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Below
is a list of Medication and Diagnostic tests used to diagnose
and treat neurological disorders. To read more information on
a medication or a diagnostic please test click on the name. |
- 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.
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- 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Dilantin to be withdrawn when Parke-Davis releases Cerebyx (Fosphenytoin).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.
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- 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)
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- 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)
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- 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)
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- 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.
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- 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)
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- 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.
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- 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.
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- 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.
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- CBC
(Complete Blood Count)
Hemoglobin/Hematocrit-used to measure the oxygen carrying
capacity of the blood and its thickness. Important in many conditions,
especially those that impact cerebral circulation.
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- WBC
(White Blood Cell count)
Especially important in infections, leukemia, and AIDS.
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- Electrolytes
Sodium and Potassium levels are critical for nervous system function.
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- BUN/Creatinine
Measure of kidney function. Kidney failure leads to confusion,
seizures, coma, tremor and other problems.
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- Glucose
Too much or too little can cause confusion, seizures, coma. Diabetes
is the most common cause of peripheral neuropathy.
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- Magnesium,
Calcium
Important in seizures and muscle problems. Protime/PTT- Measures
of blood clotting, especially important in stroke management.
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- ESR
(sed rate)
General measure of inflammation in the body. Especially important
in headaches in elderly patients and collagen vascular diseases.
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- VDRL/FTA
Diagnoses syphilis and false positives help diagnose collagen
vascular disease. Syphilis can cause dementia, nerve and blood
vessel damage.
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- ANA/RF
Helps to diagnose lupus and rheumatoid arthritis which can affect
the peripheral nerves and central nervous system.
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- SPEP/IPEP
Protein and Immune globulin measurements used to rule disorders
of white blood cells that lead to nerve damage.
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- Skull
X-Ray
Useful
to check for intracranial calcification, midline brain shift,
pituitary gland enlargement, and fractures. Largely replaced by
CT imaging where available.
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- Cranial
Ultrasound
Used in infants with openings between skull bones to diagnose
brain hemorrhage.
- CT
(computerized axial tomography or cat scan)
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A computer generated image from x-rays that is excellent for harder
tissues, good for most soft tissues, excellent for fresh blood.
Newer techniques available for vessels. Fast but uses ionizing
radiation. Best for trauma and subarachnoid hemorrhage.
- MRI
(magnetic resonance imaging)
Computer generated image based on alignment of molecules in a
magnetic field. Excellent for brain and spinal cord. Excellent
for soft tissues and white matter diseases. Best for cervical
disks and multiple sclerosis. Gives more detail than CT. Takes
longer and claustrophobia a problem with closed units. Pacemakers
and some metal in the body, especially in the eye, restrict its
use. New techniques can image vessels (MRA) and replace invasive
angiography.
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- Cerebral
Angiography
Injection of contrast dye directly into arteries after insertion
of a catheter followed by x-ray picture. Best for aneurysm and
carotid artery blockage. There is a small risk of stroke. MRA
and CT may replace this soon.
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- EEG
(Electroencephalogram)
Measures brain waves with safe scalp surface electrodes. Mainly
used for analysis of seizure disorders but also useful with dementia
and confused, encephalopathic or comatose patients. Main test
for brain death.
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- Lumbar
Puncture (LP or spinal tap)
Insertion of a long thin needle into the spinal canal and sample
fluid and measure opening pressure. A must if infection is suspected.
Also needed if ruptured aneurysm is suspected and CT is normal.
Helps diagnose multiple sclerosis and other inflammatory diseases
of the central nervous system. CT needed first to rule out a brain
mass if suspected.
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- EMG/NCV
(Electromyography/Nerve Conduction Velocity)
Electrodes are placed over nerves and electrical shocks are used
to measure nerve conduction speed and delays. Acupuncture like
needles are inserted into certain muscles to measure electrical
activity and wave formation. Often painful but excellent for diagnosis
of muscle and nerve diseases. Risk of bleeding if on anticoagulants.
Very useful in localizing pinched cervical and lumbosacral nerve
roots.
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- Evoked
Potentials
A measure of nerve conduction time from peripheral to central
nervous system from eye, ear, or limbs. Information is gathered
about brain and nerve function. Formerly very useful as aid in
multiple sclerosis, largely replaced by MRI. Still useful for
8th cranial nerve problems by brain stem auditory evoked potential.
Sometimes used to monitor brain function under anesthesia.
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- Carotid
Duplex Ultrasound
Safe test using sonar to generate a picture of carotid arteries
in the neck and to estimate blood velocity. Greater than 70% blockage
carries a risk of stroke that surgery and/or medicine can reduce.
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- Transcranial
Doppler Ultrasound
Safe test that uses sonar to measure intracranial artery blood
velocity. Mainly used to check for spasm after subarachnoid hemorrhage.
May be useful for spotting clots to brain and measuring adequacy
of collateral cerebral blood flow.
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- Brain
mapping
A computer generated picture of the brain based on EEG activity.
Not of proven use clinically at this time.
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- Myelography/CT
A myelogram is a LP with contrast dye inserted into the spinal
canal followed by x-ray to check for blocks especially from disks
or tumors. MRI can do this without needles. Myelography followed
by CT is the most accurate test for imaging disk herniation.
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- SPECT
(Single Photon Emission Computed Tomography)
Computer generated image based on brain function at time of test.
Image produced based on distribution of radioactive tracers injected
into blood and pickup by active brain tissue. Reflects blood flow,
glucose uptake, receptor binding locally in brain. Mainly of academic
interest at this time.
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- PET
(Positron Emission Tomography)
Like SPECT but can check on more than glucose metabolism with
various other tracers. Technically more difficult, more expensive,
need a particle accelerator on site to make tracers. Promising
for certain seizure patients.
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- MRS
(Magnetic Resonance Spectroscopy)
A biochemical measurement of specific brain metabolites with MRI
technology that promises to help measure the neuronal number and
function. Used in seizure research.
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- Functional
MRI
A new rapid scanning MRI technique that demonstrates alteration
in blood oxygenation. Used in seizure research.
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