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Archive for the ‘Neuro’ Category

WashU Neuromuscular Disease Center – The Ultimate Online Neurological Disease Database

Posted by medliorator on May 14, 2010

For thorough summaries of numerous neurological diseases, bookmark Washington University’s database on your mobile device before starting your neuro rotation/class.   Disorders & syndromes are searchable categorically or alphabetically.   The database is updated frequently; a detailed revision history is maintained on the database’s homepage.

Neuromuscular Disease Center [Washington University]

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Generic Versus Branded Drugs: Concerns Amidst Limited Evidence

Posted by medliorator on September 18, 2009

Many physicians have found [the switch to generic drugs] particularly problematic in classes of drugs with a narrow therapeutic range, including antiepileptics, psychotropics, antiarrhythmics, and anticoagulants.

although the generic’s mean maximal concentration and area under the concentration-time curve are typically within a few percentage points of the original’s — typically about 4% — the 90% confidence interval for those means can be 20% below or 25% above the branded drug’s mean.

much of the current evidence of problems with generic antiepileptics is anecdotal, or comes from retrospective or case-control studies — not randomized controlled trials.  But all of those studies have come to similar conclusions.

Two retrospective studies published last year in Neurology found that patients who had events like break-through seizures were much more likely to have been switched from a branded product to a generic… “Brand-to-generic seems to be the biggest issue,” Meador said. “But generic-to-generic seems to confer some risk as well.”

some non-SSRI antidepressants aren’t so forgiving, said Jeffrey Lieberman, MD, a psychiatrist at Columbia University in New York City.  He mentioned the tricyclic drug nortriptyline and bupropion (Wellbutrin) as more susceptible than most antidepressants to dosage variations.

Generics versus Brands: How It Plays Out in Practice [Medpage Today]

Posted in Neuro, Pharmacology | Comments Off on Generic Versus Branded Drugs: Concerns Amidst Limited Evidence

Duty of Care – Ethics of Neurology

Posted by medliorator on April 11, 2009

our attention was drawn to a colleague whose subtle neck and facial movements were accompanied by grunting noises while eating—phenomena indicative of complex motor tics… When he had left, the medical student attached to our team asked the obvious question: with the evidence staring us in the face, why did no one inform him of the diagnosis and proffer appropriate treatment? we launched into an animated discussion about a physician’s duty of care, asking whether the ethical imperative to treat exists only in a medical emergency or after the establishment of a formal doctor–patient relationship.

Putting Ethics on the Spot in Neurology [Medscape]

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Huntington’s Drug Approved

Posted by medliorator on August 20, 2008

[Tetrabenazine / Xenazine] will not cure the condition and it has some potentially serious side effects, such as raising the risk of suicidal behavior. However, it does provide relief for a major disabling symptom of Huntington’s: chorea

The drug works by reducing the amount of a chemical, dopamine, available at key junction sites in the brain. Dopamine is essential in communicating signals between nerve cells, but in people with Huntington’s this system is overactive. By reducing the amount of dopamine available at certain sites in the brain, the drug decreases the involuntary movements associated with Huntington’s.

1st US drug for Huntington’s disease wins approval [Yahoo News]

In some non-US countries, tetrabenazine (Xenazine) has been available for a while (35 years).  However, the FDA in the USA requires pre-approval testing that is more stringent than in most countries.  It has been difficult to do testing that is acceptable to the FDA, because good testing requires large numbers of patients.  The disease is sufficiently rare (4 to 10 cases per 100,000 persons), that it is a challenge to get enough patients.  Also, the disease progresses slowly, so there isn’t a quick way to know if the drug is working.

On 15 August, 2008, the FDA announced that tetrabenazine has been approved for the treatment of Huntington’s Disease.

Tetrabenazine (Xenazine) For Huntington’s Disease [Corpus Callosum]

Posted in Neuro, News, Pharmacology | 1 Comment »

Gender in Surgical Demographics

Posted by medliorator on August 20, 2008

Women now account for more than 50% of American medical students, but only 10% of neurosurgery residents.

part of the reason more women aren’t going into neurosurgery is because there aren’t more women in the field to serve as mentors and role models. Women account for less than 6% of the neurosurgery ranks.

Women Remain Scarce in Neurosurgery [wSJ Health Blog]

Posted in Neuro, News, Residency, Surgery | 1 Comment »