Neurological disorders, treatment

Marler JR, Jones PW, Emr M. Proceedings of a National Symposium on Rapid Identification and Treatment of Acute Stroke National Institute of Neurological Disorders and Stroke, National Institutes of Health Bethesda, Maryland 1997. 

Dunnett, SB and Bjorklund, A (1999) Prospects for new restorative and neuroprotective treatments in Parkinson s disease. Nature 399 (Neurological disorders supplement) A32-A39. 

Alteplase (rt-PA Activase) is an IV thrombolytic (fibrinolytic) that was approved for acute stroke treatment in 1996 based on the results of the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Trial.10 The current American Stroke Association guidelines include alteplase as the only Food and Drug Administration (FDA) approved acute treatment for ischemic stroke and strongly encourage early diagnosis and treatment of appropriate patients.11... 

The epilepsies constitute a common, serious neurological disorder in humans, affecting approximately 60 million people worldwide. Well in excess of 40 distinct epileptic syndromes have been identified to date. Current treatment is only symptomatic except in uncommon instances when surgical treatment is possible. While available antiseizure medications target ion channels such as the y-amino-butyric acid (GABA)a receptor and voltage activated sodium (Na+) channels, current research seeks to elucidate the cellular and molecular mechanisms by which a normal brain becomes epileptic. Hopefully, this research will lead to the identification of new targets for which small molecules can be identified and used for prevention or cure of epilepsy. 

Binda C, Newton-Vinson P, Hubalek F, et al. Structure of human monoamine oxidase B, a drug target for the treatment of neurological disorders. Nat Struct Biol 2002 9(l) 22-26. 

The onset of botulism occurs generally between 18 and 36 hours after consumption of food products containing botulin toxin. However, it may affect patients earlier or later, even on the tenth day after food consumption. The first symptoms include stomach ache, nausea, vomiting, and diarrhea, followed by neurological disorders. Other symptoms include, skin, mouth and throat dryness, diplopia, blurred vision, dysphonia, dysarthria, dysphagia, and peripheral weakness. In lethal cases of botulism, respiratory muscles are involved. This leads to respiratory failure and death. Because all the symptoms are connected with toxemia, the first step of medical treatment is to provide a patient with antiserum. 

The occurrence of tardive dyskinesia after treatment with conventional antipsychotics for a long term raises some interesting questions. Remember, dyskinesias are a symptom of HD and other neurological disorders in which there is too much dopamine flowing through the nigrostriatal pathway. How can a dopamine-blocking medication produce symptoms similar to HD ... 

The use of hGH extracted from the pituitaries of deceased human donors came to an abrupt end in 1985, when a link between treatment and Creutzfeldt-Jakob disease (CJD, a rare, but fatal, neurological disorder) was discovered. In this year, a young man who had received hGH therapy some 15 years previously died from CJD, which, investigators concluded, he had contracted from infected pituitary extract (CJD appears to be caused by a prion). At least an additional 12 CJD cases suspected of being caused in the same way have subsequently been documented. Fortunately, several recombinant hGH (rhGH) preparations were coming onstream at that time (Table 8.8), and now all hGH preparations used clinically are derived from recombinant sources. Currently, in excess of 20 000 people are in receipt of rhGH therapy. 

The benzodiazepines are one of the most widely used (and abused) classes of drugs they are widely used in the treatment of epilepsy, insomnia, anxiety, movement disorders, and a variety of other neurological disorders. The discovery of the benzodiazepines is a good example of the importance of serendipity. 

Clozapine also has been shown to benefit schizoaffective and bipolar patients with treatment-refractory mania ( 54) patients with Parkinson s disease and those with other neurological disorders with psychoses, such as Huntington s disease. Although clozapine has been shown to be an effective agent in the elderly, its usefulness in this population is limited because of its anticholinergic, sedative, cardiovascular, and potentially toxic effects on the bone marrow ( 55). In a study of 12 elderly female psychotic patients on clozapine (maximal daily dose, 300 mg), for example, five were taken off clozapine because of postural hypotension, one had a nonfatal episode of agranulocytosis, and one had leukopenia ( 56). 

Solanine hydrochloride has been used as a commercial pesticide. It has sedative and anticonvulsant properties, and has sometimes been used for the treatment of asthma, as well as for cough and common cold. However, gastrointestinal and neurological disorders result from solanine poisoning. Symptoms include nausea, diarrhoea, vomiting, stomach cramps, burning of the throat, headaches and dizziness. Other adverse reactions, in more severe cases, include hallucinations, loss of sensation, paralysis, fever, jaundice, dilated pupils and hypothermia. Solanine overdose can be fatal. 

---