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9 results

  • 8 - Lost in the Fog of Alzheimer’s

  • Daniel Gibbs, Emeritus of Oregon Health and Science University
  • Book:
    Dispatches from the Land of Alzheimer's
    Published online:
    19 January 2024
    Print publication:
    22 February 2024, pp 34-37

  • Summary

    The fog of Alzheimer’s is a commonly used metaphor, and I think it’s a pretty good one. It refers to the loss of mental acuity, disorientation, and forgetfulness that are common in Alzheimer’s. But one aspect of the metaphor that is not emphasized is that like the fog bank on the ocean, the fog of Alzheimer’s can come and go. It does for me. Sometimes there is an obvious cause such as running a fever, getting too tired, or having a second glass of wine. On the day after I got my second Covid-19 vaccination I was not mentally sharp and had trouble concentrating despite not having any other side effects. Once or twice a week on first awakening in the morning, I think I am in my childhood bedroom. It only takes a few seconds to get reoriented, and it actually is a pleasant rather than scary experience. Sometimes the fog comes in for no apparent reason, lasts a few minutes or a few hours, and then goes away. I wonder what is behind these mysterious, seemingly unprovoked but temporary episodes of cognitive impairment.

  • 33 - Repurposing Old Drugs for Alzheimer’s Treatment

  • Daniel Gibbs, Emeritus of Oregon Health and Science University
  • Book:
    Dispatches from the Land of Alzheimer's
    Published online:
    19 January 2024
    Print publication:
    22 February 2024, pp 134-137

  • Summary

    We’ve talked a lot about clinical trials of several so-called disease modifying drugs for Alzheimer’s disease. These are medications designed to slow and perhaps even stop the progression of Alzheimer’s. Most of them so far have been drugs that remove beta-amyloid from the brain or block its production. Almost all of the clinical trials of these anti-amyloid drugs have been disappointing, although recently lecanemab received accelerated approval by the FDA based on effectiveness of removing amyloid plaques from the brain and a 27% slowing of cognitive decline, breathing a bit of new life into the amyloid hypothesis. Trials of drugs designed to remove tau, the abnormal protein in neurofibrillary tangles, have all failed so far. The development costs to design, test, produce, and conduct clinical trials on new drug candidates are enormous, costing hundreds of millions if not billions of dollars. A parallel effort is under way to find out if some drugs already in use for other disorders might have a benefit in Alzheimer’s disease.

  • Synthesis, powder diffraction pattern, crystal structure determination of the pharmaceutical co-crystal of levetiracetam and 3,5-dinitrosalicylic acid

  • Lingling Shi, Zhengguo Chen, Hany Kafafy, Zhaoxia Zhang, Guocheng Zhu, Juming Yao, Guoqing Zhang
  • Journal:
    Powder Diffraction / Volume 38 / Issue 4 / December 2023
    Published online by Cambridge University Press:
    16 October 2023, pp. 244-252
    • Article
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  • (S)-α-Ethyl-2-oxo-1-pyrrolidineacetamide (trade name levetiracetam), a derivative of piracetam, is used clinically as an add-on treatment for partial-onset seizures. In this study, we report the solid-state structure of a new drug co-crystal produced from levetiracetam and 3,5-dinitrosalicylic acid through cooling crystallization. This compound was further characterized by infrared spectroscopy, powder X-ray diffraction, and single-crystal X-ray diffraction. The new co-crystals show a 1:1 stoichiometry and crystallize in the monoclinic system, space group P21, with cell parameters: a = 9.7709(3) Å, b = 6.2202(2) Å, c = 14.7280(4) Å, α = 90°, β = 96.0340(10)°, γ = 90°, V = 890.16(5) Å3, and Z = 2. It is identified that hydrogen bonds are the main interactions between levetiracetam and 3,5-dinitrosalicylic acid, and the contribution of each hydrogen bond in maintaining the stability of the crystal structure was also quantified using Hirshfeld surface analysis.

  • Cortical Spreading Depolarization in Chronic Subdural Hematoma: Bridging the Gap

  • Mathieu Levesque, Charles Deacon, Suzie Adam, Christian Iorio-Morin
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 48 / Issue 1 / January 2021
    Published online by Cambridge University Press:
    23 June 2020, pp. 31-37
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  • Cortical spreading depolarization (CSD) is recognized as a cause of transient neurological symptoms (TNS) in various clinical entities. Although scientific literature has been flourishing in the field of CSD, it remains an underrecognized pathophysiology in clinical practice. The literature evoking CSD in relation to subdural hematoma (SDH) is particularly scarce. Patients with SDH frequently suffer from TNS, most being attributed to seizures despite an atypical semiology, evolution, and therapeutic response. Recent literature has suggested that a significant proportion of those patients’ TNS represent the clinical manifestations of underlying CSD. Recently, the term Non-Epileptical Stereoytpical Intermittent Symptoms (NESIS) has been proposed to describe a subgroup of patients presenting with TNS in the context of SDH. Indirect evidence and recent research suggest that the pathophysiology of NESIS could represent the clinical manifestation of CSD. This review should provide a concise yet thorough review of the current state of literature behind the pathophysiology of CSD with a particular focus on recent research and knowledge regarding the presence of CSD in the context of subdural hematoma. Although many questions remain in the evolution of knowledge in this field would likely have significant diagnostic, therapeutic, and prognostic implications.

  • Critical Care Management of Status Epilepticus at a Tertiary Care University Hospital

  • Sherif Hanafy Mahmoud, Vanessa Marette, Therecia Lindqvist, S. Nizam Ahmed
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 46 / Issue 6 / November 2019
    Published online by Cambridge University Press:
    15 August 2019, pp. 702-710
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  • Background:

    Status epilepticus (SE) is a neurological emergency associated with significant morbidity and mortality. The objective of this study was to review the critical care management of patients with SE focusing on antiepileptic drugs (AEDs) as well as to determine the optimal dosing strategies of phenytoin (PHT) and predictors of its effectiveness.

    Methods:

    A retrospective chart review of adult patients with SE admitted to the University of Alberta Hospital, Canada, was conducted.

    Results:

    Fifty-six admissions were included. Benzodiazepines (BDZs) were initially given in 89% of our patients. Following BDZs, PHT and levetiracetam were the most commonly initiated AEDs as first- and second-line agents and were deemed effective in 30/44 and 5/11 patients, respectively. Patients who received a PHT loading dose (LD) of 1000 mg were less likely to reach target levels compared with a weight-based LD ≥15 mg/kg (29% vs. 60%). Likewise, patients who received a maintenance dose (MD) of 300 mg/day were less likely to reach target compared with 400 mg/day or >5 mg/kg per day; however, this did not reach statistical significance. Three variables were found to be associated with PHT effectiveness: tonic-clonic SE (OR 5.01, 95% CI 1.02–24.7, p = 0.048), history of seizures and BMI <30 kg/m2 (OR 0.16, 95% CI 0.03–1.07, p = 0.059).

    Conclusions:

    Further studies of the predictors of PHT effectiveness, specifically obesity, are necessary to help individualize care. Finally, we suggest that PHT should be loaded according to the guidelines as 20 mg/kg followed by an MD of at least 400 mg/day or >5 mg/kg per day.

  • Chapter 36 - Wilson disease

  • from Section 3 - Symptomatic epilepsy
  • Edited by Simon D. Shorvon, Frederick Andermann, Renzo Guerrini
  • Book:
    The Causes of Epilepsy
    Published online:
    05 March 2012
    Print publication:
    14 April 2011, pp 249-251

  • Summary

    This chapter presents the neurophysiology, pathophysiology, diagnostic testing for action myoclonus-renal failure syndrome (AMRF). AMRF is a form of progressive myoclonus epilepsy first described in four French-Canadian patients belonging to three apparently unrelated sibships living in different regions of Quebec. All patients with AMRF develop action myoclonus and seizures. Most of the patients showed diffuse cerebral and cerebellar atrophy, although some patients had normal computed tomography (CT) and magnetic resonance imaging (MRI) findings. The renal pathology based on renal biopsy specimens showed focal glomerulosclerosis in all patients examined, with features of collapsing glomerulopathy in some. Patients with AMRF have been reported to have normal or low normal β-GC in leukocytes, but very low levels in cultured fibroblasts, and elevated levels in serum. More recently, levetiracetam has been utilized for these patients, and other derivatives are now in clinical trials.

  • 15 - Antiepileptic drug interactions in the elderly

  • from Part IV - Drug interactions in specific patient populations and special conditions
    • By Jeannine M. Conway, James C. Cloyd, Epilepsy Research and Education Program, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA; Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA
  • Edited by Jerzy Majkowski, Blaise F. D. Bourgeois, Harvard University, Massachusetts, Philip N. Patsalos, Institute of Neurology, London, Richard H. Mattson, Yale University, Connecticut
  • Book:
    Antiepileptic Drugs
    Published online:
    07 September 2009
    Print publication:
    26 May 2005, pp 273-293

  • Summary

    Antiepileptic drugs (AEDs) are frequently prescribed in the elderly due to the high prevalence of AED-treatable neuropsychiatric disorders in this age group. There are several factors associated with AED therapy in the elderly that substantially increase the risk of clinically significant drug interactions. The elderly exhibit altered pharmacodynamics resulting in greater sensitivity to both pharmacological and toxicological drug effects. The use of polypharmacotherapy leaves the elderly patient at an increased risk for adverse events. There are no known drug interactions between anticoagulants/antiplatelets and the following AEDs: gabapentin (GBP), lamotrigine (LTG), levetiracetam (LEV), tiagabine (TGB), or zonisamide (ZNS). A number of AEDs either induce or inhibit drug metabolizing enzymes and, in turn, their metabolism is affected by many co-medications. Several of the newer AEDs do not appear to interact with other medications, while others are affected by enzyme induction of inhibition but do not appear to alter the disposition of co-medications.