Posted by hub (209.183.93.192) on October 19, 2000 at 07:32:16:
In Reply to: New treatment (really!) for CH in Italy. ---- Doc Greg, read please! posted by Riccardo on October 19, 2000 at 04:20:47:
This is a literal translation:
Luciano Lodoli * George D' Este ** Rome 1998 Words key: Cefalea to cluster, Metilprednisolone. Reassumed The cefalea to cluster is one of the most frightening benign affections, that in consideration of the gravity of the pain associated to attacks that they characterize it. The every day therapy with cortisonici to dosage moderated, extended until twenty - thirty days, it has been demonstrated partially effective but it places problems for the correlated effects collaterals. To leave from the observation of some cases dealt with metipredisolone to high dosage in only sitting, in which the extinction of the cluster of cefalee in course has been taken place, the authors obtained year turned out a lot promising applying the introduced terapeutico outline in this job in a small selected group of patients. The obtained result are to warning of the deserving authors of being verified with one controlled study multicentric. 1- Premised Generality the cefalea to cluster is periodic a parossistica headache, very characterized is for how much concerns the symptomatology, is as far as the chronological estrinsecazione. The painful accesses are of elevated intensity, much to prostrare the patient strictly, although their duration does not exceed of norm the thirty minuteren. E' rare affection since, in nearly all the casuistries, remains to the disotto of the three for the one hundred of all essential cefalee. It hits five times more frequently the males regarding the females. Diagnosis does not place difficulty provided that it is proceeded to one taken care of collection of the anamnestici data is generals who specific for the emicraniche syndromes. The following conditions are of norm satisfied: age of appearance: 30-40 years (with ends from 10 to 50 years); cluster: with of it attacks more painful that is introduced, with frequency of one or to the day, of norm to the same hour (circadian rhythm), for venti-trenta days, one or more times the year often in the same season (rhythm circaannuale) or, more very rarely, every due-tre years;
2- the therapy today more asserted The serious and reiterante parossistico pain constitutes main the nosologico aspect of the cefalea to cluster; such pain can transitorily upset even if the life of the patient. In therapy two objectives are pursued: the extinction of the single attack and the extinction of the cluster in course. Therapy of extinction of the attack: The possibilities of farmacologico treatment of the single ones attack are today much good ones for the patients who sopportano good the effects collaterals of the sumatripan for iniettiva way. Some patients assert of giovarsi also of the assumption of this drug for oral way. The sumatripan he is however much expensive and not employable one in you outlined of attacks or the cluster for its possible toxicity in protratta assumption. Therapy of extinction of the cluster: it has been put into effect with some result one you outlined with litio carbonate inducing one litiemia of 0.6-1.2 mEq/l. But, given the long latenza in the induction of the terapeutico effect that characterizes the litio more (than 15 days), this treatment it cannot already be useful for a cluster of normal duration in course. An alternative to the litio, profit also to dealing a cluster already in course is represented from the employment of cortisonici for os or parenterale way for all the duration of the cluster. As an example: metilprednisolone 50 mg/die or betametasone 8-12 mg/die. Such extended treatment, also if not lacking in some effectiveness, is burdened from the important risk undesired effects and can be contraindicated in numerous patients. Very many other drugs have been proposals but nobody has given turned out favorable very demonstrated. 3- New treatment of extinction of the cluster with succinato bolus to farmacologica dose of metilprednisolone sodio in only sitting In the september of 1986 a patient of 3änni came to our observation, in state of serious prostrazione and intolerance because, from four or five days, in preda to two she attacks every day emicranici, apparte Modality of somministrazione: 30 mg of metilprednisolone sodio succinato for Kg of weight of the patient, melted in 500 mililiter of solution of glucosio to 5%, instilled for venosa way, in 45-60 minuteren. Treatment of eventual attacks residual: they can be dealt with sumatripan or other drug of tried effectiveness and tollerabilità for the single patient. To the current state it appears not advisable to reimpiegare corticosteroidi in the course of the same cluster in case of insufficient effect obtained with the first somministrazione to farmacologica dose. Bibliography Couch JR Jr, ET to. " Prednisone therapy for cluster headache " Headache. 1978 Sep; 18(4): 219-221. Kudrow L. " Cluster headache: diagnosis and management " Headache. 1979 Apr; 19(3): 142-150. Sicuteri F. ET al. in EMI, modernization I, 1990, USES, Florence, 1392-1410 ______________________________________________________________________ * Medical Specialist surgeon in Anesthesiology and Specialist Resuscitation in Tisiologia and Malattie of the Respiratorio apparatus already of the Service of Anesthesia and Resuscitation and Service of TerapiaAntalgica of the Saint Hospital Giovanni of Rome " Diagnostic Center " Rome, via Pigafetta 1, 00154 Rome Luciano 00138 Lodoli http://space.tin.it/medicina/llodol > Rome, climb of Castel Giubileo 15 ** Anesthesia Service and Resuscitation of the Company Saint Hospital worker Giovanni Given pain of Rome