RESUMEN
INTRODUCTION: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a disorder in which early effective treatment is important to minimize disability from axonal degeneration. It has been suggested that some patients with CIDP may benefit from rituximab therapy, but there is no definitive evidence for this. METHODS: Baseline and post-rituximab-therapy neuromuscular Medical Research Council (MRC) sum scores, Inflammatory Neuropathy Cause and Treatment (INCAT) disability score, and functional status were assessed in 11 patients with refactory CIDP. RESULTS: The MRC sum score, INCAT disability score, and functional status improved in all patients after rituximab therapy. DISCUSSION: Our study provides evidence of the efficacy of rituximab therapy in at least some patients with CIDP. A placebo-controlled study to assess the effectiveness of rituximab therapy in CIDP with and without nodal antibodies is required to identify disease markers that predict responsiveness.
Asunto(s)
Factores Inmunológicos/uso terapéutico , Limitación de la Movilidad , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/tratamiento farmacológico , Cuadriplejía/tratamiento farmacológico , Rituximab/uso terapéutico , Adulto , Anciano , Azatioprina/uso terapéutico , Bastones , Ciclofosfamida/uso terapéutico , Femenino , Ortesis del Pié , Glucocorticoides/uso terapéutico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Persona de Mediana Edad , Ácido Micofenólico/uso terapéutico , Intercambio Plasmático , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/etiología , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/fisiopatología , Cuadriplejía/etiología , Cuadriplejía/fisiopatología , Insuficiencia del Tratamiento , Resultado del Tratamiento , AndadoresRESUMEN
Prophylactic drug injection directly onto a seizure focus has the potential to improve seizure control with fewer side effects than is produced by systemic therapy. Using a dose-response model, we evaluated the effectiveness of adenosine application for focal seizure prophylaxis in 12 rats. Total spikes and electroencephalographic ictal events were reduced significantly by treatment with adenosine compared to control (P < 0.0001). This study demonstrates effectiveness and feasibility in a model system using intracranial injection of adenosine to prevent epileptiform events.
Asunto(s)
Adenosina/administración & dosificación , Anticonvulsivantes/administración & dosificación , Hipocampo/efectos de los fármacos , Convulsiones/prevención & control , Animales , Bicuculina/farmacología , Convulsivantes/farmacología , Relación Dosis-Respuesta a Droga , Electroencefalografía/efectos de los fármacos , Hipocampo/fisiología , Inyecciones Intraventriculares , Masculino , Ratas , Ratas Sprague-Dawley , Convulsiones/inducido químicamenteRESUMEN
We developed a screening methodology to test the ability of putative antiepileptic drugs delivered directly to a seizure focus to prevent epileptiform activity. The left hippocampi of 15 rats were implanted with an injection cannula and bipolar recording electrodes. Bone screws were used to record neocortical EEG activity. Diazepam (DZP) at one of four possible concentrations or control solution was injected into the hippocampus, followed 5 min later by bicuculline methiodide. DZP suppressed spikes and ictal events in a dose-dependent manner (P<0.0001). At 100 mM, DZP reduced spikes from 678+/-128 to 87+/-35 for a 15 min segment. Numbers of ictal events (seizure) and latency to the first event were reduced by prophylactic DZP. The study establishes a protocol for testing of intracranially-injected drugs to prevent focal seizures.
