Approved Medication:
Below is a list of medication used to treat neurological disorders. To read more information on a medication please click on the name.
- DHE-45
- Fosphenytoin
- Copolymer 1
- Estrogen Replacement Therapy
- Gabapentin
- Sumatriptan
- High dose Gabapenti
- Selegiline
- Lidocaine
- DHE-45
Nasal Spray studied again for migraine.
This drug has been around since 1945 and is very helpful for migraine given intravenously. It has long been rumored to be coming out in a nasal spray. - Fosphenytoin
Dilantin to be withdrawn when Parke-Davis releases Cerebyx (Fosphenytoin). The new medication metabolizes quickly to phenytoin but has a lower side effect profile. It also can be given in IM loading doses unlike phenytoin. Administration guidelines will be similar to Dilantin. (AAN Meeting, SF 1996) It is highly water soluble and, therefore, will be an excellent parenteral medication. It is near physiologic pH and easier on veins. This makes extravasation of little consequence. It is rapidly converted to phenytoin in organs and blood. It binds to phenytoin albumin binding sites leaving more phenytoin free in serum. Dosing and infusion rates will be expressed as amount of phenytoin delivered and will be easy to learn. IM administration will be safe, even with loading doses of 20mg/kg. Little muscle pain is reported. Peak plasma levels are reached within 2 hours of IM loading. Paramedics can start loading of patients enroute to the emergency room with little risk to the patient. - Copolymer 1
Copolymer 1 shows significant beneficial effect on multiple sclerosis relapse rate and disability in a phase 3 trial for relapsing and remitting multiple sclerosis. A 20mg daily subcutaneous dose was well tolerated. (AAN Meeting ,SF 1996) - Estrogen Replacement Therapy
Women using estrogen replacement therapy in menopause had a 56% reduction in risk of developing Alzheimer's disease. The dementia was 2.3x more frequent in women who never used estrogen replacement. (AAN Meeting, SF 1996) - Gabapentin
Neurontin (gabapentin) was noted to be effective in migraine prophylaxis at doses of 900-1,800mg/d. The treatment was well tolerated. (AAN Meeting, SF 1996) - Sumatriptan
Imitrex (sumatriptan) is expensive but a recent study of migraine patients found it to be cost effective as it reduced outpatient office and emergency room visits over a 12 month period. Patients also noted improved quality of life. (AAN Meeting, SF 1996) A 2 year review of 453 migraine patients was published by Visser, et al. (Ny July 96). In 2/3 of their attacks 85% of patients had relief in 2 hours. However, 75% of patients had recurrent headache in 8-12 hours. Waning efficacy over 2 years was noted in 18% of patients. Improved response to the drug was found in 12% of patients. Chest symptoms affected 58% of patients at least once and 10% of patients discontinued the drug due to them. A total of 25% stopped Sumatriptan due to headache recurrence, side effects, or cost. - High dose Gabapentin
High dose Gabapentin was well tolerated and effective as monotherapy in partial epilepsy. Doses were 3,000-4,800mg per day. Parke-Davis has a program to limit daily cost to the patient of < $5 per day. (Beydoun et al., AAN Meeting, SF 96) - Avonex
On May 17, 1996 Avonex (interferon beta 1a) was approved for relapsing remitting progressive multiple sclerosis. A study of 300 patients showed some slowing of disability over two years although it was not dramatic. Dosing is IM once per week. There is a flu like side effect in <24% of patients which lessens after 4 months. No site reaction or depression was reported. Cost is about the same as Betaseron ($9,230/yr). For further information contact Avonex Customer Service at 1-800-456-2255. - Selegiline
Selegiline (Eldepryl) is used in late Parkinsonism to enhance the action of L-dopa and to reduce motor fluctuations. It is also used in early disease due to a reported neuroprotective effect with long term use. However, the Parkinson's Research Group-UK recently noted a 10% higher mortality in patients on Selegiline and L-dopa compared to L-dopa patients without Selegiline. C. Warren Olanow, MD notes problems with this study as the overall mortality is excessive and he points out other potential study flaws in Neurology Forum, June 1996. More research is needed to clarify this matter. - Lidocaine
As reported in JAMA (July 24/31 1996) Maizels reported nasal drops containing Lidocaine gave prompt relief in 55% of 53 patients with migraine. Significant relief was noted within 5 minutes. Unfortunately, relapse was at least 42%. Lidocaine solution (4%) was compared to placebo. Complete relief was obtained by 11 (21%) of the Lidocaine group and 2 (7%) of the placebo group. Side effects include local burning, numbness, unpleasant taste, and gagging. A commercial nasal preparation is not available and more study of long term side effects and efficacy is warranted.