Levetiracetam in spinal cord injury pain: a randomized controlled trial

Udgivelsesdato: 2009-Jun-9Study design:A randomized, double-blind, placebo-controlled, crossover, multicenter trial. A 1-week baseline period was followed by two treatment periods of 5 weeks duration with levetiracetam increased from 500 mg b.i.d. to a maximum of 1500 mg b.i.d. separated by a 1-week washout period.Objectives:The objective of the study was primarily to evaluate the efficacy of the anticonvulsant levetiracetam in patients with spinal cord injury (SCI) at- and below-level pain and secondarily to evaluate the effect on spasm severity.Setting:Outpatients at two spinal cord units and a pain center.Methods:Patients were allowed to continue their usual pain treatment at a constant dose. The primary outcome measure was the change in median daily pain score (on a 0-10 point numeric rating scale) from 1-week baseline period to the last week of each treatment period. Secondary outcome measures included pain relief of at- and below-level pain, allodynia, spasms and spasticity.Results:A total of 36 patients with SCI at- and or below-level pain were enrolled. Of these, 24 patients completed the trial. We found no effect of levetiracetam on the primary (P=0.46) or any of the secondary outcome measures. Only two patients continued levetiracetam treatment following the trial, and one patient was still in levetiracetam treatment at the 6-month follow-up. Levetiracetam was generally well tolerated with no serious adverse events.Conclusions:Levetiracetam does not relieve neuropathic pain or spasm severity following spinal cord injury.Spinal Cord advance online publication, 9 June 2009; doi:10.1038/sc.2009.55

Risk factors for revision due to infection after primary total hip arthroplasty: A population-based study of 80,756 primary procedures in the Danish Hip Arthroplasty Registry

There has been a limited amount of research on risk factors for revision due to infection following total hip arthroplasty (THA), probably due to low absolute numbers of revisions. We therefore studied patient- and surgery-related risk factors for revision due to infection after primary THA in a population-based setting

Comparison of the efficacy of gabapentin and pregabalin for neuropathic pain in patients with spinal cord injury: A crossover study

Objectives: To compare the efficacy and side effects of gabapentin and pregabalin for the treatment of neuropathic pain(NP) in spinal cord injury (SCI). Methods: Twenty eight patients were included in the study. The patients were randomized to receive pregabalin or gabapentin. VAS(Visual analog scale) pain score, neuropathic pain scale(NPS), Lattinen test(LT), Beck Depression Inventory(BDI) pain diary measures were used for the patient evaluation. We assessed patients at 4th and 8th weeks. Treatment groups were crossed over after 2 weeks of wash-out period to receive the other treatment. Results: At the end of the study there was significant improvement in VAS both with gabapentin and pregabalin (p0.05). In NPS, and LT parameters, no difference was present between the two study groups before or after the treatment (p>0.05). In both groups no significant improvement was seen in emotional status as assessed with BDI (p>0.05). Frequency of side effects and exclusion from the study due to side effects were higher for the pregabalin group but it was not significant between the groups (p>0.05). Conclusions: It is concluded that both drugs are effective and safe for the treatment of NP due to SCI but no difference exist between the two drugs. We are in the opinion that large studies that include more patients and placebo control should be carried out for more accurate data about this topic

Relapsed acute megakaryoblastic leukemia in Down syndrome (AMKL-DS) may be cured with chemotherapy alone, without stem cell transplantation (HSCT)

17543 Background: Children with recurrent AMKL -DS have an extremely poor prognosis without HSCT. Methods: We report a case of a relapsed AMKL-DS cured with intensive chemotherapy alone, without HSCT. Results: A 19 month old boy with Down syndrome, who had transient leukemia as a newborn, developed AMKL-DS (GATA1 positive) and was treated with four cycles of CI-TAD: continuous infusion of cytarabine and daunorubicin, and oral thioguanine for four days, and intrathecal cytarabine; followed by two cycles of high dose cytarabine plus L-Asparaginase; and three weekly doses of intrathecal cytarabine. Although he achieved remission at the completion of first cycle of the induction chemotherapy, he relapsed within 6 weeks after the completion of therapy. He then received the following chemotherapy over the next six months: Cycle 1 and 2. High dose Ara-C ( 33. 3 mg/kg q 12 hours x 8 doses) on days 0 to 3 plus mitoxantrone 0. 4 mg/kg/day x 4 on days 3 to 6 Cycle 3. High dose Ara-C 33. 3 mg/kg q 12 hours x 8 doses Cycle 4 and 5 (FLAG): Fludarabine 0. 8 mg/kg/day x 4 plus Ara-C 67 mg/kg/d x 4 and G-CSF 10 mcg/kg/day x 4 all on days 0 to 3. He achieved complete remission after the 1st cycle of chemotherapy, and underwent further cycles of chemotherapy while waiting for HSCT from an unrelated donor. But after the 5th cycle of chemotherapy, he developed a pulmonary lesion of fungal etiology for which he received three months of therapy with liposomal amphotericin. Because of a persistent lung lesion on imaging, he was considered ineligible for HSCT, and no further therapy was given. His bone marrow aspirate after the 3rd cycle of therapy was negative for GATA1. He has been disease-free for 59 months after the completion of his last cycle of chemotherapy, and he is currently in good health without any evidence of pulmonary or cardiac dysfunction. Conclusions: Intensive chemotherapy alone, without HSCT, may be curative for relapsed AMKL- DS. No significant financial relationships to disclose. </jats:p

Gabapentin is a first line drug for the treatment of neuropathic pain in spinal cord injury

Study Design. Prospective, randomized, double blind, placebo-controlled, crossover clinical trial. Objectives. To determine the efficacy of gabapentin in the treatment of neuropathic pain related to spinal cord injury. Summary of Background Data. Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system. Neuropathic pain associated with spinal cord injury is quite refractory, and current treatments are not effective. Gabapentin, an anticonvulsant, has become the first choice in the treatment of neuropathic pain. The place of gabapentin in the treatment of spinal cord injury-related neuropathic pain was questioned in only a few recent reports; however, they are retrospectively designed, nonstandardized, and uncontrolled studies, or involve a very small series of patients using less than optimum doses. Methods. A total of 18-week study period included a 4-week medication/ placebo titration period. This was followed by a 4-week stable dosing period when the patients continued to receive maximum tolerated doses, a 2-week washout period, then a crossover of 4 weeks of medication/ placebo titration, and another 4 weeks of stable dosing period. Twenty paraplegic patients (female/male: 7/13) with complete spinal cord injury at the thoracic and lumbar level, aged between 20 and 65 years, with neuropathic pain for more than 6 months were recruited for the study. Results. All patients completed the study. Gabapentin reduced the intensity as well as the frequency of pain, relieved all neuropathic pain descriptors except the itchy, sensitive, dull, and cold types, and improved the quality of life ( P < 0.05). Conclusions. Gabapentin can be added to the list of first-line medications for the treatment of chronic neuropathic pain in spinal cord injury patients. It is a promising new agent and offers advantages over currently available treatments

Identification of Campylobacter pylori by using the rapID NH system

Campylobacter pylori has been associated with chronic active antral gastritis. The organism was isolated from 19 of 45 gastric mucosal biopsies on blood agar plates with increased CO2 at 35 degrees C. The RapID NH system, a set of dehydrated substrates for preformed enzymes, was used to assist in the identification of C. pylori. All C. pylori gave the same biochemical profile, and it was different from those of all other organisms in the profile index of the manufacturer. The RapID NH system is useful in the identification of C. pylori.</jats:p

AB0572 CARPAL TUNNEL SYNDROME IN PATIENTS WITH PSORIATIC ARTHRITIS; ULTRASONOGRAPHY AND MAGNETIC RESONANCE IMAGING FINDINGS

Background:Carpal tunnel syndrome(CTS) is the most common form of entrapment neuropathies,caused by compression of the median nerve in the carpal tunnel at the wrist. But there is no gold standard technique for diagnosing CTS. Electrodiagnostic studies (EDS) are generally used but have some limitations. Recent years, magnetic resonance imaging(MRI) and ultrasonography(US) have facilitated the diagnosis of CTS. The median nerve cross section area(CSA) measured by US or MRI has been found to be associated with CTS[1]][2].CTS is usually idiopatic but it can be seen more in some disease. Psoriatic arthritis(PsA) occurs in up to 30% of people with psoriasis and can have serious debilitating effects on the peripheral joints, spine, tendon insertions, and fingers[3]. Because of arthritis, steroid use and flexor tenosynovitis play an important role in the pathogenesis of CTS, we think that CTS can be seen more in PsA patients.Objectives:We aimed to investigate the CTS in PsA patients with EDS, US and MRI than compare them with healthy controls.Methods:68 people, including 39 PsA (according to CASPAR criteria) and 28 healthy volunteers were included in study within 1 year. EDS, US and MRI were performed within maximum 2 weeks, and measurements were made by different doctors who were blind to other measurments. EDS was started with median and ulnar nerve motor conduction study than continued with sensory conduction studies. CTS diagnose was made according to the routine laboratory standards. The CSA measurement was made from the inner border of the hyperechoic ring around median nerve by using continuous tracing method at psiform bone level. US examinations were performed with a high frequency linear transducer (4-14 MHz), MRI examinations were performed on a 3-T imaging system. The statistical analyses were performed with Statistical Package for the Social Science Program Version 22. Descriptive statistics, T tests, chi-square test, Pearson correlation test were used.Results:No statifically significant difference was found between the groups for demographic characteristics. 12 (30.76%) of 39 PsA patients had CTS, whereas CTS was not detected in the control group(p= 0.001). US and MRI show larger CSA in PsA patients compared to the healthy control group(9,49 ± 3,00 mm2 vs 8,30 ±1,73mm2 p=0,005, 11,24 ± 3,41mm2 vs 9,35 ± 1,81mm2 p&lt;0,001); in patients with CTS compared to others(11,63 mm2 ± 3,25 vs 8,60 ± 2,26mm2 p=0,002, 13,37 ± 3,37 mm2 vs 9,90 ± 1,58mm2 p&lt;0,001) and in PsA patients which have CTS compared to PsA patients with normal EDS(11,63 ± 3,25 mm2 vs 8,87 ± 2,64 mm2 p=0,001, 13,37 ± 3,37 mm2 vs 10,52 ±3,15 mm2 p=0,003). When the CSA compared PsA patients which have normal EDS and healthy volunteers; US (8,87 ± 2,64 vs 8,30 ±1,73 p=0,180) and MRI (10,52 ±3,15 vs 9,35 ± 1,81 p=0,026) show larger CSA in PsA patients. But differance isn’t statistically significant for US measurments. The Pearson correlation coefficient between MRI and US measurements of the CSA was 0.85 (P&lt;0,001).Conclusion:CTS is more common in patients with PsA. The relationship between CTS diagnosed by EDS and CSA measured by US or MRI was observed in both PsA patients and all participants. Diagnosis can be supported by US or MRI in patients who can not undergo EDS or who do not accept EDS. For PsA patients, cut off values obtained from normal people should not be used. The limitations of our study were that our CTS population was small and most of them was mild. We think that this study will be the precursor of CTS studies in PsA patients.References:[1]M. S. Cartwright et al., “Evidence-based guideline: Neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome,” Muscle and Nerve, vol. 46, no. 2, pp. 287–293, Aug. 2012.[2]M. Ikeda, M. Okada, M. Toyama, T. Uemura, K. Takamatsu, and H. Nakamura, “Comparison of median nerve cross-sectional area on 3-T MRI in patients with carpal tunnel syndrome,” Orthopedics, vol. 40, no. 1, pp. e77–e81, Jan. 2017.[3]C. T. Ritchlin, R. A. Colbert, and D. D. Gladman, “Psoriatic Arthritis,” N. Engl. J. Med., vol. 376, no. 10, pp. 957–970, Mar. 2017.Disclosure of Interests:None declared.</jats:sec