Larry Leonard – Brain Blogger Health and Science Blog Covering Brain Topics Wed, 30 May 2018 15:00:03 +0000 en-US hourly 1 Migraines? Ask Your Doctor About TPM Fri, 30 Mar 2007 13:16:33 +0000 Neuroscience_Neurology2.jpgAre you among the nearly twelve percent of the adult population who suffer from migraines? If so, read on.

The migraine is a highly prevalent, disabling, undiagnosed, and undertreated disease, with considerable economic and social impact. Treatment strategies are both preventive and acute, using a plan that usually includes educating patients about their illness and its management (for instance, mechanisms, recognizing and avoiding triggers, and lifestyle changes), acute treatment, and preventive treatment. During a migraine attack, nerves in the brain dilate blood vessels that, in turn, cause pain, further nerve activation, and inflammation. Because nerve events are linked to circulatory system events, migraine is a neurovascular headache disorder. Current prescriptions such as aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs, opiates, combination analgesics, and migraine-specific treatments (ergotamine, dihydroergotamine, and the triptans) are used.

In 2006, the U.S. Food and Drug Administration approved topiramate (brand name Topamax), also known as TPM, in 25-, 100-, and 200-mg tablet formulations for migraine prevention. TPM is rapidly and almost completely absorbed after oral administration and readily penetrates the central nervous system. It is a neuromodulator with a structurally unique formula that provides multiple mechanisms of action and can influence the electrical activity in the brain by binding to the membrane.

Test participants experienced a significant reduction in the frequency of migraine headaches, number of migraine days, and use of acute medications. But there’s more good news: TPM is effective for patients who are concerned about gaining weight, are currently overweight, or have coexisting epilepsy. TPM should also be useful for children with migraines.


Bigal, M. E. & Krymchantowski, A.V. (2006). Emerging drugs for Migraine Prophylaxis and Treatment. Medscape General Medicine, 8(2):31. Posted 5-4-06.

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Hypertension Drugs Affect Alzheimer’s Thu, 21 Dec 2006 12:00:49 +0000 Neuroscience_Neurology2.jpgEarly studies are reporting the use of some drugs for high blood pressure may be protecting against Alzheimer’s disease, in animal studies according to Gulio Maria Pasinetti, M.D., Ph.D., of the Mount Sinai Hospital in New York.

Dr. Pasinetti as reported that people with cardiovascular disease have a higher risk of dementia, but some epidemiological and clinical studies have suggested that treatment with anti-hypertension drugs, such as propranolol (sold under various brand names), nicardapine (Cardene), and losartan (Cozaar) — that were tested in a short-term dosing study in mice, reduces the risk.

The research has the “potential” to help prevent Alzheimer’s but it’s still very early in the scientific process, commented Vahram Haroutunian, Ph.D., who is also at Mount Sinai but was not involved in the research. “The issue is complicated because humans often have a range of disease, not just high blood pressure,” he said.

Very little is known about the pharmacokinetics of the medications in the brain. In the animals, the level of propranolol, for example, was five times higher in the brain than in plasma, according to Dr. Pasinetti.

Continued research may help prevent Alzheimer’s but it’s early in the scientific process, commented Vahram Haroutunian, Ph.D., who chaired the panel. Dr. Haroutunian is also at Mount Sinai but was not involved in the research.

Primary Source: ACNP Conference Report December 2006

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Antipsychotic Drug Development off Course? Wed, 20 Dec 2006 16:09:18 +0000 Psychiatry_Psychology.jpgAntipsychotic drug development may be off course. Since its accidental discovery during 1951 (Shen 1999), 15 to 40 drugs have been used to treat antipsychotic symptoms. Further developement in drug treatment was on hold until the introduction of Clozapine treatment in the United States in 1990. Discontinuation of antipsychotic medications is common because they don’t work in all patients and because of adverse effects, including metabolic side effects, weight gain and involuntary movements (Tandon 2006).

The newer antipsychotic drugs are no better than earlier medications in improving quality of life for patients, according to researchers in a Cambrige England study. A large U.S. government-funded study, the 2003 Department of Veterans’ Affairs Co-operative Study, also showed no advantage for a second-generation antipsychotic over an earlier-generation drug.

The newer class of drugs are more expensive than the older ones and all large studies showed the increased cost gave no improvement in patients symptoms or side effects, according to the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial (2006), a randomized trial that compared Trilafon with four second generation medications. Robert Rosenheck, M.D., of Yale also reports the older drug is more beneficial to the patient.

Primary source: American Journal of Psychiatry

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