UHDRS), and the Montreal Cognitive Assessment (MoCA). All completed the Swallowing Disturbances Questionnaire (SDQ) and the SWAL-QOL questionnaire.ResultsFourteen HD patients were recruited. All were able to complete the FEES study. The FEES demonstrated delayed swallowing reflex, solid food residues, and pre/post swallowing spillage in most patients (50%, 53.5%, 83.3%, and 87.5%, respectively). The mean SDQ score was 13.2. Significant correlations were found between the SWAL-QOL fear of eating score; the SDQ oral, pharyngeal, and total scores; and the FEES parameters of pureed and solid food bolus flow time. Significant correlations were also found between the total UHDRS score, the volitional cough score, and the SWAL-QOL disease burden score.ConclusionHD patients exhibit prominent unique oropharyngeal dysphagia features that may serve as a marker of disease progression. The FEES and the SDQ are valuable tools for detecting these features in HD patients with swallowing disturbance.

scholarly journals Anterior Cruciate Ligament Reconstruction with LARS Artificial Ligament—Clinical Results after a Long-Term Follow-Up

Joints ◽  
2018 ◽  
Vol 06 (02) ◽  
pp. 075-079 ◽  
Author(s):  
Paolo Parchi ◽  
Gianluca Ciapini ◽  
Carlo Paglialunga ◽  
Michele Giuntoli ◽  
Carmine Picece ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Rating Scale ◽  
Cruciate Ligament ◽  
Case Series ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Anterior Cruciate

Purpose The aim of this retrospective study was to evaluate the subjective and functional outcome of anterior cruciate ligament (ACL) reconstruction with the synthetic Ligament Advanced Reinforcement System (LARS) ligament. Methods Twenty-six patients were reviewed at an average follow-up of 11.6 years. Objective clinical evaluation was performed with stability tests. Patient-reported outcomes (Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score, and Cincinnati Knee Rating Scale) were used to assess subjective and functional outcomes. Results Overall satisfactory results were obtained in 22 cases (84.6%). Four patients (15.4%) showed mechanical failure of the graft. No cases of synovitis or infection were reported. Conclusion LARS ligament can be considered a safe and suitable option for ACL reconstruction in carefully selected cases, especially elderly patients needing a rapid postoperative recovery. Level of Evidence Level IV, retrospective case series.

scholarly journals Medical cannabis for the treatment of fibromyalgia syndrome: a retrospective, open-label case series

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Manuela Mazza
Keyword(s):  
Side Effects ◽  
Conventional Therapy ◽  
Fibromyalgia Syndrome ◽  
Rating Scale ◽  
Case Series ◽  
Depression Scale ◽  
Pain Clinic ◽  
Medical Cannabis ◽  
Paired Data ◽  
Oil Extract

Abstract Background The use of cannabis for treating fibromyalgia syndrome (FMS) has not been comprehensively investigated. Thus, we have assessed the efficacy and adverse events (AEs) of short- and long-term medical cannabis (MC) treatment for FMS. Methods Data were obtained from medical reports archived in the pain clinic of Ponderano (Italy; retrospective study). FMS patients, who were resistant to conventional therapy, received licensed MC with various Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) content, as powdered whole flowers (decoction or vaporization) or oil extracts. Demographic and clinical parameters, including Numerical Rating Scale (NRS), Oswestry Disability Index (ODI), Hospital Anxiety and Depression Scale, Widespread Pain Index (WPI), Severity Score (SyS), and side effects, were obtained after 1, 3, and 12 months. Data were analyzed with Wilcoxon signed-rank tests for paired data. Results Thirty-eight patients were included. Thirty, 18, and 12 patients continued therapy for 1, 3, and 12 months, respectively. Significant improvements (p < 0.01) were observed in NRS, ODI, WPI, and SyS at 1 month; in NRS, ODI, and WPI at 3 months; and in NRS, ODI, and SyS at 12 months. Therapy was interrupted by 17 patients (48.6%) owing to nonserious AEs according to the FDA. The most common side effects were mental confusion (37%), dizziness (14%), nausea/vomiting (14%), and restlessness/irritation (14%). The median daily dose of milled flowers administered as THC-dominant MC and hybrid MC (with similar THC/CBD ratio) was 200 mg/day and 400 mg/day, respectively. After 3 months of titration, the median content of THC administered with THC-dominant MC cultivars was 46.2 mg, and of THC + CBD administered as a hybrid MC cultivar, was 23.6 mg + 38 mg. At 3 months, median THC content administered in the oil extract of the THC-dominant MC cultivars was 9.7 mg, while that of THC + CBD administered in the oil extract of the hybrid MC cultivars was 1.8 mg + 2 mg. Conclusions MC may represent an alternative treatment for patients with FMS who are unresponsive to conventional therapy. However, its application may be limited by the incidence of nonserious AEs.

scholarly journals Systemic Minoxidil Accidental Exposure in a Paediatric Population: A Case Series Study of Cutaneous and Systemic Side Effects

2021 ◽  
Vol 10 (18) ◽  
pp. 4257
Author(s):  
Manuel Sánchez-Díaz ◽  
David López-Delgado ◽  
Trinidad Montero-Vílchez ◽  
Luis Salvador-Rodríguez ◽  
Alejandro Molina-Leyva ◽  
...  
Keyword(s):  
Side Effects ◽  
Treatment Time ◽  
Case Series ◽  
Paediatric Population ◽  
High Dose ◽  
Retrospective Case ◽  
Case Series Study ◽  
High Doses ◽  
Initial Zone ◽  
Series Study

Oral minoxidil is an approved treatment for high blood pressure which is also used as an off-label drug for alopecia. Knowledge about the effects of systemic minoxidil in the paediatric population is limited. A retrospective case series study of paediatric patients with history of systemic minoxidil intake due to contaminated sets of omeprazole was performed to describe side effects of high dose oral minoxidil intake in children. Twenty patients aged between 2 months and 13 years joined the study. They had received high doses of oral minoxidil (mean dose 0.90 mg/kg/day) during a mean time of 38.3 days. Hypertrichosis appeared in 65%, with a mean latency time of 24.31 days. Treatment time was associated with the appearance of hypertrichosis (p < 0.05). Most common initial zone of hypertrichosis was the face. Systemic effects developed in 15%, with no cases of severe disorders. The present study shows a novel insight into the side effects of high doses of oral minoxidil in children.

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