Utilization of Multiple Sclerosis Therapies in the Middle East Over a Decade: 2009 –2018
AbstractBackgroundThe multiple sclerosis (MS) landscape has changed over the past two decades across the world and in the Middle East. The Middle East is an ethnically diverse region located between 12 ° and 42° of latitude and 35° and 54° of longitude and varying altitudes. The magnitude of the shifts observed in the epidemiology and management of MS differ in each region and from country to country.ObjectivesThe aim of this study was to provide a clinicodemographic overview of the cohorts of patients contributed to MSBase, a large international MS registry, in the Middle East and describe disease-modifyin...
Source: CNS Drugs - June 23, 2021 Category: Neurology Source Type: research

The Pharmacology and Clinical Efficacy of Antiseizure Medications: From Bromide Salts to Cenobamate and Beyond
AbstractEpilepsy is one of the most common and disabling chronic neurological disorders. Antiseizure medications (ASMs), previously referred to as anticonvulsant or antiepileptic drugs, are the mainstay of symptomatic epilepsy treatment. Epilepsy is a multifaceted complex disease and so is its treatment. Currently, about 30 ASMs are available for epilepsy therapy. Furthermore, several ASMs are approved therapies in nonepileptic conditions, including neuropathic pain, migraine, bipolar disorder, and generalized anxiety disorder. Because of this wide spectrum of therapeutic activity, ASMs are among the most often prescribed ...
Source: CNS Drugs - June 18, 2021 Category: Neurology Source Type: research

The NOP Receptor System in Neurological and Psychiatric Disorders: Discrepancies, Peculiarities and Clinical Progress in Developing Targeted Therapies
AbstractThe nociceptin opioid peptide (NOP) receptor and its endogenous ligand nociceptin/orphanin FQ (N/OFQ) are the fourth members of the opioid receptor and opioid peptide families. Although they have considerable sequence homology to the other family members, they are not considered opioid per se because they do not have pharmacological profiles similar to the other family members. The number of NOP receptors in the brain is higher than the other family members, and NOP receptors can be found throughout the brain. Because of the widespread distribution of NOP receptors, N/OFQ and other peptide and small molecule agonis...
Source: CNS Drugs - May 31, 2021 Category: Neurology Source Type: research

Diroximel Fumarate in Relapsing Forms of Multiple Sclerosis: A Profile of Its Use
AbstractDiroximel fumarate (Vumerity®), an orally administered disease-modifying drug (DMD), expands the available treatment options for adults with relapsing forms of multiple sclerosis (MS), including clinically isolated syndrome, relapsing-remitting MS (RRMS), and active secondary progressive MS. It demonstrates bioequivalence to dimethyl fumarate and was developed to provide similar clinical benefits, but with an improved gastrointestinal (GI) tolerability profile. In RRMS patients who are treatment-na ïve or were previously treated with interferon-β or glatiramer acetate, diroximel fumarate reduces annua...
Source: CNS Drugs - May 31, 2021 Category: Neurology Source Type: research

Effect of a Multi-Layer, Extended-Release Methylphenidate Formulation (PRC-063) on Sleep in Adults with ADHD: A Randomized, Double-Blind, Forced-Dose, Placebo-Controlled Trial Followed by a 6-month Open-Label Extension
AbstractBackgroundThe effects of stimulant treatment on sleep in adults with attention-deficit/hyperactivity disorder (ADHD) are complex and varied, with some individuals experiencing worsening of sleep but others experiencing improvement.MethodsData from previously reported trials of the clinical efficacy and safety of the long-acting methylphenidate formulation PRC-063 (Adhansia XR® in the USA; Foquest® in Canada) in adults with ADHD were used to evaluate patient-reported sleep outcomes, as captured using the Pittsburgh Sleep Quality Index (PSQI) and adverse events of insomnia. The trials comprised 4  weeks ...
Source: CNS Drugs - May 31, 2021 Category: Neurology Source Type: research

Correction to: OnabotulinumtoxinA in Chronic Migraine: A Profile of Its Use
A correction to this paper has been published: https://doi.org/10.1007/s40263-021-00828-7 (Source: CNS Drugs)
Source: CNS Drugs - May 21, 2021 Category: Neurology Source Type: research

The Effect of Statin Treatment on Outcomes of Cardioembolic Stroke: A Systematic Review and Meta-Analysis of Real-World Studies
ConclusionsAlthough the use of statins does not enhance the prevention of stroke recurrence in PWCS, statin treatment is associated with improved clinical outcomes in PWCS. Statins play a beneficial role in the treatment of cardioembolic stroke. (Source: CNS Drugs)
Source: CNS Drugs - May 21, 2021 Category: Neurology Source Type: research

Irritability in Mood Disorders: Neurobiological Underpinnings and Implications for Pharmacological Intervention
AbstractFeeling irritable is a common experience, both in health and disease. In the context of psychiatric illnesses, it is a transdiagnostic phenomenon that features across all ages, and often causes significant distress and impairment. In mood disorders, irritability is near ubiquitous and plays a central role in diagnosis and yet, despite its prevalence, it remains poorly understood. A neurobiological model of irritability posits that, in children and adolescents, it is consequent upon deficits in reward and threat processing, involving regions such as the amygdala and frontal cortices. In comparison, in adults with mo...
Source: CNS Drugs - May 21, 2021 Category: Neurology Source Type: research

Viloxazine in the Management of CNS Disorders: A Historical Overview and Current Status
AbstractViloxazine has a long history of clinical use in Europe as an antidepressant, and has recently been repurposed into an extended-release form for the treatment of attention-deficit/hyperactivity disorder in the USA. An immediate-release formulation was approved for the treatment of depression in the UK in 1974, and was subsequently marketed there and in several European countries for 30 years with no major safety concerns. In contrast to first-generation antidepressants (e.g., tricyclic antidepressants, monoamine oxidase inhibitors), viloxazine was associated with a relatively low risk for cardiotoxicity. Gastrointe...
Source: CNS Drugs - May 18, 2021 Category: Neurology Source Type: research

The Evolution of Medication Overuse Headache: History, Pathophysiology and Clinical Update
AbstractMedication overuse headache (MOH), the development or worsening of chronic headache resulting from frequent and excessive intake of medications used for acute treatment of headache, is a common secondary headache disorder and is associated with significant personal and societal burdens. The plausible physiologic mechanism is that chronic exposure to acute care migraine treatment leads to suppression of endogenous antinociceptive systems, consequently facilitating the trigeminal nociceptive process via up-regulation of the calcitonin gene-related peptide (CGRP) system. Recognizing and preventing its development is a...
Source: CNS Drugs - May 17, 2021 Category: Neurology Source Type: research

Pharmacology of Cenobamate: Mechanism of Action, Pharmacokinetics, Drug –Drug Interactions and Tolerability
AbstractCenobamate is one of the latest antiseizure medications (ASMs) developed for the treatment of focal onset seizures in adult patients. The recommended starting dose is 12.5  mg/day, titrated gradually to the target daily dose of 200 mg, which may be increased to a maximum of 400 mg/day based on clinical response. Although the high rate of seizure freedom observed in randomized, placebo-controlled clinical trials has resulted in exciting expectations, further clinical studies are needed to better define its clinical profile. Cenobamate is characterized by a peculiar pharmacology regarding both pharmacodynamics a...
Source: CNS Drugs - May 16, 2021 Category: Neurology Source Type: research

Pathophysiology and Treatment of Non-motor Dysfunction in Amyotrophic Lateral Sclerosis
AbstractAmyotrophic lateral sclerosis is a progressive and fatal neurodegenerative disease typically presenting with bulbar or limb weakness. There is increasing evidence that amyotrophic lateral sclerosis is a multisystem disease with early and frequent impacts on cognition, behaviour, sleep, pain and fatigue. Dysfunction of normal physiological and metabolic processes also appears common. Evidence from pre-symptomatic studies and large epidemiological cohorts examining risk factors for the future development of amyotrophic lateral sclerosis have reported a high prevalence of changes in behaviour and mental health before ...
Source: CNS Drugs - May 15, 2021 Category: Neurology Source Type: research

Erythropoietin Improves Poor Outcomes in Preterm Infants with Intraventricular Hemorrhage
The objective of this study was to evaluate the protective effect of repeated low-dose recombinant human erythropoietin (rhEPO) in preterm infants with IVH.MethodsThis was a single-blinded prospective randomized controlled trial. Preterm infants ≤ 32 weeks gestational age who were diagnosed with IVH within 72 h after birth were randomized to receive rhEPO 500 IU/kg or placebo (equivalent volume of saline) every other day for 2 weeks. The primary outcome was death or neurological disability assessed at 18 months of corrected age.ResultsA total of 316 eligible infants were included in the study, with 157 in the rhEPO...
Source: CNS Drugs - May 6, 2021 Category: Neurology Source Type: research

Real-World Evidence of the Clinical and Economic Impact of Long-Acting Injectable Versus Oral Antipsychotics Among Patients with Schizophrenia in the United States: A Systematic Review and Meta-Analysis
ConclusionsBased on multiple studies with varying sub-types of patient populations with schizophrenia in the United States published in the last decade, this meta-analysis demonstrated that LAI antipsychotics were associated with improved medication adherence and significant clinical benefit such as reduced hospitalizations and ER admissions compared with OA. The lower medical costs offset the higher pharmacy costs, resulting in a non-significant difference in total healthcare costs. Taken together, these findings provide strong evidence on the clinical and economic benefits of LAI compared with OA for the treatment of sch...
Source: CNS Drugs - April 28, 2021 Category: Neurology Source Type: research

Novel Glutamatergic Modulators for the Treatment of Mood Disorders: Current Status
AbstractThe efficacy of standard antidepressants is limited for many patients with mood disorders such as major depressive disorder (MDD) and bipolar depression, underscoring the urgent need to develop novel therapeutics. Both clinical and preclinical studies have implicated glutamatergic system dysfunction in the pathophysiology of mood disorders. In particular, rapid reductions in depressive symptoms have been observed in response to subanesthetic doses of the glutamatergic modulator racemic (R,S)-ketamine in individuals with mood disorders. These results have prompted investigation into other glutamatergic modulators fo...
Source: CNS Drugs - April 26, 2021 Category: Neurology Source Type: research

Is Adjunct Aripiprazole Effective in Treating Hyperprolactinemia Induced by Psychotropic Medication? A Narrative Review
AbstractPsychotropic medication treatment can cause elevated serum prolactin levels and hyperprolactinaemia (HPRL). Reports have suggested that aripiprazole may decrease elevated prolactin. The aim of this review was to assess evidence for the efficacy of adjunct aripiprazole in the treatment of psychotropic-induced HPRL. PubMed and Google Scholar were searched to identify randomised placebo-controlled trials (RCTs) of adjunct aripiprazole in patients with HPRL attributed to primary psychotropic medications. Data for individual patients from case studies, chart reviews and open-label studies were also identified and assess...
Source: CNS Drugs - April 20, 2021 Category: Neurology Source Type: research

Clinically Significant Drug Interactions Between Psychotropic Agents and Repurposed COVID-19 Therapies
AbstractAs many patients with underlying psychiatric disorders may be infected with COVID-19, and COVID-19-affected subjects may frequently experience a new onset of psychiatric manifestations, concomitant use of psychotropic medications and COVID-19 therapies is expected to be highly likely and raises concerns of clinically relevant drug interactions. In this setting, four major mechanisms responsible for drug interactions involving psychotropic agents and COVID-19 therapies may be identified: (1) pharmacokinetic drug –drug interactions mainly acting on cytochrome P450; (2) pharmacodynamic drug–drug interactio...
Source: CNS Drugs - April 18, 2021 Category: Neurology Source Type: research

Predictors of Quality of Life Improvement with Escitalopram and Adjunctive Aripiprazole in Patients with Major Depressive Disorder: A CAN-BIND Study Report
ConclusionThe final model explained the most variance in psychological (68%) and physical (67%) QoL. Less variance was explained for environmental (43%) and social QoL (33%), highlighting a need for further exploration of predictors in these domains. Strategies such as functional remediation may have potential to support QoL for individuals with persistent depressive symptoms.Clinical Trials RegistryClinicalTrials.gov identifier: NCT016557. (Source: CNS Drugs)
Source: CNS Drugs - April 16, 2021 Category: Neurology Source Type: research

Disruption of Pharmacotherapy During the Transition from Adolescence to Early Adulthood in Patients with Attention-Deficit/Hyperactivity Disorder: A Claims Database Analysis Across the USA
AbstractBackground and ObjectiveAttention-deficit/hyperactivity disorder (ADHD) treatment rates in adults are low, possibly owing to discontinuation of pediatric care due to various circumstances (including inadequate health insurance coverage, poor disease insight, and patient/family resistance, as well as those who manage their ADHD independent of pharmacologic intervention) during the transition from adolescence to adulthood. To improve the understanding of treatment patterns during this transition, this study characterized pharmacotherapy use in patients with ADHD aged 16 –21 years.MethodsA retrospective claims a...
Source: CNS Drugs - April 15, 2021 Category: Neurology Source Type: research

Predicting Infection Risk in Multiple Sclerosis Patients Treated with Ocrelizumab: A Retrospective Cohort Study
ConclusionsHigher serum IgA and IgG and older age were associated with reduced odds of infection. Our findings highlight that infection risk is not uniform in patients with MS receiving ocrelizumab and substantiate the need to monitor immunoglobulin levels pre-treatment and whilst on therapy. (Source: CNS Drugs)
Source: CNS Drugs - April 13, 2021 Category: Neurology Source Type: research

Comparative Efficacy and Safety of Ozanimod and Dimethyl Fumarate for Relapsing-Remitting Multiple Sclerosis Using Matching-Adjusted Indirect Comparison
ConclusionsAfter adjustment of baseline patient characteristics, the MAIC demonstrated that the efficacy and safety of ozanimod 1.0 mg OD was superior to that of DMF 240 mg BID. Although a MAIC is less likely to produce biased estimates than a na ïve or a standard indirect treatment comparison via a common comparator, limitations include potential confounding due to unobserved and thus unaccounted for baseline differences. (Source: CNS Drugs)
Source: CNS Drugs - April 13, 2021 Category: Neurology Source Type: research

Pharmacotherapy for Frontotemporal Dementia
AbstractFrontotemporal dementia is a heterogeneous spectrum of neurodegenerative disorders. The neuropathological inclusions are tau proteins, TAR DNA binding protein 43 kDa-TDP-43, or fused in sarcoma-ubiquitinated inclusions. Genetically, several autosomal mutations account for the heritability of the disorder. Phenotypically, frontotemporal dementia can present with a behavioral variant or a language variant called primary progressive aphasia. To date, there are no approved symptomatic or disease-modifying treatments for frontotemporal dementia. Currently used therapies are supported by low-level of evidence (mostly unc...
Source: CNS Drugs - April 11, 2021 Category: Neurology Source Type: research

The Impact of Antipsychotic Formulations on Time to Medication Discontinuation in Patients with Schizophrenia: A Dutch Registry-Based Retrospective Cohort Study
ConclusionsTime to discontinuation differed considerably between formulations. The duration of recent antipsychotic use was a strong predictor of time to discontinuation. While oral-daily formulations had the longest time to discontinuation in the long-term recent antipsychotic use group, discontinuation trends were similar for oral-weekly and depot formulations. An oral-weekly formulation, whose administration route is noninvasive, might therefore be considered an alternative to depot formulations. (Source: CNS Drugs)
Source: CNS Drugs - April 10, 2021 Category: Neurology Source Type: research

Sphingosine 1-Phosphate Receptor Modulators for Multiple Sclerosis
AbstractFingolimod (Gilenya) received regulatory approval from the US FDA in 2010 as the first-in-class sphingosine 1-phosphate (S1P) receptor (S1PR) modulator and was the first oral disease-modifying therapy (DMT) used for the treatment of the relapsing forms of multiple sclerosis (MS). Development of this new class of therapeutic compounds has continued to be a pharmacological goal of high interest in clinical trials for treatment of various autoimmune disorders, including MS. S1P is a physiologic signaling molecule that acts as a ligand for a group of cell surface receptors. S1PRs are expressed on various body tissues a...
Source: CNS Drugs - April 2, 2021 Category: Neurology Source Type: research

Pharmacokinetics and Bioavailability of Monomethyl Fumarate Following a Single Oral Dose of Bafiertam ™ (Monomethyl Fumarate) or Tecfidera ® (Dimethyl Fumarate)
ConclusionsBased on the statistical analysis results of the pharmacokinetic parameters of MMF, a single oral dose of two Bafiertam ™ DR 95 mg capsules is bioequivalent to a single oral dose of one Tecfidera® DR 240  mg capsule.Clinical Trial RegistrationThis study was retrospectively registered with ClinicalTrials.gov (NCT04570670) on 30 September, 2020. (Source: CNS Drugs)
Source: CNS Drugs - March 30, 2021 Category: Neurology Source Type: research

Comparing Long-Acting Antipsychotic Discontinuation Rates Under Ordinary Clinical Circumstances: A Survival Analysis from an Observational, Pragmatic Study
ConclusionsClinicians should be aware that LAI discontinuation is a frequent occurrence. LAI choice should be carefully discussed with the patient, taking into account individual characteristics and possible obstacles related to the practicalities of each formulation. (Source: CNS Drugs)
Source: CNS Drugs - March 29, 2021 Category: Neurology Source Type: research

Pharmacotherapy for Preschool Children with Attention Deficit Hyperactivity Disorder (ADHD): Current Status and Future Directions
AbstractIn this review, we consider issues relating to the pharmacological treatment of young children with attention deficit hyperactivity disorder (ADHD). ADHD in preschool-age children has a profound impact on psychosocial function and developmental trajectory. Clinical studies on pharmacotherapies for ADHD in young children have expanded rapidly in the past 2 decades, providing some evidence of efficacy for both psychostimulant and non-psychostimulant medications. However, preschool children may be more susceptible to adverse effects of medications, including growth reduction and cardiovascular side effects. Many quest...
Source: CNS Drugs - March 26, 2021 Category: Neurology Source Type: research

First-in-Human Randomized Trial to Assess Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of the KDM1A Inhibitor Vafidemstat
ConclusionsVafidemstat displayed good safety and tolerability. This phase I trial confirmed KDM1A TE and CNS penetration and permitted characterization of platelet dynamics and selection of phase IIa doses.Trial registrationEUDRACT No. 2015-003721-33, filed 30 October 2015. (Source: CNS Drugs)
Source: CNS Drugs - March 23, 2021 Category: Neurology Source Type: research

Highly Purified Cannabidiol for Epilepsy Treatment: A Systematic Review of Epileptic Conditions Beyond Dravet Syndrome and Lennox –Gastaut Syndrome
ConclusionsThe currently available data suggest that response to treatment with a highly purified, plant-derived CBD oil-based solution can be seen in patients across a broad range of epilepsy disorders and etiologies. The existing evidence can provide preliminary support for additional research. (Source: CNS Drugs)
Source: CNS Drugs - March 22, 2021 Category: Neurology Source Type: research

COVID-19 in Patients with Multiple Sclerosis: Associations with Disease-Modifying Therapies
The objective of this study was to describe the overall risk of coronavirus disease 2019 (COVID-19) infection, severe disease course, and potential population-level predictors of COVID-19 infection in PwMS, and to provide a context using a cohort of patients with systemic lupus erythematosus (SLE). In addition, the association of different MS DMTs with the incidence and clinical course of COVID-19 was evaluated. Safety data from the Biogen Global Safety Database are also presented on reported cases of COVID-19 in patients treated with Biogen MS therapies.MethodsThe IBM® Explorys electronic health record database of>...
Source: CNS Drugs - March 20, 2021 Category: Neurology Source Type: research

Problem Gambling Associated with Aripiprazole: A Nested Case-Control Study in a First-Episode Psychosis Program
ConclusionsFindings from this study suggest that FEP patients with a gambling history, problematic or not, may be at increased risk of developing PBG when receiving aripiprazole. They also highlight the importance of systematically screening for PBG all individuals with psychotic disorders, as this comorbidity hinders recovery. While the results also add credence to a causal association between aripiprazole and PBG, further prospective studies are needed to address some of the limitations of this present study. (Source: CNS Drugs)
Source: CNS Drugs - March 13, 2021 Category: Neurology Source Type: research

Cognitive Outcomes with Sequential Escitalopram Monotherapy and Adjunctive Aripiprazole Treatment in Major Depressive Disorder: A Canadian Biomarker Integration Network in Depression (CAN-BIND-1) Report
ConclusionsEscitalopram monotherapy in acute MDD did not result in significant cognitive improvements. We provide novel evidence that escitalopram continuation in responders does not adversely affect cognition, but adjunctive aripiprazole in escitalopram non-responders worsens reaction time. Treatments targeting cognitive dysfunction are needed in MDD.ClinicalTrials.gov identifierNCT01655706; 2 August, 2012. (Source: CNS Drugs)
Source: CNS Drugs - March 8, 2021 Category: Neurology Source Type: research

Targeting β-Arrestins in the Treatment of Psychiatric and Neurological Disorders
AbstractTherapies for psychiatric and neurological disorders have been in the development and refinement process for the past 5 decades. Yet, most of these therapies lack optimal therapeutic efficacy and have multiple debilitating side effects. Recent advances in understanding the pathophysiological processes of psychiatric and neurological disorders have revealed an important role for β-arrestins, which are important regulators of G-protein-coupled receptor (GPCR) function, including desensitization and intracellular signaling. These findings have pushed β-arrestins to the forefront as potential therapeutic targ...
Source: CNS Drugs - March 2, 2021 Category: Neurology Source Type: research

Psychotropic Drug-Induced Glaucoma: A Practical Guide to Diagnosis and Management
This article provides a practical review of the diagnosis and management of angle closure induced by psychotropic agents, including tricyclic antidepressants, antipsychotics and anticonvulsants. Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors and antipsychotics may trigger angle closure by influencing pupil configuration through adrenergic, anticholinergic, serotonergic or dopaminergic mechanisms. Patients with narrow iridocorneal angles are at risk, and these are more common in people with hypermetropia (near-sightedness), older people and individuals wit...
Source: CNS Drugs - February 19, 2021 Category: Neurology Source Type: research

Effect of Enzyme-Inducing Antiseizure Medications on the Risk of Sub-Therapeutic Concentrations of Direct Oral Anticoagulants: A Retrospective Cohort Study
ConclusionsConcurrent EI-ASM and DOAC use presents a possible risk for DOAC concentrations below the expected range. The clinical significance of the interaction is currently unclear. (Source: CNS Drugs)
Source: CNS Drugs - February 17, 2021 Category: Neurology Source Type: research

Use of Topiramate in the Spectrum of Addictive and Eating Disorders: A Systematic Review Comparing Treatment Schemes, Efficacy, and Safety Features
DiscussionThough off-label, addiction specialists should consider topiramate as a second-line option for drinking reduction in alcohol use disorder, as well as for binge eating disorder or cocaine use disorder. (Source: CNS Drugs)
Source: CNS Drugs - February 16, 2021 Category: Neurology Source Type: research

24-Hour Levodopa-Carbidopa Intestinal Gel: Clinical Experience and Practical Recommendations
AbstractInfusion of levodopa-carbidopa intestinal gel (LCIG; also designated carbidopa-levodopa enteral suspension) for 16 hours is a standard treatment for patients with advanced Parkinson ’s disease, and clinical observations suggest that 24-hour LCIG infusion may further reduce symptoms. This review provides practical advice on the management of patients transitioning to 24-hour LCIG infusion. We review available clinical data for 24-hour infusion and discuss adjustments to dosing , recommendations for monitoring, and management of patient concerns, based on our clinical experience. Data from multiple studies sugg...
Source: CNS Drugs - February 13, 2021 Category: Neurology Source Type: research

Sex Differences in the Risk of Cutaneous Adverse Drug Reactions Induced by Antiseizure Medications: A Systematic Review and Meta-analysis
This study sought to perform a systematic review, meta-analysis, and meta-regression to compare the ASM cADR risks between females and males.MethodsWe searched the literature using three databases (EMBASE, PubMed, and Web of Science) between October 1998 and November 2018, later updated to October 2019. Studies were included in the meta-analysis if they met the following criteria: (1) observational studies that estimated the incidence of cADRs related to ASMs; (2) provided the risk or odds ratio (OR) for cADRs among female and male patients exposed to ASMs; and (3) provided information on patients ’ characteristics. ...
Source: CNS Drugs - February 12, 2021 Category: Neurology Source Type: research

Rotigotine Transdermal Patch for Motor and Non-motor Parkinson ’s Disease: A Review of 12 Years’ Clinical Experience
AbstractMotor and non-motor symptoms (NMS) have a substantial effect on the health-related quality of life (QoL) of patients with Parkinson's disease (PD). Transdermal therapy has emerged as a time-tested practical treatment option, and the rotigotine patch has been used worldwide as an alternative to conventional oral treatment for PD. The efficacy of rotigotine on motor aspects of PD, as well as its safety and tolerability profile, are well-established, whereas its effects  on a wide range of NMS have been described and studied but are not widely appreciated. In this review, we present our overall experience wi...
Source: CNS Drugs - February 9, 2021 Category: Neurology Source Type: research

Pharmacotherapy to Manage Central Post-Stroke Pain
AbstractCentral post-stroke pain is a chronic neuropathic pain syndrome following a cerebrovascular accident. The development of central post-stroke pain is estimated to occur in 8 to 55% of stroke patients and is described as constant or intermittent neuropathic pain accompanied by dysesthesia of temperature and/or pressure sensations. These pain and sensory deficits are within the area of the body corresponding to the stroke lesion. The onset of pain is usually gradual, though it can develop either immediately after stroke or years after. Given the diversity in its clinical presentation, central post-stroke pain is a cha...
Source: CNS Drugs - February 7, 2021 Category: Neurology Source Type: research

Idarucizumab Reversal of Dabigatran in Patients with Acute Ischemic Stroke and Intracranial Hemorrhage: Comparison with Non-idarucizumab-Treated Patients
AbstractBackgroundIdarucizumab reverses the anticoagulant dabigatran; it is recommended during intravenous thrombolysis treatment of dabigatran-treated patients with acute ischemic stroke (AIS) and in dabigatran-treated patients with intracranial hemorrhage (ICH).MethodsOutcomes of consecutive idarucizumab/dabigatran-treated patients with intravenous thrombolysis-treated AIS (n = 22) were compared with consecutive similar intravenous thrombolysis-treated patients with AIS who were not anticoagulated (n = 182) [primary aim]; idarucizumab/dabigatran-treated patients with ICH (n = 13) were compared with patients with ICH who ...
Source: CNS Drugs - February 6, 2021 Category: Neurology Source Type: research

Application of Real-World Data and the REWARD Framework to Detect Unknown Benefits of Memantine and Identify Potential Disease Targets for New NMDA Receptor Antagonists
ConclusionThe present results confirm that NMDA receptor antagonism may have broader therapeutic utility than previously recognized. Further observational and clinical research may be warranted to explore the therapeutic benefit of NMDA antagonists for the outcomes found in this study. (Source: CNS Drugs)
Source: CNS Drugs - February 4, 2021 Category: Neurology Source Type: research

Inhibitors of Src Family Kinases, Inducible Nitric Oxide Synthase, and NADPH Oxidase as Potential CNS Drug Targets for Neurological Diseases
AbstractNeurological diseases share common neuroinflammatory and oxidative stress pathways. Both phenotypic and molecular changes in microglia, astrocytes, and neurons contribute to the progression of disease and present potential targets for disease modification. Src family kinases (SFKs) are present in both neurons and glial cells and are upregulated following neurological insults in both human and animal models. In neurons, SFKs interact with post-synaptic protein domains to mediate hyperexcitability and neurotoxicity. SFKs are upstream of signaling cascades that lead to the modulation of neurotransmitter receptors and ...
Source: CNS Drugs - January 30, 2021 Category: Neurology Source Type: research

Intranasal Insulin for Alzheimer ’s Disease
AbstractBrain insulin signaling contributes to memory function and might be a viable target in the prevention and treatment of memory impairments including Alzheimer ’s disease. This short narrative review explores the potential of central nervous system (CNS) insulin administration via the intranasal pathway to improve memory performance in health and disease, with a focus on the most recent results. Proof-of-concept studies and (pilot) clinical trials in ind ividuals with mild cognitive impairment or Alzheimer’s disease indicate that acute and prolonged intranasal insulin administration enhances memory perfor...
Source: CNS Drugs - January 30, 2021 Category: Neurology Source Type: research

Pharmacokinetic Characteristics of Long-Acting Injectable Antipsychotics for Schizophrenia: An Overview
AbstractThe availability of long-acting injectable (LAI) antipsychotics for the treatment of schizophrenia provides clinicians with options that deliver continuous drug exposure and may improve adherence compared with daily oral antipsychotics. However, all LAI antipsychotics have unique formulations and pharmacokinetic characteristics that have implications for medication selection, administration interval, and injection site. This review outlines key differences in drug formulations and pharmacokinetics among LAI antipsychotics. A systematic search of the PubMed database was conducted to identify physical and formulation...
Source: CNS Drugs - January 28, 2021 Category: Neurology Source Type: research

Expanding the Treatment Landscape for Lennox-Gastaut Syndrome: Current and Future Strategies
AbstractLennox-Gastaut syndrome (LGS), a childhood-onset severe developmental and epileptic encephalopathy (DEE), is an entity that encompasses a heterogenous group of aetiologies, with no single genetic cause. It is characterised by multiple seizure types, an abnormal EEG with generalised slow spike and wave discharges and cognitive impairment, associated with high morbidity and profound effects on the quality of life of patients and their families. Drug-refractory seizures are a hallmark and treatment is further complicated by its multiple morbidities, which evolve over the patient ’s lifetime. This review provides...
Source: CNS Drugs - January 21, 2021 Category: Neurology Source Type: research

Correction to: Siponimod: A Review in Secondary Progressive Multiple Sclerosis
The article Siponimod: A Review in Secondary Progressive Multiple Sclerosis (Source: CNS Drugs)
Source: CNS Drugs - January 18, 2021 Category: Neurology Source Type: research

Correction to: OnabotulinumtoxinA in Chronic Migraine: A Profile of Its Use
The article OnabotulinumtoxinA in Chronic Migraine: A Profile of Its Use, written by James E. Frampton, was originally published electronically on SpringerLink on 11 December 2020 without open access. After publication in volume 34, issue 12, page 1287 –1298, AbbVie requested that the article be Open Choice to make the article an open access publication. Post-publication open access was funded by AbbVie. Therefore, the copyright of the article has been changed to © Springer Nature Switzerland AG 2020 and the article is forthwith distributed und er the terms of the Creative Commons Attribution NonCommercial 4.0 I...
Source: CNS Drugs - January 16, 2021 Category: Neurology Source Type: research

Efficacy and Safety of Ibuprofen Plus Paracetamol in a Fixed-Dose Combination for Acute Postoperative Pain in Adults: Meta-Analysis and a Trial Sequential Analysis
AbstractBackgroundIbuprofen and paracetamol (acetaminophen) are very commonly used for analgesia and pain. In 2020, the US FDA gave its first approval of a fixed-dose combination (FDC) of the two drugs in the same tablet for postoperative pain. There has been no quantitative, summative analysis of the FDC effect size measures against postoperative pain in adults. Similar analyses exist, but only in pediatric patients.ObjectiveThis was the first meta-analysis to compare the efficacy and safety outcomes of the ibuprofen/paracetamol FDC against placebo, administered postoperatively, for moderate to severe pain relief in adult...
Source: CNS Drugs - January 11, 2021 Category: Neurology Source Type: research

Safety and Efficacy of Sovateltide (IRL-1620) in a Multicenter Randomized Controlled Clinical Trial in Patients with Acute Cerebral Ischemic Stroke
AbstractBackgroundSovateltide (IRL-1620, PMZ-1620), an endothelin-B receptor agonist, has been previously shown to increase cerebral blood flow, have anti-apoptotic activity and produce neurovascular remodeling when administered intravenously following acute cerebral ischemic stroke in rats. Its safety and tolerability were confirmed in healthy human volunteers (CTRI/2016/11/007509).ObjectiveOur objective was to determine the safety, tolerability and efficacy of sovateltide as an addition to standard of care (SOC) in patients with acute cerebral ischemic stroke.MethodsA prospective, multicentric, randomized, double-blind, ...
Source: CNS Drugs - January 11, 2021 Category: Neurology Source Type: research