2005, volume 21, issue 1
Adam Kobayashi, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii, 2005, 1, 5-18
Contemporary treatment of acute ischemic stroke focuses on drugs inducing early reperfusion of occluded arteries leading blood to the brain. Thrombolysis with recombinant tissue plasminogen activator (rt-PA, alteplase) is the only agent proved to be effective in clinical trials and having a considerably low rate of adverse effects if introduced within 3 hours of stroke symptom onset. Recently studies on expanding the therapeutic window, what could result in increasing the number of treated patients and inducing rt-PA efficacy are being performed. Clinical trials and our experience confirm it's higher efficacy compared to other known stroke treatments.
Farmakoterapia w Psychiatrii i Neurologii, 2005, 1, 19-24
Epidemiological and observational studies have not shown clear association between cholesterol concentration and risk of stroke. However many clinical studies with long use of statins (HMG-CoA reductase inhibitors) in patients with coronary heart disease have shown that statins decrease also stroke incidence. Recent clinical trial with use of simvastatin in elderly persons with a high risk of vascular events (myocardial infarction, stroke, vascular death) confirmed that statins decrease the risk of stroke by 20%. Till now there are no prospective studies showing beneficial role od statins in prevention of stroke recurrence. Hovever it seems rational to use statins for secondary stroke prevention in cases of stroke patients who have high concentration of cholesterol, history of coronoary disease, atherosclerosois of carotid or peripheral arteries or diabetes. Statins have not only antiatherosclerotic properties but also seems to have neuroprotective effect.
Iwona Kurkowska-Jastrzębska, Sławomir Pilip, Krystyna Niedzielska, Maria Barańska-Gieruszczak
Farmakoterapia w Psychiatrii i Neurologii, 2005, 1, 25-31
Many studies indicate the role of genetic factors in the refractory epilepsy. The main directions of research enclose polymorphism of genes encoding enzymes that participate in drug metabolism, polymorphism or mutations of genes encoding multidrug-transporter proteins and drug receptors. The research of the mechanisms of refractory epilepsy development provide to better understanding and eventually to successful treatment of the disease.
Wojciech Wicha, Jacek Zaborski
Farmakoterapia w Psychiatrii i Neurologii, 2005, 1, 33-41
Due to high prevalence multiple sclerosis is a common neurological disorder and major young adults disability cause. Despite great expectations following interferon beta and glatiramer acetate development, there is no evidence for a significant break-up in MS treatment. Furthermore, some clinical trials results seem to be dubious. For these reasons chemotherapeutic agents such as azathioprine, cyclophosphamide, cladribine, methotrexate and mitoxantrone are currently reviewed as disease modifying drugs.
Dagmara Mirowska-Guzel, Marcin Głuszkiewicz, Andrzej Członkowski, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii, 2005, 1, 43-50
Lack of the efficient treatment of multiple sclerosis (MS) and large diversity of disease symptoms is the main cause of using alternative treatment by patients with MS. Our studies revealed that about 70% of patients actually use or have ever used any alternative methods. In the article the main aspects of alternative therapy in multiple sclerosis (MS) and the most popular methods of alternative therapy used by MS patients were presented.
Ewa Z. Bałkowiec-Iskra, Iwona Kurkowska-Jastrzębska
Farmakoterapia w Psychiatrii i Neurologii, 2005, 1, 51-59
Studies describing immune system dysfunctions, observed during neurological diseases, let a new branch of science, the neuroimmunology, to be born. In the study, data showing immune system abnormalities accompanied to dopaminergic system changes have been revealed. Influence of dopamine on immune cell functioning as well as decreased concentration of central dopamine on immune system have been described.
Ewa Bałkowiec-Iskra, Iwona Kurkowska-Jastrzębska, Anna Członkowska, Andrzej Członkowski
Farmakoterapia w Psychiatrii i Neurologii, 2005, 1, 61-70
Inflammation has recently been shown to pay an essential role in pathogenesis of neurodegenerative diseases. A typical reaction observed during neurodegenerative processes in the central nervous system is microglial activation, astroglkosis and increased expression of various inflammatory molecules. Presence of activated microglia and activated T lymphocytes as well as elevated expression of complement proteins and variety of cytokines have been reported in Alzheimer's disease. Parkinson's disease appears to be characterised by peripheral immunological system disturbances and presence of inflammatory cells in the substantia nigra and striatum. However, it has not been explained so far, what role exactly inflammatory reaction plays in the pathogenesis of neurodegenerative diseases.
In recent years a protective role of inflammation that accompany neurodegeneration had been studied. It has been suggested, that a clue role in these processes play myelin-specific autoreactive T lymphocytes and macrophages, gathering in area of injury. Due to its functions and properties (cytokines and trophic factors secretion, ability to necrotic tissue removal) these cells can limit degenerative processes and stimulate regeneration.
Precise evaluation of inflammation processes during neurodegeneration might help in future improving therapeutic strategies, used in prophylaxis and CNS degenerative diseases treatment.
Jacek Zaborski, Wojciech Wicha
Farmakoterapia w Psychiatrii i Neurologii, 2005, 1, 71-80
After stroke and brain trauma approximately 90% of patients experience some persistent neurological disability. A main role in rehabilitation play physiotherapy and neuropsychological therapy. For many years due to limited effectiveness of rehabilitation, pharmacological methods to enhance results are researched. Now days is supposed that main role in enhance of brain plasticity plays activation of alfaadrenergic system as results of increased level of norepinephirne, dopamine and serotonin. On the theoretical backgrounds the possibility of use selected drugs in clinical practice to enhance effectiveness of neurorehablitation could be possible. Those drugs may potentially promote recovery when added to a regimen of physiotherapy. The results of animal experiments and clinical trials remain unclear and now are not possible to recommended one drug to enhance neurological rehabilitation. There are: stimulants as amphetamine and methylphenidate, as well as, levodopa, fluoxetine. Other drugs, such benzodiazepines, antiepileptic drugs, neuropleptics and alfa agonists such doxazosine and prasosine may have determined effect on neurological improvement. Therefore clinicians should avoid prescribing these drugs in patients undergoing neurological rehabilitation.