2000, volume 16, issue 3


Statyny a ryzyko udaru mózgu

Beata Błażejewska-Hyżorek, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii, 2000, 3, 223-239

Atherosclerosis plays the crucial role in pathogenesis of stroke, both ischemic and haemorrhagic. The majority of risk factors of coronary artery disease (hypertension, smoking, diabetes, obesity, age) are also the risk factors of stroke. Hypecholesterolaemia is a specific risk factor of atherosclerosis; however, the role of lipid disorders in the pathogenesis of stroke is still unclear. A positive correlation between level of cholesterol and stroke has been proved many times, but in some studies it has not been confirmed. Neither drugs decreasing cholesterol level such as cholestyramine, niacin, gemfibrosil, clofibrate nor low-cholesterol diet significantly influence stroke incidence.
Some studies with statins that have been conducted recently (4S, LIPID and CARE) in patients with coronary artery disease have revealed, that these drugs decrease the risk of stroke by 30%. There are many suggested mechanisms of this influence: slowing the progress of atherosc1erotic pathology in coronary arteries (coronary artery disease is the risk factor of stroke), influence on the cerebral arteries in a different mechanism than inhibition of cholesterol deposition (e.g. endothelial stabilisation, anti-inflammatory action). Studies with the use of statins were carried out in patients with coronary artery disease, who were younger than average stroke patient; therefore statins cannot be regarded as drugs with documented efficacy in stroke prevention. Statins should be prescribed in patients who have had a stroke episode only in cases of co-existing coronary artery disease.
There is a prospective study with the use of atorvastatin in secondary stroke prevention being carried out now.


Tryptany w migrenie

Tadeusz Mendel
Farmakoterapia w Psychiatrii i Neurologii, 2000, 3, 240-245

The introductions of triptans for the treatment of migraine within last ten years started a new era in the management of this disease. Author presented informations about triptans. How are they divided, mechanism of action, indications and contraindications, the clinical efficacy and adverse events.


Farmakoterapia zawrotów głowy – ocena tolerancji i skuteczności betahistyny

Tomasz Litwin, Maria Barańska-Gieruszczak
Farmakoterapia w Psychiatrii i Neurologii, 2000, 3, 246-251

The article reviews published research on the diagnostic and treatment of vertigo especially with using betahistine. Authors also made open study to assess the effect of oral betahistine in 40 patients who had acute vertigo. All these patient were treated for eight weeks by oral administration of betahistine (48 mg daily in three doses). These study confirmed that treatment with betahistine is very effective – after eight weeks of treatment regression of vertigo was achieved in 92.5% patients. The drug was also well tolerated: only 7.5% of patients reported adverse events which were gastric, minor and completely retreat after leave of Betaserc.


Analiza zależności między odchyleniami w zakresie profilu cząsteczek adhezyjnych leukocytów krwi obwodowej a innymi parametrami stanu klinicznego u chorych na stwardnienie rozsiane

Aleksandra Paź, Urszula Fiszer, Jacek Zaborski, Andrzej Członkowski, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii, 2000, 3, 267-274

The aim of the present study was to determine the relationships between profile or adhesion molecules of peripheral blood leukocytes, and MRI, the physical disability, or the progression rate in patients with relapsing-remitting or secondary progressive form of MS. In patients with new lesions detected by brain MRI, we have observed a positive correlation between the number of Tl Gd-enhancing lesions and percentage CD11b+CD18+ granulocytes in peripheral blood. In our analysis the progression rate was also positively correlated with the expression of CD44 antigen on lymphocytes in patients with relapsing-remitting form of MS. Our findings suggest the relation between expression of adhesion molecules on leukocytes and the c1inical status of MS patients.


Farmakologiczne leczenie spastyczności w przebiegu stwardnienia rozsianego

Wojciech Wicha
Farmakoterapia w Psychiatrii i Neurologii, 2000, 3, 275-283

Multiple sclerosis is common neurological entity and spasticity is widespread and debilitating condition affecting quality of life of MS patients. While not all cases of spasticity need to be, or even should be, treated, the physician now has available a wide range of potentially effective treatments. Strengths and weaknesses of each option play an important role in treatment decision-making.


Phenotyping of drug metabolism

Urszula Pych, Jowita Moroz-Kalata, Andrzej Bidziński, Adam Płaźnik
Farmakoterapia w Psychiatrii i Neurologii, 2000, 3, 284-301

Current information about action, function and polymorphism of Cytochrome P450 enzymes is presented in the paper. The different phenotypes (EM, UM, PM), and the meaning of phenotypes for evaluation of genetically determinated reactions to administrated drugs are characterized. The kind of phenotype can be a genetic marker of many diseases. Phenotyping methods are described (Sparteine Test, Debrisoquine Test). The latest information on molecular biology achievements related to the problem of genotyping is also given.


Perspektywy farmakoterapii otyłości – nowe kierunki badań nad ośrodkową regulacją masy ciała i jej podłożem genetycznym

Marzena Łabarzewska, Agnieszka Falińska, Adam Płaźnik
Farmakoterapia w Psychiatrii i Neurologii, 2000, 3, 302-316

Obesity is a chronic disease associated with serious health hazards. A review of evidence indicates that it is neither a simple failure nor the question of willpower. Traditional weight reducing methods including diet, exercise or behavioural modification are rarely effective over the long term. Thus there is a continued need for safe and effective treatment of obesity which tends to be quite possible in the near future provided that our management should be targeted on primary cause of the disturbances of food intake and energy balance. The recent studies on pathophysiology of appetite and energy balance regulation, in particular the discovery of leptin and studies on genetic background of obesity have led to major developments in our understanding of obesity pathogenesis. It is now recognised that CNS and hypothalamus are key structures involved in the control of body weight regulation. A variety of neuromodulators stimulate food intake like NPY, orexins, MCH (Melarun-Concentrating-Hormone). In contrast a large number of peptides and neurotransmitters including leptin, biogenic amines or α-MSH exert the opposite effect. The role of uncoupling proteins has recently been understood. They are believed to increase energy expenditure by disturbing the process of ATP synthesis. The great progress in studies on obesity resulted in new molecular targets for antiobesity agents. They include marketed recently in our country sibutramine, and other promising compounds being currently under clinical investigation such as β3 agonists and 5HT2C agonists. Data from animal studies suggest that other agents including antagonists of neuropeptide Y Y5 receptors or melanocortin MC4-R receptors agonists may turn out to be effective as well. However further research is needed to understand the individually different genetic and pathophysiological basis of obesity.