ABSTRACT
BACKGROUND: Memantine, an NMDA antagonist, is effective for moderate to severe Alzheimer's disease. OBJECTIVE: Determine whether memantine improves cognitive performance (CP) among subjects with multiple sclerosis (MS) and cognitive impairment (CI). METHODS: This double-blind, randomized, placebo-controlled trial (Clinicaltrials.gov NCT00300716) compared memantine 10 mg twice a day (4 week titration followed by 12 weeks on the highest tolerated dose) with placebo. The primary outcome was the change from baseline to exit on the Paced Auditory Serial Addition Test (PASAT) and the California Verbal Learning Test-II (CVLT-II) Long Delay Free Recall (LDFR). Secondary outcomes included additional neuropsychological tests; self-report measures of quality of life, fatigue, and depression; and family/caregiver reports of subjects' CI and neuropsychiatric symptoms. RESULTS: The differences between the groups on the change on the PASAT (placebo-memantine = 0.0 correct responses, 95% CI 3.4, 3.4; p = 0.9) and on CVLT-II LDFR (placebo-memantine =-0.6 words, 95% CI -2.1, 0.8; p = 0.4) as well as on the other cognitive tests were not significant. Subjects on memantine had no serious adverse events (AEs) but had more fatigue and neurological AEs as well as, per family members' reports, less cognitive improvement and greater neuropsychiatric symptoms than subjects on placebo. CONCLUSION: Memantine 10 mg twice a day does not improve CP in subjects with MS, ages 18-65, without major depression, who have subjective cognitive complaints and perform worse than one SD below the mean on the PASAT or on the California Verbal Learning Test-II (total recall or delayed free recall).
Subject(s)
Cognition Disorders/drug therapy , Memantine/therapeutic use , Multiple Sclerosis/complications , Adolescent , Adult , Aged , Cognition Disorders/complications , Cognition Disorders/psychology , Depression/psychology , Double-Blind Method , Fatigue/psychology , Female , Humans , Male , Middle Aged , Multiple Sclerosis/psychology , Neuropsychological Tests , Patient Selection , Quality of Life/psychology , Surveys and Questionnaires , Treatment OutcomeABSTRACT
Atresia of the biliary tree has always baffled the brightest of minds. Nothing about its etiology and pathogenesis up to the present, more so on its definitive management where success has always been elusivePresented is a case of a 2 month-old baby boy with congenital biliary atresia diagnosed within the golden period and subsequently managed with definitive surgeryThis paper was prepared to show that early recognition, diagnosis, proper timing and the appropriate surgical intervention are of utmost importance to assure patient survival. (Author)