Fluoxetine for motor recovery after acute intracerebral hemorrhage (FMRICH): study protocol for a randomized, double-blind, placebo-controlled, multicenter trial.

BACKGROUND: Spontaneous, nontraumatic intracerebral hemorrhage (ICH) is a subtype of stroke that causes a great amount of disability and economic and social burden. This is particularly true in developing countries where it accounts for between 20% and 50% of all strokes. Pharmacological and surgical interventions have been attempted to reduce the mortality and disability caused by ICH, with unsuccessful results. Recently, the use of fluoxetine in addition to physical rehabilitation has been proven useful to improve motor recovery following cerebral infarct. The purpose of this study is to test whether a 3-month treatment with fluoxetine enhances motor recovery in nondepressed patients with acute intracerebral hemorrhage. METHODS/DESIGN: Our study is a randomized, double-blind, placebo-controlled, multicenter clinical trial. We will recruit 86 patients with intracerebral hemorrhage of both sexes, aged >18 years, from four Mexican hospitals. The patients will receive either 20 mg of fluoxetine or a placebo once daily for 90 days. The primary outcome is the mean change in the Fugl-Meyer Motor Scale score between inclusion (day 0) and day 90. The secondary outcomes will be changes in the Barthel Index, the Modified Rankin scale and the National Institutes of Health stroke scale. The outcomes will be measured at day 42 ± 7 days and at day 90, for a total of four visits with each subject (at screening and at 0, 42 and 90 days). DISCUSSION: Current guidelines recommend early supported hospital discharge and home-based rehabilitation programs as the only cost-effective intervention to aid the recovery of patients with intracerebral hemorrhage. Nevertheless, such interventions are dependent on available resources and funding, which make them very difficult to implement in developing countries. We believe that the identification of a helpful pharmacological intervention to aid the motor recovery of these patients will constitute a breakthrough that will have a major impact in reducing the burden of disease caused by this subtype of stroke worldwide, especially in the developing world. TRIAL REGISTRATION: Current Controlled Trials NCT01737541.

Meningitis criptocócica tras tratamiento con etanercept / Cerebral cryptococcosis associated with etanercept

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La aspirina, los antiinflamatorios no esteroides y el sistema nervioso central / Aspirin, ANSAIDs and central nervous system

La aspirina es un medicamento que desde 1980 ha sido aceptado formalmente (Food and Drug Administration) como antiagregante plaquetario para prevenir la recurrencia del ataque isquémico transitorio y el infarto cerebral, hecho demostrado en diversos estudios. La dosis ideal áun no se ha definido pero la mayoría de los investigadores sugieren individualizar cada caso y si es posible usar dosis medias (325-600 mg al día) o altas (1,000-1,200 mg al día). En la prevención primaria de la enfermedad vascular cerebral, todavía no ha sido probada la eficacia de este fármaco de manera absoluta. Estudios recientes han demostrado cierto beneficio a corto plazo con el uso de aspirina en la isquemia cerebral aguda, que habrá de confirmarse con futuras investigaciones. En los últimos diez años se han acumulado evidencias de la utilidad de algunos antiinflamatorios no esteroides para mejorar los aspectos cognocitivos de los pacientes con Enfermedad de Alzheimer, lo cual amplía las expectativas de mejorar la calidad de vida de estos enfermos