scholarly journals Efficacy of low-dose Topiramate in Migraine Prophylaxis

2015 ◽  
Vol 31 (2) ◽  
pp. 70-75
Author(s):  
Muhammad Abdul Momen Khan ◽  
Mohammad Bahadur Ali Miah ◽  
Md Shahidullah ◽  
Md Rafiqul Islam ◽  
Subash Kanti Day ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Baseline Level ◽  
Low Dose ◽  
Prospective Trial ◽  
Severe Headache ◽  
Migraine Prophylaxis ◽  
Base Line ◽  
Population Total ◽  
The Mean

Background: Anticonvulsants are now commonly used for migraine prophylaxis, among them topiramate, one of the newer anticonvulsants, recently has been demonstrated to be effective as mono-therapy for migraine prophylaxis. Objectives: To observe the efficacy and safety of low dose topiramate in migraine prophylaxis. Methods: This prospective trial was carried out in the Out Patient Department (OPD) & Headache Clinic, Department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Total 60 patients around the age range of 18 to 50 years diagnosed as migraine (with aura or without aura) according to ICHD-3 criteria, were recruited as the study population. Total 60 patients were administered by Tab.Topiramate 50 mg/ day. Out of them, total 47 patients had completed the study due to drop out of 13 patients. During trial, three follow up visits were taken, 1st follow up after 4 weeks of baseline information (Before starting prophylactic medication), 2nd follow up after 4 weeks of treatment, 3rd follow up after 8 weeks of treatment. Efficacy of treatment was measured by headache frequency, duration and severity as measured by the VAS. Effectiveness was assessed by comparing baseline & on-treatment migraine status. Results: The mean (SD) age of patients were found 29.72 (9.58) years. Female sex was predominant. The mean (SD) value of frequency of migraine at baseline level with 1st and 2nd follow up were statistically significant [Baseline 9.28 (2.39) vs. 1st FU 7.55 (3.07), p=0.001; Baseline 9.28 (2.39) vs. 2nd FU 4.72 (2.80), p<0.001]. Duration of each episode of migraine ,comparing the mean (SD) value of duration of migraine of baseline level with 1st and 2nd follow up were statistically significant [Baseline 10.85 (5.26) vs. 1st FU 8.06 (4.11) hr, p<0.001; Baseline 10.85 (5.26) vs. 2nd FU 5.53 (2.98) hr, p<0.001]. According to severity of migraine based on VAS in base line period all patients had experienced moderate & severe headache but in 1st follow up, few patients had experienced mild headache from moderate headache, few patients had experienced moderate headache from severe headache & in 2nd follow up, patients had better condition and had experienced mild and moderate headache, no patient had experienced severe headache. In this study, 23.4% patients developed adverse effects. Among the adverse effects, 8.5% develop dizziness, 6.3% drowsiness, 4.2% anorexia & blurring of vision. Conclusion: The present study suggest that low dose topiramate are effective for migraine prophylaxis in reduction of frequency, severity and duration of migraine headache . Bangladesh Journal of Neuroscience 2015; Vol. 31 (2): 70-75

scholarly journals Efficacy of Low Dose Topiramate and Propranolol in Migraine Prophylaxis

2018 ◽  
Vol 9 (2) ◽  
pp. 49-54
Author(s):  
Muhammad Abdul Momen Khan ◽  
Jannatul Ferdous ◽  
AKM Golam Kabir ◽  
Md Mamnur Rashid ◽  
Md Enayet Ul Islam ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Low Dose ◽  
Migraine Prophylaxis ◽  
Drop Out ◽  
Group I ◽  
Significant Difference ◽  
Propranolol Group ◽  
Baseline Information ◽  
Group Ii

Background: Migraine, the second most common cause of headache that can significantly impair the lives of people. Various drugs are available for migraine prophylaxis but all of which have varying degrees of adverse effects that may significantly limit their use.Objectives: To observe whether low dose topiramate is more effective compared to propranolol in migraine prophylaxis.Methods: Total 120 patients the age range of 18 to 50 years were recruited as study population of migraine in the Out Patient Department (OPD) & Headache Clinic,BSMMU.60 patients were administered by Tab.Topiramate 50 mg/ day named as group-I and rest of 60 patients were administered by Tab. Propranolol 80 mg /day named as group-II. Out of them in total 96 patients had completed the study. 47 patients had completed study in group-I and 49 patients in group-II. During trial, three follow up visits were taken for both groups, 1st follow up after 4 weeks of baseline information, 2nd follow up after 4 weeks of treatment, 3rd follow up after 8 weeks of treatment. Efficacy of treatment was measured by frequency, duration and severity of headache as measured by the visual analogue scale (VAS).Results: The mean (SD) age of group-I (topiramate) and group-II (propranolol) group were found 29.72±9.58 years and 30.96±10.11 years respectively. Female sex was found predominant in both groups. At final follow up, there was statistically significant difference in mean (SD) value of frequency of migraine between topiramate and propranolol group (4.72±2.80 vs. 3.48±2.20; p=0.024]. Propranolol appeared statistically significant than topiramate [TPM 5.53±2.98 vs. PRO 4.36±1.55; p=0.047].Regarding severity of headache, better results also were observed in the propranolol group than topiramate (p< 0.05). Both drugs appeared significant in efficacy measurement (p<0.001). Patient drop out was more in the topiramate group than the propranolol group (21.68 % vs. 18.34%). Furthermore, in the topiramate group, patients complained of more adverse effects than propranolol group (23.4% vs. 14.3%), which was statistically significant.Conclusion: The present study suggests that low dose topiramate and propranolol are effective for migraine prophylaxis in reduction of frequency, severity and duration of migraine individually and propranolol appears more effective compared to that of topiramate.J Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 49-54

Low-Dose Oral Mini-Pulse Dexamethasone Therapy in Progressive Unstable Vitiligo

2013 ◽  
Vol 17 (4) ◽  
pp. 259-268 ◽  
Author(s):  
Amrinder J. Kanwar ◽  
Rahul Mahajan ◽  
Davinder Parsad
Keyword(s):  
Adverse Effects ◽  
Disease Activity ◽  
Low Dose ◽  
Disease Free Survival ◽  
Pulse Therapy ◽  
Dose Oral ◽  
Dexamethasone Therapy ◽  
Pulse Dexamethasone ◽  
The Mean

Background: The course of vitiligo is unpredictable. If the disease is spreading rapidly, the progression can be controlled with the use of systemic steroids daily or in pulsed form. The present study was planned to assess the efficacy of low-dose dexamethasone oral mini-pulse therapy in progressive unstable vitiligo. Materials and Methods: In this retrospective study, the case records of patients with vitiligo during the period from January 2006 to December 2010 were studied. Patients who had progressive unstable disease were included. These patients were administered oral dexamethasone 2.5 mg per day on 2 consecutive days after breakfast in a week. The patients were asked to come for regular follow-up to assess the arrest of disease activity, relapse of disease activity, and adverse effects. Results: A total of 444 patients were analyzed. In 408 (91.8%) patients, arrest of disease activity was achieved at a mean duration of 13.2 ± 3.1 weeks. In addition, some repigmentation of the lesions was seen in all patients after a mean of 16.1 ± 5.9 weeks. During the follow-up, 50 of 408 (12.25%) patients experienced one or two episodes of relapse in disease activity, which were treated with reinstitution of low-dose dexamethasone oral mini-pulse therapy. The mean disease-free survival (DFS) until the first relapse was 55.7 ± 26.7 weeks, and the mean DFS until the second relapse was 43.8 ± 7.2 weeks. Adverse reactions such as weight gain, lethargy, and acneiform eruptions were observed in 41 (9.2%) patients. Conclusion: Low-dose oral mini-pulse dexamethasone therapy is a good option for arresting progressive unstable vitiligo with minimal adverse effects.

Neurodevelopmental Outcome at 36 Months' Corrected Age of Preterm Infants in the Multicenter Indomethacin Intraventricular Hemorrhage Prevention Trial

PEDIATRICS ◽  
1996 ◽  
Vol 98 (4) ◽  
pp. 714-718 ◽  
Author(s):  
Laura R. Ment ◽  
Betty Vohr ◽  
William Oh ◽  
David T. Scott ◽  
Walter C. Allan ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Intraventricular Hemorrhage ◽  
Maternal Education ◽  
Low Dose ◽  
Very Low Birth Weight ◽  
Cranial Ultrasound ◽  
The Mean ◽  
English Monolingual

Objectives. Low-dose indomethacin has been shown to prevent intraventricular hemorrhage (IVH) in very low birth weight neonates, and long-term neurodevelomental follow-up data are needed to validate this intervention. We hypothesized that the early administration of low-dose indomethacin would not be associated with adverse cognitive outcome at 36 months' corrected age (CA). Methods. We enrolled 431 neonates of 600 to 1250 g birth weight with no IVH at 6 to 12 hours in a randomized, prospective trial to determine whether low-dose indomethacin would prevent IVH. A priori, neurodevelopmental follow-up examinations, including the Stanford-Binet Intelligence Scale and Peabody Picture Vocabulary Test-Revised, and standard neurologic examinations were planned at 36 months' CA. Results. Three hundred eighty-four of the 431 infants survived (192 [92%] of 209 infants receiving indomethacin versus 192 [86%] of 222 infants receiving saline), and 343 (89%) children were examined at 36 months' CA. Thirteen (8%) of the 166 infants who received indomethacin and 14 (8%) of 167 infants receiving the placebo were found to have cerebral palsy. There were no differences in the incidence of deafness or blindness between the two groups. For the 248 English-monolingual children for whom IQ data follow, the mean gestational age was significantly younger for the infants who received indomethacin than for those who received the placebo. None of the 115 infants who received indomethacin was found to have ventriculomegaly on cranial ultrasound at term, compared with 5 of 110 infants who received the placebo. The mean ± SD Stanford-Binet IQ score for the 126 English-monolingual children who had received indomethacin was 89.6 ± 18.92, compared with 85.0 ± 20.79 for the 122 English-monolingual children who had received the placebo. Although maternal education was strongly correlated with Stanford-Binet IQ at 36 months' CA, there was no difference in educational levels between mothers of the infants receiving indomethacin and the placebo. Conclusions. Indomethacin administered at 6 to 12 hours as prophylaxis against IVH in very low birth weight infants does not result in adverse cognitive or motor outcomes at 36 months' CA.

Does Lead at Low Dose Affect Intelligence in Children?

PEDIATRICS ◽  
1981 ◽  
Vol 68 (6) ◽  
pp. 894-896
Author(s):  
Herbert L. Needleman ◽  
David Bellinger ◽  
Alan Leviton
Keyword(s):  
Adverse Effects ◽  
Low Dose ◽  
Intelligence Test ◽  
Pediatric Clinic ◽  
Study Find ◽  
Group Data ◽  
Low Levels ◽  
The One ◽  
The Individual

Ernhart et al, on the basis of their own follow-up data and an incorrect critique of a single study, find reason to question the entire literature documenting the adverse effects of low levels of lead. They assert that, if effects exist, they are minimal. To reach this sweeping conclusion, they contradict or ignore the findings of the earlier study by Perino and Ernhart, misread a table from the one study they single out for criticism, and draw debatable conclusions from their own data. We conclude by calling the readers' attention to this sentence: "While the effects of subclinical lead intoxication may not be noted in the individual cases seen in a pediatric clinic, analysis of group data indicate quite clearly (emphasis added) that performance on an intelligence test is impaired."

scholarly journals Percutaneous ultrasound-guided laser ablation for the treatment of cervical tuberculous lymphadenitis: a pilot study

2019 ◽  
Vol 47 (4) ◽  
pp. 1512-1520
Author(s):  
Gaoyi Yang ◽  
Jianhua Fang ◽  
Tianzhuo Yu ◽  
Ying Zhang ◽  
Wenzhi Zhang ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Adverse Effects ◽  
Lymph Nodes ◽  
Tuberculous Lymphadenitis ◽  
Good Tolerability ◽  
Minimal Invasiveness ◽  
Contrast Enhanced ◽  
The Mean ◽  
Larger Sample

Objective This study was performed to assess the feasibility, effectiveness, and safety of percutaneous ultrasound (US)-guided laser ablation (LA) for the treatment of cervical tuberculous lymphadenitis (CTBL). Methods We retrospectively reviewed 11 patients with CTBL (mean age, 32.0 ± 8.6 years; range, 18–47 years) who underwent percutaneous US-guided LA from June 2014 to December 2016 with a subsequent 12-month follow-up. We assessed the mean volume reduction and contrast-enhanced US (CEUS) changes of the target lymph nodes as well as the tolerability and adverse effects of LA. Results The mean ablation energy was 522 ± 312 J (range, 204–1317 J). All 17 enrolled target lymph nodes were completely non-enhanced after LA treatment as detected by CEUS, indicating complete ablation of all lymph nodes (100%). The target lymph nodes significantly decreased in volume by a mean of 74.0% ± 15.6% from baseline to 12 months after LA. The LA procedure was well tolerated, and none of the 11 patients developed severe complications during the 12-month follow-up. Conclusion Percutaneous US-guided LA for the treatment of CTBL exhibits good tolerability, minimal invasiveness, and few adverse effects. Further investigations with larger sample sizes and longer follow-up periods are warranted to confirm these findings.

Grading of Radiographic Osteolytic Changes after Silastic Metacarpophalangeal Arthroplasty and a Prospective Trial of Osteolysis Following Use of Swanson and Sutter Prostheses

2005 ◽  
Vol 30 (4) ◽  
pp. 382-387 ◽  
Author(s):  
T. J. PARKKILA ◽  
E. A. BELT ◽  
M. HAKALA ◽  
H. J. KAUTIAINEN ◽  
J. LEPPILAHTI
Keyword(s):  
Rheumatoid Arthritis ◽  
Prospective Trial ◽  
New Method ◽  
The Mean ◽  
Swanson Implant ◽  
Silicone Prostheses

The purpose of this study was to compare the incidence of radiographic osteolysis following insertion of 89 Swanson and 126 Sutter metacarpophalangeal implants in rheumatoid arthritis patients. The mean follow-up time in the two groups of patients was 57 (40–80) and 55 (36–79) months, respectively. This paper proposes a new method of classifying radiographic osteolysis. The remarkable number of osteolytic changes seen in the bones adjacent to MCP prostheses in this study would suggest that silastic prostheses should only be used when other surgical alternatives cannot be used and that long-term control by radiography be maintained after implantation of silicone prostheses into the MCP joint. In all grades of our classification, osteolysis was more frequent in the Sutter than in the Swanson group in this study, suggesting that use of the Sutter rather than the Swanson implant is questionable.

scholarly journals P577 Withdrawal of thiopurines in patients with Ulcerative Colitis in remission

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S534-S534
Author(s):  
C Amor Costa ◽  
C Suárez Ferrer ◽  
J Poza Cordón ◽  
J L Rueda García ◽  
M Sánchez Azofra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ulcerative Colitis ◽  
Standard Deviation ◽  
Adverse Effects ◽  
Medical Decision ◽  
Concomitant Treatment ◽  
Duration Of Treatment ◽  
The Mean ◽  
Time To Relapse

Abstract Background Thiopurines (TP) are widely used in monotherapy in patients with ulcerative colitis (UC), mainly for the maintenance of remission in case of corticodependence or corticoresistance after cyclosporine use. However, these are drugs with significant side effects, especially in the long term. The optimal duration of treatment with TP remains unknown, so it is important to determine the risk factors for relapse in order to identify the group of patients in which treatment can be withdrawn. Methods A retrospective study was performed. Patients with UC in remission, in maintenance treatment with TP, who had discontinued the drug due to either maintained remission or the onset of adverse effects were included. Results 26 patients were included, 1 with proctitis, 9 with left colitis and 16 with pancolitis. 24 (92.31%) were treated with azathioprine and 2 (7.69%) with mercaptopurine. The mean treatment time with TP was 68.09 months (standard deviation 56.65). 11 patients (42.31%) discontinued TP due to adverse effects and the remaining patients (57.69%) discontinued it by medical decision because they were in prolonged remission. After withdrawal of TP, 92.34% of patients continued treatment with mesalazine and the remaining 7.69% without concomitant treatment. During follow-up, 10 patients (38.4%) relapsed and 16 patients (61.53%) had no relapse until the end of follow-up. The mean time from TP withdrawal to the onset of relapse was 69.15 months (standard deviation 52.53). Of the 10 patients who presented a flare, 5 (50%) were controlled by optimizing the dose of mesalazine, 4 (40%) required the addition of oral corticosteroids and 1 (10%) required biologics. No significant differences were found when comparing the time to relapse if the reason for discontinuation of TP was having had an adverse effect (65.05 months) or maintained remission (79.79 months) (p=0.42). No statistically significant differences were found in time to relapse when comparing time on TP treatment, presence of concomitant treatment with mesalazine or active smoking. Conclusion One third of patients relapsed after TP withdrawal. Discontinuation of TP in patients with UC in remission should be individualized according to the patient’s risk factors, the indication and the duration of treatment.

scholarly journals The efficacy of low dose short-term prednisone therapy for remission induction in newly diagnosed rheumatoid arthritis patients

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
John M. Stacy ◽  
Jacob R. Greenmyer ◽  
James R. Beal ◽  
Abe E. Sahmoun ◽  
Erdal Diri
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Severity ◽  
Low Dose ◽  
Response Criteria ◽  
Newly Diagnosed ◽  
Short Term ◽  
Eular Response ◽  
The Mean ◽  
Dose Prednisone

Abstract Background The ACR/EULAR recommendations endorse the use of glucocorticoids (GCs) for rheumatoid arthritis (RA) patients’ flares and as a bridge to a DMARD. However, the recommendation of low dose short-term monotherapy with (GCs) remains open to the discretion of the clinician. The aim of this study was to assess whether a short-term use of low dose prednisone monotherapy was effective in inducing remission in newly diagnosed RA patients. Methods A retrospective analysis of patients newly diagnosed with RA at a Community Health Center in North Dakota was performed based on the ACR/EULAR RA classification criteria. Demographic and clinical data were abstracted from patients’ medical charts. Patients treated with (< 10 mg/day) of prednisone up to 6 months were included. Response to prednisone was analyzed according to pre- and post-treatment DAS28-ESR score and EULAR response criteria. Results Data on 201 patients were analyzed. The mean prednisone dose was 8 mg/day (range: 5–10; SD = 1.2) and the mean treatment duration was 42.2 days (12–177; 16.9). Disease severity significantly improved from baseline to follow-up for: tender joint count (8.6 ± 4.8 vs. 1.5 ± 3.3; P < 0.001), swollen joint count (6.2 ± 5.0 vs. 1.4 ± 3.0; P < 0.001), and visual analog pain score (4.8 ± 2.6 vs. 2.1 ± 2.5; P < 0.001). DAS28-ESR disease severity significantly improved from baseline to follow-up: (5.1 ± 1.2 vs. 2.7 ± 1.3; P < 0.001). Per EULAR response criteria, 69.7% of patients showed good response to treatment and 20.4% showed moderate response. 54.2% of patients reached remission. Conclusion Short-term use of low dose prednisone monotherapy induced disease remission and improved clinical severity of RA in the majority of newly diagnosed patients.

Acupuncture versus topiramate in chronic migraine prophylaxis: A randomized clinical trial

Cephalalgia ◽  
2011 ◽  
Vol 31 (15) ◽  
pp. 1510-1521 ◽  
Author(s):  
C-P Yang ◽  
M-H Chang ◽  
P-E Liu ◽  
T-C Li ◽  
C-L Hsieh ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Prophylactic Treatment ◽  
Medication Overuse ◽  
Severe Headache ◽  
Migraine Prophylaxis ◽  
Acupuncture Group ◽  
Maintenance Period ◽  
Acute Medication ◽  
Group A ◽  
The Mean

Background: The aim of this study was to investigate the efficacy and tolerability of acupuncture compared with topiramate treatment in chronic migraine (CM) prophylaxis. Methods: A total of 66 consecutive and prospective CM patients were randomly divided into two treatment arms: 1) acupuncture group: acupuncture administered in 24 sessions over 12 weeks (n = 33); and 2) topiramate group: a 4-week titration, initiated at 25 mg/day and increased by 25 mg/day weekly to a maximum of 100 mg/day followed by an 8-week maintenance period (n = 33). Results: A significantly larger decrease in the mean monthly number of moderate/severe headache days (primary end point) from 20.2 ± 1.5 days to 9.8 ± 2.8 days was observed in the acupuncture group compared with 19.8 ± 1.7 days to 12.0 ± 4.1 days in the topiramate group (p < .01) Significant differences favoring acupuncture were also observed for all secondary efficacy variables. These significant differences still existed when we focused on those patients who were overusing acute medication. Adverse events occurred in 6% of acupuncture group and 66% of topiramate group. Conclusion: We suggest that acupuncture could be considered a treatment option for CM patients willing to undergo this prophylactic treatment, even for those patients with medication overuse.

scholarly journals Results of tadalafil treatment in patients following an open nerve-sparing radical prostatectomy

2016 ◽  
Vol 88 (1) ◽  
pp. 4
Author(s):  
Erkan Hirik ◽  
Aliseydi Bozkurt ◽  
Mehmet Karabakan ◽  
Özkan Onuk ◽  
Mustafa Bahadır Can Balcı ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Adverse Effects ◽  
Erectile Function ◽  
Nerve Sparing ◽  
Ultrasound Evaluation ◽  
Significant Difference ◽  
Daily Dose ◽  
The Mean ◽  
Positive Effect

Purpose: To evaluate the effect of postoperatively administering a low daily dose of tadalafil on the erectile function of patients who underwent a nerve-sparing radical prostatectomy(NSRP) due to localized prostate cancer (PCa). Materials and Methods: Of 138 patients, who underwent NSRP due to PCa between 2012 and 2014, 55 patients who had not had pre-operative erectile dysfunction (ED) were included in the study. The mean age of the patients was 64 (54-72). On the 15th day after surgery, after ultrasound evaluation, all 55 patients started on a daily dose of 5 mg tadalafil that was continued for 2.5 months. The erectile function of patients was evaluated pre-operatively, post-operatively, and at the 3rd and 6th month after surgery using the International Index of Erectile Function (IIEF-5) test. None of the patients was treated with hormonal therapy or radiotherapy before or after surgery. Results: Three patients were excluded from the study due to the adverse effects of tadalafil and two patients elected to discontinue the treatment. Of the remaining 50 patients whose pre-operative erectile function had been found normal, at 3 months after surgery, 36 (72%) had normal erectile function; of the remaining patients in the study six (12%) presented with mild, two (4%) with moderate, and six (12%) with severe ED. Six months after surgery, 35 patients (70%) had normal erectile function while seven (14%) had mild, three (6%) moderate and five (10%) severe ED. There was no statistically significant difference between the results obtained at the 3rd and 6thmonth follow-up (p &gt; 0.05). Three patients reported adverse effects with tadalafil including flushes in 2 (3.6%) and a headache in 1 (1.8%). Conclusions: The administration of a 5 mg post-operative dose of tadalafil to patients that had undergone a bilateral NSRP was found to have a positive effect on the recovery and maintenance of erectile function. However, there is still a need to investigate a larger series of cases.

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