INTRODUCTION: Neuropathic pain poses a therapeutic challenge since it is multifactorial. It is thought to be governed by multiple mechanisms and has various clinical manifestations Current treatments are palliative and require use of different kinds of drugs which include anticonvulsants, tricyclic anti-depressants, non-opiod analgesics and opiods. Neuropathic pain is often highly refractory to treatment, with maximum reductions in pain intensity of 30% to 40% as the norm (2). Lamotrigine inhibits the release of glutamate by stabilizing the neural membrane through blocking activation of voltage-sensitive sodium channels and by inhibiting the presynaptic release of glutamate (3) which acts on the postulated pathophysiologic process of neuropathic pain which is the influx of sodium into the nerves and release of excitatory amino acids particularly glutamate.

OBJECTIVE: To assess the evidence from randomized controlled trials the efficacy of lamotrigine in reducing painful diabetic neuropathy.

DESIGN: Meta-analysis of 3 randomized trials identified through Medline/Pubmed, Google and Cochrane Library (2001 up to present). All comparisons were performed according to intent to treat principle. The studies were analyzed using Review Manager Version 5. Heterogeneity of dichotomous outcome was assessed using the Q test. Data were overviewed with random effects model.

RESULTS: Total of 266 patients with diabetic neuropathy was included. Patients were randomized to receive lamotrigine and placebo. The main outcome measure was changed in the mean a pain intensity score based on the numerical pain scale. Overall assessment showed that lamotrigine is efficacious in reducing painful diabetic neuropathy with a combined mean difference for primary outcome of -0.79 with a 95% confidence interval.

CONCLUSION: Based on this meta-analysis, lamotrigine is an effective and well-tolerated treatment for painful diabetic neuropathy.

Human ; Humans ; Diabetic Neuropathies ; Lamotrigine ; Anticonvulsants ; Glutamic Acid ; Sodium ; Confidence Intervals ; Triazines ; Neuralgia ; Analgesics ; Medline ; Outcome Assessment (health Care) ; Sodium Channels

INTRODUCTION: Posterior Inferior Cerebellar Artery aneurysms are rare and constitute 0.5 to 2% of total aneurysms in the brain. The majority of cases involve aneurysms in the proximal area of the vertebral artery from which the PICA arise (1). Distal PICA aneurysms are even rarer and account for approximately 0.3% of all PICA aneurysms. In a study done by Park et al, only five cases of distal PICA aneurysms were reported among 386 brain aneurysms making it a rare entity. They present typical computed tomography (CT) scan findings, but it can easily be overlooked on initial diagnosis.

CASE PRESENTATION: A 56-year-old female presented with a subarachnoid hemorrhage in the basal cisterns and CP angles associated with compression of the pons and intraventricular extension of the hemorrhage. CT angiography showed saccular, lobulated aneurysm measuring 5.9 x 4.7 x 4.6 cm with a narrow 2mm neck along the right PICA medullary-cranial loop junction accompanied by minimal focal vasospasm of the proximal medullary segment. Patient underwent coiling of the aneurysm. achieving subtotal filing of the aneurysm and there was complete preservation of parent arteries. The patient recovered without neurological sequelae.

DISCUSSION: PICA aneurysms commonly occur in patients in their 5th and 6th decades without gender predilection. The age and sex distribution of PICA aneurysms are similar to those of general aneurysms (1). Our case was in the 5th decade. Symptoms of PICA aneurysms are similar to those of subarachnoid hemorrhage. These symptoms include sudden onset of severe headache, sensorial changes, syncope and meningeal irritation. As in our case, the patient presented with severe headache followed by unresponsiveness. Non-invasive vascular imaging techniques are useful in detecting presence of aneurysm like 3D CT angiography and Magnetic Resonance Angiography. As in our case, a CT angiography became very useful in finding out the exact cause of the subarachnoid hemorrhage and in discovering the exact location of the aneurysm. Outcome of patients with ruptured distal PICA aneurysms is generally favorable; the incidence of rebleeding after rupture of a distal PICA aneurysm is higher than the rebleeding rate of Il intracranial aneurysms (78% vs 34%) (7).

CONCLUSION: When we are confronted with a case of subarachnoid hemorrhage in the fourth ventricle of unknown origin, particular attention should also be made to the distal PICA due to the rare occurrence of aneurysm in the said location.

Human ; Humans ; Female ; Middle Aged ; Intracranial Aneurysm ; Subarachnoid Hemorrhage ; Vertebral Artery ; Magnetic Resonance Angiography ; Computed Tomography Angiography ; Fourth Ventricle ; Incidence ; Filing ; Pica ; Aneurysm, Ruptured ; Pons ; Syncope ; Sex Distribution ; Attention ; Headache

INTRODUCTION: Vertigo is the illusion of motion and as patients age it becomes an increasingly common complaint. Effective symptomatic treatment of chronic and recurrent vertigo remains a difficult therapeutic challenge. Piracetam has been reported to relieve vertigo of both central and peripheral origin. It is a nootropic agent that improves higher cerebral integrative functions and is without sedative or psychostimulant properties.
OBJECTIVE: To describe and assess the evidence from RCTs on the efficacy and tolerability of piracetam among patients with vertigo.
METHODS: This meta-analysis included three RCTs. Comparisons were performed according to intenttreat principle. Data were run through the Comprehensive Meta-analysis software and standard differences in means were determined.
RESULTS: A total of 223 adult patients were included. Treatment tolerability was similar in both piracetam and placebo. Over-all assessment showed a significant favorable outcome among subjects treated with piracetam for the symptomatic relief of vertigo (CI 95%).
CONCLUSION: Piracetam provides symptomatic relief of vertigo among adult patients and is well tolerated and relatively free from adverse events. It diminished the number of exacerbations and improved the background symptoms between episodes and was relevant both in vertigo of central origin and in peripheral vestibular disorders.

Human ; Otorhinolaryngologic Diseases ; ; Ear Diseases ; ; Labyrinth Diseases ; ; Vestibular Diseases ; ; Piracetam ; ; Nootropic Agents ; ; Hypnotics And Sedatives ; ; Illusions ; ; Vertigo ; ; Dizziness ; ; Treatment Outcome