Metoclopramide Eases Adult Migraine
Metoclopramide is an effective migraine treatment for adults; one in four migraine patients will experience significant pain reduction with the drug.
However, other drugs may have more effect on migraine-related nausea, according to Ian Colman, a postgraduate student at the University of Cambridge (England) and his colleagues.
The metaanalysis included five studies of metoclopramide versus placebo (263 adults); three studies of metoclopramide versus other antiemetics (194 patients); two studies of metoclopramide versus nonantiemetics (60 patients): and seven studies of metoclopramide combinations versus other agents (211 patients).
The drug was almost three times as effective as placebo for pain and nausea but not as effective as other phenothiazine antiemetics (prochlorperazine and chlorpromazine). Metoclopramide compared favorably with ibuprofen and sumatriptan, but there was not enough evidence to make firm conclusions about its relative effectiveness (BMJ 2004;329:1369–73).
Stabbing Triggered Hydrocephalus
Though rare, hydrocephalus should be considered a possible late complication of a spinal stabbing injury in a patient whose condition suddenly deteriorates, reported G. Joseph, M.D., and colleagues.
Five months after a knife attack that involved partial transection of the cervical cord just above the craniovertebral junction, a 19-year-old man developed muscle spasms and dysreflexia episodes, followed by two seizures. Computerized axial tomography showed communicating hydrocephalus resulting in enlargement of all four ventricles, said the investigators, of Southern General Hospital, Glasgow, Scotland (Spinal Cord 2005;43:56–8).
His condition stabilized with placement of a ventriculoperitoneal shunt and gradually improved. Over the next 3 months, the man was partially weaned off ventilator. At 6 years' follow-up, he had recovered complete sensation in all limbs but still required ventilator support at night.
“In our patient … pathogenesis may be related to the high level of the penetrating injury leading to blood from the site of injury entering the basal cisterns and impairing the absorption of the CSF by the arachnoid villi over the hemispheres,” they wrote.
Refractory Epilepsy's Costs for Kids
Controlling seizures often lessens behavioral and neuropsychological problems that are ubiquitous in children with refractory epilepsy, said Marc Boel, M.D., of University Hospitals Gasthuisberg, Leuven, Belgium.
Among 573 such children seen in his clinic, 80% showed behavioral problems, and 15% showed significant mental decline related to their epilepsy.
About half of the entire group had an IQ of below 50 (Eur. J. Pediatr. Neurol. 2005;8:291–7).
Most of the children had either partial epilepsy (29%) or secondary generalized tonic-clonic epilepsy (25%). Approximately 4% had Lennox-Gastaut syndrome.
The most frequent neurobehavioral disorders were pervasive developmental disorder (8%); attention deficit hyperactivity disorder (7.5%); loss of self-esteem (9%), and self-induction of seizures (7%). Psychosis, anxiety disorders, intermittent explosive disorder, and cursive seizures were seen at lower rates.
In 101 of the 220 children who achieved seizure control, behavioral problems disappeared or were minimized.
A Toast for the Aging Brain
A drink a day appears to protect elderly women from cognitive decline, according to new data from the ongoing Nurses' Health Study.
Interviewers gave four cognitive tests to over 11,000 women aged 70–81 years, said Meir Stampfer, M.D., of Brigham and Women's Hospital, Boston, and associates.
They found that moderate drinkers (one drink/day) had a 20% lower risk of cognitive decline than nondrinkers or those who drank two or more drinks/day. Both wine and beer were associated with the protective effect (N. Engl. J. Med. 2005;3:245–53).