[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Painful peripheral neuropathy (PPN) is common in haemodialysis patients and associated with impaired health-related quality of life (HR-QoL). Gabapentin and pregabalin have not been fully investigated in haemodialysis patients. Therefore, we compared the effects of gabapentin and pregabalin on intensity of pain and associated HR-QoL in haemodialysis patients with PPN. METHODS: Gabapentin and pregabalin were administered after each haemodialysis session at doses of 300 and 75 mg, respectively. Patients were randomized into two groups; after 6 weeks patients underwent a 2-week washout and crossover and received another 6 weeks of treatment. All patients underwent electromyography at the outset. The short-form McGill pain questionnaire (SF-MPQ) for assessment of pain, and short-form medical outcomes study for assessment of HR-QoL at baseline and at the end of the study were applied. RESULTS: Forty patients completed the 14-week study period. Gabapentin and pregabalin significantly improved SF-MPQ total scores compared with pretreatment values (mean ± SD) [from 18.9 ± 4.3 to 9.3 ± 4.3 for gabapentin, p < 0.001, and from 18.5 ± 3.9 to 9.8 ± 3.6 for pregabalin, p < 0.001]. There was no significant difference between the study drugs in terms of efficacy against neuropathic pain (p > 0.05). Both gabapentin and pregabalin significantly improved HR-QoL at the end of the study compared with pretreatment scores (p < 0.001). CONCLUSION: Our results showed strong efficacy of gabapentin and pregabalin on pain intensity in the given doses. HR-QoL was also significantly improved by both drugs.
Clinical Drug Investigation 04/2013; 33(6). DOI:10.1007/s40261-013-0080-2 · 1.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aim: Pruritus is common in dialysis patients. Peripheral neuropathy is also prevalent in this patient population. However, the role of neuropathy in the genesis of uraemic itch has not been adequately studied to date. Therefore, we aimed to investigate the effects of gabapentin and pregabalin on uraemic pruritus along with neuropathic pain in patients receiving haemodialysis. Methods: This is a 14 week long randomized, prospective, cross-over trial. Haemodialysis patients with established neuropathy and/or neuropathic pain were included. Fifty patients were randomly assigned to gabapentin 300 mg after each haemodialysis session and pregabalin 75 mg daily. After 6 weeks of treatment, cross-over was performed and patients received the other drug for another 6 weeks. Short Form of McGill Pain Questionnaire and Visual Analogue Scale were used to evaluate pain and pruritus, respectively. At each week's visit, patients were interrogated in terms of adverse effects of study drugs. Baseline laboratory data and demographic characteristics were recorded from patient charts. Results: Forty (12 males, 28 females) out of 50 patients completed the study. Mean age was 58.2 +/- 13.7. Overall, 29 out of 40 patients (72.5%) had pruritus symptoms at baseline evaluation. Fifteen patients (37.5%) were diabetic. Thirty-one out of 40 patients (77.5%) had electromyography (EMG)-proven peripheral neuropathy. Twenty three patients (57.5%) had both EMG-proven neuropathy and pruritus. Gabapentin and pregabalin improved both neuropathic pain and pruritus significantly. There was no difference between the study drugs in terms of efficacy against pain and pruritus. Conclusion: Treatment of neuropathic pain with either pregabalin or gabapentin effectively ameliorates uraemic itch.
[Show abstract][Hide abstract] ABSTRACT: Colchicine has been used in a number of disorders. Because colchicine is partially excreted from the kidney, there is a need for dose reduction in case of renal functional impairment. There are no data with regards to safe dosing schedule of colchicine in hemodialysis patients. We aimed to evaluate adverse effects of colchicine use in a hemodialysis cohort. We screened hemodialysis patients who were using colchicine for any reason. All patients were interviewed regarding possible toxicities of colchicine use and were examined with a special focus on neuromuscular system. Creatine kinase and myoglobin were used to detect any subclinical muscle injury or rhabdomyolysis, respectively. Twenty-two maintenance hemodialysis patients who were on colchicine for more than 6 months and 20 control hemodialysis patients not using colchicine were included in the study. Four of 22 patients were using 0.5 mg/day, 4 patients were using 1.5 mg/day, and 14 patients were using 1 mg/day colchicine. Mean duration for colchicine use was 8.9 ± 8.2 years. There was no difference between the groups in terms of myoneuropathic signs and symptoms and blood counts except for white blood cell count, which was significantly higher in patients on colchicine. Serum creatine kinase (56.3 ± 39.5 and 52.1 ± 36.1 for colchicine and control groups, respectively, P = 0.72) and myoglobin (191.4 ± 108.8 and 214.6 ± 83.5 for colchicine and control groups, respectively, P = 0.44) levels were not different between the groups. We conclude that in a small number of haemodialysis patients who were apparently tolerating colchicine, detailed assessment revealed no evidence of sublinical toxicity when compared with controls.
American journal of therapeutics 08/2012; DOI:10.1097/MJT.0b013e31825a364a · 1.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE: In dialysis patients, painful peripheral neuropathy (PPN) is associated with sleep disturbance and mood disorders. Our goal was to compare the effects of gabapentin and pregabalin on improving sleep quality and depression among hemodialysis patients with PPN. METHODS: Fifty hemodialysis patients with PPN were randomized into 2 groups, to receive gabapentin and pregabalin, respectively. After 6 weeks of treatment, patients underwent a 2-week washout period, followed by crossover and another 6 weeks of treatment. All patients underwent electromyography (EMG) at the outset and completed the modified Short Form of McGill Pain Questionnaire (SF-MPQ), the Beck Depression Inventory (BDI) and the Pittsburgh Sleep Quality (PSQI) assessment at baseline and at the end of the study. Forty out of 50 patients completed the 14-week study period. RESULTS: Thirty-one out of 40 patients (77.5 %) had EMG-proven PPN. Both gabapentin and pregabalin significantly improved SF-MPQ, BDI and PSQI scores at the end of the study compared with pretreatment scores (p < 0.001). There was no significant difference between the two drugs in any studied parameter. CONCLUSıONS: Our results showed for the first time a good and similar efficacy of both drugs on pain intensity, quality of sleep and depression in hemodialysis patients with PPN.
International Urology and Nephrology 05/2012; 45(3). DOI:10.1007/s11255-012-0193-1 · 1.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Digital neuropathy is a pure sensory neuropathy of a digital nerve. It may be caused by acute or chronic local trauma or pressure, or accompany systemic illnesses such as rheumatoid disease, leprosy, Raynaud disease, dysproteinemia, or diabetes mellitus. We describe an extraordinary case of digital neuropathy of the median and ulnar nerves caused by Dupuytren contracture.
A 56-year-old right-handed man was presented with numbness and tingling of the little finger of the right and ring finger of the left hand. The clinical and EMG findings in this patient were consistent with a lesion of the median and ulnar palmar digital nerves of the right and left ring and little fingers.
Dupuytren tissue usually affects the palmar fascia, superficial to the digital nerves, and it may rarely affect the spiral cord in the digits. A spiral cord may cause sensory loss due to impingement of digital nerves or Dupuytren tissue may have been compressing the palmar digital nerves against the relatively inelastic deep transverse metacarpal ligament. As a result, digital neuropathy can develop in those with Dupuytren's contracture, and nerve conduction studies should also be performed to determine the condition. New studies are needed to provide better diagnostic criteria for the condition.
The Neurologist 08/2009; 15(4):217-9. DOI:10.1097/NRL.0b013e3181a8c983 · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to elucidate the chronic effects of tobacco smoking on the P300, a neurophysiological index of cognitive function. Prospective study participants were recruited from a family medicine polyclinic. We selected 32 right-handed smokers who had smoked more than 15 cigarettes per day, by inhalation, for more than 2 years. The control population consisted of 32 right-handed, age-matched healthy individuals who had never smoked. Event-related potentials (ERPs) were recorded with the auditory "oddball" two-tone discrimination task. The data from the central (Cz) and frontal (Fz) electrodes were analyzed. The P300 and N1 amplitudes at Fz were lower in the study population compared to the control group. The early component of ERP, the measure of mental speed (N1) latency at Fz was prolonged in the study group compared to the controls, possibly because early cognitive processes such as sensory input or initial encoding of sensory information were delayed in this group. For those who smoke, a decreased N1 amplitude might indicate delayed information processing and possibly short-term memory disturbance. Thus, chronic tobacco smoking may produce prefrontal cognitive dysfunction.
[Show abstract][Hide abstract] ABSTRACT: The main aim of this study is to evaluate the role of blink reflex for early diagnosis of cranial neuropathy in diabetic patients with or without polyneuropathy. Ninety-five diabetic patients were included in the present study for the evaluation of blink reflex. The diabetic patients were divided into two groups according to having diabetic neuropathy or not. Both R1, R2i and R2c latencies in all diabetic patients with or without polyneuropathy were prolonged relative to controls and the differences were statistically significant (p < .001). R1 latencies in diabetic patients with polyneuropathy were prolonged relative to diabetic patients without polyneuropathy and the differences were statistically significant (p < .001). These findings presumably reflect that facial nerve is severly involved in diabetic polyneuropathy. Finally blink reflex is of value in detection of clinically silent intraaxial brainstem functional abnormalities or extraaxial lesions in diabetic patients before peripheral neuropathy.
The International journal of neuroscience 09/2008; 118(9):1287-98. DOI:10.1080/00207450701870378 · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Brucellosis is a common zoonosis in many parts of the world, including Mediterranean and Middle Eastern countries. The disease is primarily related to occupations at risk, such as veterinarians, farmers, laboratory technicians, abattoir workers, and others working with animals and their products. Neurologic complications of brucellosis are quite rare, ranging from 1.7 to 10% of those infected. To date, no cases of neurobrucellosis with hydrocephalus have been reported. A 38-year-old right-handed farmer complained of headaches, nausea, vomiting, gait disturbance, and sweating for 2 days. He also complained of bilateral hearing loss of 4 months duration. On neurologic examination, dysmmetry, dysdiadochokinesis, ataxia on the left, and bilateral sensorineural hearing loss existed. On cranial MRI, a communicating hydrocephalus was noted. Because the patient consumed fresh sheep cheese and was a farmer, brucellosis was considered in the differential diagnosis. Brucella agglutination was positive with a 1/320 titer in the blood and a 1/80 titer in the cerebrospinal fluid. Ceftriaxone, doxycycline, and rifampicin were administered and by the fourth week of treatment, the ataxia was markedly improved, and the patient was able to walk without support. His cranial MRI demonstrated a total regression of the hydrocephalus. As a result, we suggest that neurobrucellosis should be considered in patients with hydrocephalus, especially if they live in an endemic area for brucellosis, even in the absence of other systemic signs.
[Show abstract][Hide abstract] ABSTRACT: Unlike other drugs which act in the region of the synapse, local anesthetics are agents that reversibly block the generation and conduction of nerve impulses along a nerve fiber. This study aims to investigate the comparative inhibitions of bupivacaine and ropivacaine on the frog sciatic nerve. Isolated nerves were transferred to the nerve chamber which includes Ringer's solution. The nerves were stimulated by standard square wave pulse protocols and the responses were recorded with conventional systems. Bupivacaine (n = 8) and ropivacaine (n = 8) were administered in the nerve chamber bath with cumulative concentrations (10(-9) to 10(-3) M) and the effects were monitored for variable time periods (5, 10 and 15 min). Both bupivacaine and ropivacaine significantly depressed the compound action potential (CAP) parameters in a dose-dependent (p < 0.05) and reversible manner. Difference in the effects of these two drugs was detectable only when the dose (> or =10(-5) M) and exposure time (15 min) were increased. Percent inhibitions in maximum derivatives and latency-period measurements have shown that ropivacaine is not only fast but also much more powerful in conduction block for longer and higher doses. Bupivacaine, on the other hand, is effective in the group of fibers with relatively slower conduction velocity for all the measured doses and time periods. In conclusion, ropivacaine has a sensory specific side of action, when compared with the bupivacaine.
Methods and Findings in Experimental and Clinical Pharmacology 06/2007; 29(5):337-41. DOI:10.1358/mf.2007.29.5.1117558 · 0.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In order to get early information on the functional state of smaller myelinated fibers this article investigated the applicability of conduction velocity distribution on compound action potential recorded in experimentally demyelinated frog sciatic nerve. Conduction velocity distribution histograms were estimated by using the mathematical model the authors enhanced. The results suggest that by using appropriate conduction velocity distribution model the diagnosis time in demyelinating neuropathy may be shortened at least three times as compared with conventional conduction velocity assessment. Therefore, it may be concluded that a well-defined model designed for the estimation of the conduction velocity distribution may be used as a diagnostic tool for the early phase of peripheral demyelinating neuropathies.
International Journal of Neuroscience 03/2007; 117(2):203-13. DOI:10.1080/00207450600582496 · 1.53 Impact Factor