ANTIEPILEPTIC EFFECT OF CALCIUM CHANNEL BLOCKERS ALONE AND IN COMBINATION WITH PHENYTOIN ON MES INDUCED EPILEPSY IN RATS

Background: The currently available antiepileptic drugs have a low therapeutic index, and provide satisfactory seizure control in only 60-70% of patients. Calcium channel blocker has shown potentials of a useful add-on drug for the existing antiepileptic drugs. Objectives: To study the effect of calcium channel blockers (CCBs) nifedipine and verapamil on maximal electroshock (MES)-induced convulsions and also to evaluate their effect in combination with Phenytoin. Methods: For this study, Male Wistar rats were used. Effects of nifedipine (5 mg/kg), verapamil (20mg/kg) alone and in combination with phenytoin (25mg/kg) were studied in MES model. Abolition of hind limb tonic extension and reduction of duration of tonic extension was considered as the index for antiepileptic activity in MES. Results: Verapamil and nifedipine produced significant antiepileptic effect alone. Verapamil and nifedipine potentiated the antiepileptic effect of phenytoin sodium. Conclusion: Dose of phenytoin sodium can be reduced in epileptic patients receiving verapamil or nifedipine for some other clinical conditions. Verapamil and nifedipine can also be used alone in the treatment of generalized tonic clonic seizures. However it needs further confirmation to establish clinical utility of calcium channel blockers. KEY WORDS: Nifedipine, verapamil, phenytoin, MES seizure rats

Incidence of fracture in adjacent levels in patients treated with balloon kyphoplasty: a review of the literature

The available evidence suggests that the treatment of painful vertebral compression fractures (VCFs) secondary to osteoporosis or multiple myeloma, by cement augmentation with balloon kyphoplasty (BK), is both safe and effective. However, there is uncertainty in the literature concerning the potential of the procedure to influence the risk for adjacent segment fracture. The aim of this article is to review the available peer-reviewed literature, regarding adjacent vertebral body fractures after kyphoplasty augmentation

Morphological changes of injected calcium phosphate cement in osteoporotic compressed vertebral bodies

SUMMARY: This study was undertaken to investigate the radiologic and clinical outcomes of vertebroplasty with calcium phosphate (CaP) cement in patients with osteoporotic vertebral compression fractures. The morphological changes of injected CaP cement in osteoporotic compressed vertebral bodies were variable and unpredictable. We suggest that the practice of vertebroplasty using CaP should be reconsidered. INTRODUCTION: Recently, CaP, an osteoconductive filler material, has been used in the treatment of osteoporotic compression fractures. However, the clinical results of CaP-cement-augmented vertebrae are still not well established. The purpose of this study is to assess the clinical results of vertebroplasty with CaP by evaluating the morphological changes of CaP cement in compressed vertebral bodies. METHODS: Fourteen patients have been followed for more than 2 years after vertebroplasty. The following parameters were reviewed: age, sex, T score, compliance with osteoporosis medications, visual analog scale score, compression ratio, subsequent compression fractures, and any morphological changes in the filler material. RESULTS: The morphological changes of injected CaP included reabsorption, condensation, bone formation (osteogenesis), fracture of the CaP solid hump, and heterotopic ossification. Out of 14 patients, 11 (78.6%) developed progression of the compression of the CaP-augmented vertebral bodies after vertebroplasty. CONCLUSIONS: The morphological changes of the injected CaP cement in the vertebral bodies were variable and unpredictable. The compression of the CaP-augmented vertebrae progressed continuously for 2 years or more. The findings of this study suggest that vertebroplasty using CaP cement should be reconsidered.ope

Vertebroplasty and kyphoplasty: a comparative review of efficacy and adverse events

Vertebroplasty and kyphoplasty have become common surgical techniques for the treatment of vertebral compression fractures. Vertebroplasty involves the percutaneous injection of bone cement into the cancellous bone of a vertebral body with the goals of pain alleviation and preventing further loss of vertebral body height. Kyphoplasty utilizes an inflatable balloon to create a cavity for the cement with the additional potential goals of restoring height and reducing kyphosis. Vertebroplasty and kyphoplasty are effective treatment options for the reduction of pain associated with vertebral body compression fractures. Biomechanical studies demonstrate that kyphoplasty is initially superior for increasing vertebral body height and reducing kyphosis, but these gains are lost with repetitive loading. Complications secondary to extravasation of cement include compression of neural elements and venous embolism. These complications are rare but more common with vertebroplasty. Vertebroplasty and kyphoplasty are both safe and effective procedures for the treatment of vertebral body compression fractures

Risks and benefits of percutaneous vertebroplasty or kyphoplasty in the management of osteoporotic vertebral fractures.

Vertebral fracture (VF) is the most common osteoporotic fracture and is associated with high morbidity and mortality. Conservative treatment combining antalgic agents and rest is usually recommended for symptomatic VFs. The aim of this paper is to review the randomized controlled trials comparing the efficacy and safety of percutaneous vertebroplasty (VP) and percutaneous balloon kyphoplasty (KP) versus conservative treatment. VP and KP procedures are associated with an acceptable general safety. Although the case series investigating VP/KP have all shown an outstanding analgesic benefit, randomized controlled studies are rare and have yielded contradictory results. In several of these studies, a short-term analgesic benefit was observed, except in the prospective randomized sham-controlled studies. A long-term analgesic and functional benefit has rarely been noted. Several recent studies have shown that both VP and KP are associated with an increased risk of new VFs. These fractures are mostly VFs adjacent to the procedure, and they occur within a shorter time period than VFs in other locations. The main risk factors include the number of preexisting VFs, the number of VPs/KPs performed, age, decreased bone mineral density, and intradiscal cement leakage. It is therefore important to involve the patients to whom VP/KP is being proposed in the decision-making process. It is also essential to rapidly initiate a specific osteoporosis therapy when a VF occurs (ideally a bone anabolic treatment) so as to reduce the risk of fracture. Randomized controlled studies are necessary in order to better define the profile of patients who likely benefit the most from VP/KP