6 research outputs found
Brazilian Guidelines For The Treatment Of Narcolepsy [diretrizes Brasileiras Para O Tratamento Da Narcolepsia]
This manuscript contains the conclusion of the consensus meeting of the Brazilian Sleep Association with Brazilian sleep specialists on the treatment of narcolepsy based on the review of medical literature from 1980 to 2010. The manuscript objectives were to reinforce the use of agents evaluated in randomized placebo-controlled trials and to issue consensus opinions on the use of other available medications as well as to inform about safety and adverse effects of these medications. Management of narcolepsy relies on several classes of drugs, namely, stimulants for excessive sleepiness, antidepressants for cataplexy and hypnotics for disturbed nocturnal sleep. Behavioral measures are likewise valuable and universally recommended. All therapeutic trials were analyzed according to their class of evidence. Recommendations concerning the treatment of each single symptom of narcolepsy as well as general recommendations were made. Modafinil is the first-line pharmacological treatment of excessive sleepiness. Second-line choices for the treatment of excessive sleepiness are slow-release metylphenidate followed by mazindol. The first-line treatments of cataplexy are the antidepressants, reboxetine, clomipramine, venlafaxine, desvenlafaxine or high doses of selective serotonin reuptake inibitors antidepressants. As for disturbed nocturnal sleep the best option is still hypnotics. Antidepressants and hypnotics are used to treat hypnagogic hallucinations and sleep paralysis.323305314Morgenthaler, T.I., Kapur, V.K., Brown, T., Swick, T.J., Alessi, C., Aurora, R.N., Boehlecke, B., Zak, R., Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin (2007) Sleep, 30 (12), pp. 1705-1711. , Standards of Practice Committee of the American Academy of Sleep MedicineSackett, D.L., Rules of evidence and clinical recommendations for the management of patients (1993) Can J Cardiol, 9 (6), pp. 487-489Eddy, D., (1992) A Manual for Assessing Health Practices and Designing Practice Policies: The Explicit Approach, , Philadelphia: American College of PhysiciansLevels of Evidence, , http://www.cebm.net/index.aspx0=1025, Web Site. [cited 2009 dez 16]. 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Philadelphia: Butterworth Heinman, ElsevierZaharna, M., Dimitriu, A., Guilleminault, C., Expert opinion on pharmacotherapy of narcolepsy (2010) Expert Opin Pharmacother, , In pressZolkowska, D., Jain, R., Rothman, R.B., Partilla, J.S., Roth, B.L., Setola, V., Prisinzano, T.E., Baumann, M.H., Evidence for the involvement of dopamine transporters in behavioral stimulant effects of modafinil (2009) J Pharmacol Exp Ther, 329 (2), pp. 738-746Boutrel, B., Koob, G.F., What keeps us awake: The neuropharmacology of stimulants and wakefulness-promoting medications (2004) Sleep, 27 (6), pp. 1181-1194Volkow, N.D., Fowler, J.S., Logan, J., Alexoff, D., Zhu, W., Telang, F., Hooker, J.M., Apelskog-Torres, K., Effects of modafinil on dopamine and dopamine transporters in the male human brain (2009) JAMA, 301 (11), pp. 1148-1154Qu, W.M., Huang, Z.L., Xu, X.H., Matsumoto, N., Urade, Y., Dopamin ergic D1 and D2 receptors are essential for the arousal effect of modafinil (2008) J Neurosci, 28 (34), pp. 8462-8469Beierlein, M., Gibson, J.R., Connors, B.W., A network of electrically coupled interneurons drives synchronized inhibition in neocortex (2000) Nat Neurosci, 3 (9), pp. 904-910Hestrin, S., Galarreta, M., Electrical synapses define networks of neocortical GABAergic neurons (2005) Trends in Neurosciences, 28 (6 SPEC. 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5-HT3 receptor (1996) Neuroscience Letters, 220 (1), pp. 5-8. , DOI 10.1016/S0304-3940(96)13212-2, PII S0304394096132122Ferraro, L., Antonelli, T., O'Connor, W.T., Tanganelli, S., Rambert, F., Fuxe, K., The antinarcoleptic drug modafinil increases glutamate release in thalamic areas and hippocampus (1997) NeuroReport, 8 (13), pp. 2883-2887De La Mora, M.P., Aguilar-Garcia, A., Ramon-Frias, T., Ramirez-Ramirez, R., Mendez-Franco, J., Rambert, F., Fuxe, K., Effects of the vigilance promoting drug modafinil on the synthesis of GABA and glutamate in slices of rat hypothalamus (1999) Neuroscience Letters, 259 (3), pp. 181-185. , DOI 10.1016/S0304-3940(98)00905-7, PII S0304394098009057Willie, J.T., Renthal, W., Chemelli, R.M., Miller, M.S., Scammell, T.E., Yanagisawa, M., Sinton, C.M., Modafinil more effectively induces wakefulness in orexin-null mice than in wild-type littermates (2005) Neuroscience, 130 (4), pp. 983-995. , DOI 10.1016/j.neuroscience.2004.10.005, PII S0306452204009339Scammell, T.E., Estabrooke, I.V., McCarthy, M.T., Chemelli, R.M., Yanagisawa, M., Miller, M.S., Saper, C.B., Hypothalamic arousal regions are activated during modafinil-induced wakefulness (2000) J Neurosci, 20 (22), pp. 8620-8628Randomized trial of modafinil for the treatment of pathological somnolence in narcolepsy (1998) Ann Neurol, 43 (1), pp. 88-97. , US Modafinil in Narcolepsy Multicenter Study GroupRandomized trial of modafinil as a treatment for the excessive daytime somnolence of narcolepsy (2000) Neurology, 54 (5), pp. 1166-1175. , US Modafinil in Narcolepsy Multicenter Study GroupBroughton, R.J., Fleming, J.A.E., George, C.F.P., Hill, J.D., Kryger, M.H., Moldofsky, H., Montplaisir, J.Y., Murphy, W.F., Randomized, double-blind, placebo-controlled crossover trial of modafinil in the treatment of excessive daytime sleepiness in narcolepsy (1997) Neurology, 49 (2), pp. 444-451Mitler, M.M., Hirsh, J., Hirshkowitz, M., Guilleminault, C., Long-term efficacy and safety of modafinil (PROVIGIL) for the treatment of excessive daytime sleepiness associated with narcolepsy (2000) Sleep Med, 1 (3), pp. 231-243. , for the US Modafinil in Narcolepsy Multicenter Study GroupMoldofsky, H., Broughton, R.J., Hill, J.D., A randomized trial of the long-term, continued efficacy and safety of modafinil in narcolepsy (2000) Sleep Med, 1 (2), pp. 109-116Schwartz, J., Feldman, N.T., Bogan, R.K., Dose response and dose regimen effects of modafinil in sustaining daytime wakefulness in narcoleptic patients with residual excessive sleepiness (2005) J Neuropsychiatry Clin Neurosci, 17 (3), pp. 405-412Dauvilliers, Y., Neidhart, E., Billiard, M., Tafti, M., Sexual dimorphism of the catechol-O-methyltransferase gene in narcolepsy is associated with response to modafinil (2002) Pharmacogenomics Journal, 2 (1), pp. 65-68. , DOI 10.1038/sj.tpj.6500088Robertson Jr., P., Hellriegel, E.T., Clinical pharmacokinetic profile of modafinil (2003) Clin Pharmacokinet, 42 (2), pp. 123-137Wong, Y.N., Simcoe, D., Hartman, L.N., Laughton, W.B., King, S.P., McCormick, G.C., Grebow, P.E., A double-blind, placebo-controlled, ascending-dose evaluation of the pharmacokinetics and tolerability of modafinil tablets in healthy male volunteers (1999) Journal of Clinical Pharmacology, 39 (1), pp. 30-40. , DOI 10.1177/00912709922007534Schawartz, J.R., Modafinil in the treatment of excessive sleepiness (2009) Drug des Devel Ther, 2, pp. 71-85Kumar, R., Approved and investigational uses of modafinil: An evidence-based review (2008) Drugs, 68 (13), pp. 1803-1839Walsleben, J.A., Ristanovic, R., Hirshkowitz, M., Provigil (modafinil) in the treatment of excessive daytime sleepiness in narcolepsy: Effect of previous treatment with stimulants on clinical response and safety (2000) Sleep, 23, pp. A303-4Schwartz, J.R.L., Feldman, N.T., Fry, J.M., Harsh, J., Efficacy and safety of modafinil for improving daytime wakefulness in patients treated previously with psychostimulants (2003) Sleep Medicine, 4 (1), pp. 43-49. , DOI 10.1016/s1389-9457(02)00240-xThorpy, M.J., Schwartz, J.R.L., Kovacevic-Ristanovic, R., Hayduk, R., Initiating treatment with modafinil for control of excessive daytime sleepiness in patients switching from methylphenidate: An open-label safety study assessing three strategies (2003) Psychopharmacology, 167 (4), pp. 380-385Roth, T., Schwartz, J.R.L., Hirshkowitz, M., Erman, M.K., Dayno, J.M., Arora, S., Evaluation of the safety of modafinil for treatment of excessive sleepiness (2007) Journal of Clinical Sleep Medicine, 3 (6), pp. 595-602Jasinski, D.R., Kovacevi-Ristanovi, R., Evaluation of the abuse liability of modafinil and other drugs for excessive daytime sleepiness associated with narcolepsy (2000) Clin Neuropharmacol, 23 (3), pp. 149-156Myrick, H., Malcolm, R., Taylor, B., LaRowe, S., Modafinil: Preclinical, clinical, and post-marketing surveillance - A review of abuse liability issues (2004) Ann Clin Psychiatry, 16 (2), pp. 101-106Jasisnki, D.R., An evaluation of the abuse potential of modafinil using methylphenidate as a reference (2000) J Psychopharmacol, 14 (1), pp. 53-60Andersen, M.L., Kessler, E., Murnane, K.S., McClung, J.C., Tufik, S., Howell, L.L., Dopamine transporter-related effects of modafinil in rhesus monkeys (2010) Pshychopharmacology, 210 (3), pp. 439-448. , BerlProvigil Consumer Information, , www.fda.gov/cder/consumerinfo/druginfo/provigil, [cited 2009 mar 2]. Available fromBogan, R.K., Armodafinil in the treatment of excessive sleepiness (2010) Expert Opin Pharmacother, 11 (6), pp. 993-1002Nishino, S., Okuro, M., Emerging treatments for narcolepsy and its related disorders (2010) Expert Opin Emerg Drugs, 15 (1), pp. 139-158Auger, R.R., Goodman, S.H., Silber, M.H., Krahn, L.E., Pankratz, V.S., Slocumb, N.L., Risks of high-dose stimulants in the treatment of disorders of excessive somnolence: A case-control study (2005) Sleep, 28 (6), pp. 667-672Dauvilliers, Y., Arnulf, I., Mignot, E., Narcolepsy with cataplexy (2007) Lancet, 369 (9560), pp. 499-511Mitler, M.M., Hajdukovik, R., Relative efficacy of drugs used for the treatment of narcolepsy (1991) Sleep, 14 (3), pp. 218-220Wallin, M.T., Mahowald, M.W., Blood pressure effects of long-term stimulant use in disorders of hypersomnolence (1998) J Sleep Res, 7 (3), pp. 209-215Thorpy, M., Current concepts in the etiology, diagnosis and treatment of narcolepsy (2001) Sleep Med, 2 (1), pp. 5-17Mitler, M.M., Aldrich, M.S., Koob, G.F., Zarcone, V.P., Narcolepsy and its treatment with stimulants. ASDA standards of practice (1994) Sleep, 17 (4), pp. 352-371Shindler, J., Schachter, M., Brincat, S., Parkes, J.D., Amphetamine, mazindol, and fencamfamin in narcolepsy (1985) Br Med J (Clin Res Ed), 290 (6476), pp. 1167-1170Lijima, S., Sugita, Y., Teshima, Y., Hishikawa, Y., Therapeutic effects of mazindol on narcolepsy (1986) Sleep, 9 (1 PART 2), pp. 265-268Alvarez, B., Dahlitz, M., Grimshaw, J., Parkes, J.D., Mazindol in long-term treatment of narcolepsy (1991) Lancet, 337 (8752), pp. 1293-1294Mayer, G., Meier-Ewert, K., Selegiline hydrochloride treatment in narcolepsy. A double-blind, placebo-controlled study (1995) Clin Neuropharmacol, 18 (4), pp. 306-319Hublin, C., Partinen, M., Heinonen, E., Puuka, P., Salmi, T., Selegiline in the treatment of narcolepsy (1994) Neurology, 44 (11), pp. 2095-2101Pratt, D.S., Dubois, R.S., Hepatotoxicity due to pemoline (Cylert): A report of two cases (1990) J Pediatr Gastroent Nutri, 10 (2), pp. 239-241Nehra, A., Mullick, F., Ishak, K.G., Zimmerman, H.J., Pemoline-associated hepatic injury (1990) Gastroenterol, 99 (5), pp. 1517-1519Beaumont, M., Batejat, D., Pierard, C., Coste, O., Doireau, P., Van Beers, P., Chauffard, F., Lagarde, D., Slow release caffeine and prolonged (64-h) continuous wakefulness: Effects on vigilance and cognitive performance (2001) Journal of Sleep Research, 10 (4), pp. 265-276. , DOI 10.1046/j.1365-2869.2001.00266.xHoughton, W.C., Scammell, T.E., Thorpy, M., Pharmacotherapy for cataplexy (2004) Sleep Med Rev, 8 (5), pp. 355-366Vignatelli, L., D'Alessandro, R., Candelise, L., Antidepressant drugs for narcolepsy (2005) Cochrane Database Syst Rev, 20, p. 3. , CD0003724Frey, J., Darbonne, C., Fluoxetine suppresses human cataplexy: A pilot study (1994) Neurology, 44 (4), pp. 707-709Poceta, J.S., Hajdukovic, R., Mitler, M.M., Improvement in cataplexy with yohimbine and paroxetine: Case report (1994) Sleep Res, 23, p. 304Thirumalai, S.S., Shubin, R.A., The use of citalopram in resistant cataplexy (2000) Sleep Med, 1 (4), pp. 313-316Smith, M., Parkes, J.D., Dahlitz, M., Venlafaxine in the treatment of the narcoleptic syndrome (1996) J Sleep Res, 5, p. 217Larrosa, O., De La Llave, Y., Bario, S., Granizo, J.J., Garcia-Bor Reguero, D., Stimulant and anticataplectic effects of reboxetine in patients with narcolepsy: A pilot study (2001) Sleep, 24 (3), pp. 282-285Mayer, G., Meier-Ewert, K., Selegiline hydrochloride treatment in narcolepsy. A double-blind, placebo-controlled study (1995) Clin Neuropharmacol, 18 (4), pp. 306-319A randomized, double-blind, placebo-controlled multicenter trial comparing the effects of three doses of orally administered sodium oxybate with placebo for the treatment of narcolepsy (2002) Sleep, 25 (1), pp. 42-49. , US XYREM Multicenter Study GroupFurther evidence support ing the use of sodium oxybate for the treatment of cataplexy: A double-blind, placebo-controlled study in 228 patients (2005) Sleep Med, 6 (5), pp. 415-421. , U.S. XYREM Multicenter Study GroupA double-blind placebo controlled study demonstrates sodium oxybate is effective for the treatment of excessive daytime sleepiness in narcolepsy (2005) J Clin Sleep Med, 1 (4), pp. 391-397. , XYREM International Study GroupBlack, J., Houghton, W.C., Sodium oxybate improves excessive daytime sleepiness in narcolepsy (2006) Sleep, 29 (7), pp. 939-946Lammers, G.J., Bassetti, C., Billiard, M., Black, J., Broughton, R., Dauvilliers, Y., Ferini Strambi, L., Thorpy, M., Sodium oxybate is an effective and safe treatment for narcolepsy (2010) Sleep Med, 11 (1), pp. 105-106Grozinger, M., Hartter, S., Hiemke, C., Griese, E.-U., Roschke, J., Interaction of modafinil and clomipramine as comedication in a narcoleptic patient (1998) Clinical Neuropharmacology, 21 (2), pp. 127-129Wu, D., Victoria Otton, S., Inaba, T., Kalow, W., Sellers, E.M., Interactions of amphetamine analogs with human liver CYP2D6 (1997) Biochemical Pharmacology, 53 (11), pp. 1605-1612. , DOI 10.1016/S0006-2952(97)00014-2, PII S0006295297000142Thorpy, M.J., Snyder, M., Aloe, F.S., Ledereich, P.S., Starz, K.E., Short-term triazolam use improves nocturnal sleep of narcoleptics (1992) Sleep, 15 (3), pp. 212-216Bonakis, A., Howard, R.S., Ebrahim, I.O., Merritt, S., Williams, A., REM sleep behaviour disorder (RBD) and its associations in young patients (2009) Sleep Med, 10 (6), pp. 641-645Suzanne Hoover-Stevens, S., Ruzica Kovacevic-Ristanovic, R., Management of narcolepsy in pregnancy (2000) CIin Neuropharmacol, 23 (4), pp. 175-181Rogers, A.E., Aldrich, M.S., Berrios, A.M., Rosenberg, R.S., Compliance with stimulant medications in patients with narcolepsy (1997) Sleep, 20 (1), pp. 28-3
Knowledge about epilepsy among teachers and epileptic patients
223 epileptics patients and their families and 136 teachers from public and private schools were submitted to similar questionnaires related to inheritance, transmission, cure, complilcation rates, care during seizures, need for information on the disease, habits, comparison with other diseases and to the educational and social performances of epileptics. Cure and complication nates accounted for the main differences between those populations. Epileptics could recognize a bigger number of complications but still expected to be cured from the disease. The majority of teachers and patients have never been informed about epilepsy and this finding was related to the big number of equivocal answers obtained from them. Put together, the data showed that social and educational performance of epileptic patients could be disturbed by medical and social parameters. Some, of them could be improved by an educational program towards these aspects of epilepsy
Brazilian Guidelines For The Diagnosis Of Narcolepsy [diretrizes Brasileiras Para O DiagnĂłstico Da Narcolepsia]
This manuscript contains the conclusion of the consensus meeting on the diagnosis of narcolepsy based on the review of Medline publications between 1980-2010. Narcolepsy is a chronic disorder with age at onset between the first and second decade of life. Essential narcolepsy symptoms are cataplexy and excessive sleepiness. Cataplexy is defined as sudden, recurrent and reversible attacks of muscle weakness triggered by emotions. Accessory narcolepsy symptoms are hypnagogic hallucinations, sleep paralysis and nocturnal fragmented sleep. The clinical diagnosis according to the International Classification of Sleep Disorders is the presence of excessive sleepiness and cataplexy. A full in-lab polysomnography followed by a multiple sleep latency test is recommended for the confirmation of the diagnosis and co-morbidities. The presence of two sleep-onset REM period naps in the multiple sleep latency test is diagnostic for cataplexy-free narcolepsy. A positive HLA-DQB1*0602 with lower than 110pg/mL level of hypocretin-1 in the cerebrospinal fluid is required for the final diagnosis of cataplexy- and sleep-onset REM period-free narcolepsy.323294304(2005) International Classification of Sleep Disorders, Second Edition: Diagnostic and Coding Manual, , American Academy of Sleep Medicine. 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familial aspects of narcolepsy (1998) Neurology, 50 (2 SUPPL. 1), pp. S16-22Mignot, E., Lin, L., Rogers, W., Honda, Y., Qiu, X., Lin, X., Okun, M., Risch, N., Complex HLA-DR and -DQ interactions confer risk of narcolepsycataplexy in three ethnic groups (2001) Am J Hum Genet, 68 (3), pp. 686-699Pelin, Z., Guilleminault, C., Risch, N., Grumet, F.C., Mignot, E., HLA-DQB1*0602 homozygosity increases relative risk for narcolepsy but not disease severity in two ethnic groups (1998) Tissue Antigens, 51 (1), pp. 96-100. , US Modafinil in Narcolepsy Multicenter Study GroupMignot, E., Kimura, A., Latlermann, A., Lin, X., Yasunaga, S., Mueller-Eckhardt, G., Rattazzi, C., Underbill, P., Extensive HLA class II studies in 58 non-DRB 1*15 (DR2) narcoleptic patients with cataplexy (1997) Tissue Antigens, 49 (4), pp. 329-341Ellis, M.C., Hetisimer, A.H., Ruddy, D.A., Hansen, S.L., Kronmal, G.S., McClelland, E., Quintana, L., Mignot, E., HLA class II haplotype and sequence analysis support a role for DQ in narcolepsy (1997) Immunogenetics, 46 (5), pp. 410-417Mignot, E., Lin, X., Arrigoni, J., Macaubas, C., Olive, F., Hallmayer, J., Underhill, P., Grumet, F.C., DQB1*0602 and DQA1*0102 (DQ1) are better markers than DR2 for narcolepsy in Caucasian and black Americans (1994) Sleep, 17 (8 SUPPL.), pp. S60-7Mignot, E., Hayduk, R., Black, J., Grumet, F.C., Guilleminault, C., HLA DQB1*0602 is associated with cataplexy in 509 narcoleptic patients (1997) Sleep, 20 (11), pp. 1012-1020Morgun, A., Gonçalves-Primo, A., Shulzhenko, N., Rampim, G.F., Mine, K.L., Gerbase-DeLima, M., HLA-DQB1 and -DRB1 Alleles, Cytokine Polymorphismis and KIR Gene Frequencies in a Population (Caucasian) from South East Brazil (2004) Hum Immunol, 65 (9), pp. 879-882Temin, J., Marques, G.D., Morgun, A., Shulzhenko, N., Rampim, G.F., Gerbase-de Lima, M., HLA-DQB1 and -DRB1 Alleles and Cytokine Polymorphismis in a Mulatto population from South East Brazil (2004) Hum Immunol, 65 (9), pp. 882-886Miyagawa, T., Honda, M., 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A clinical and microbiological evaluation of systemic and local metronidazole delivery in adult periodontitis patients
Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus
Item does not contain fulltextBACKGROUND AND OBJECTIVE: The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. METHODS: A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. RESULTS: The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. CONCLUSIONS: This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption