- Email: [email protected]
345 New drugs in paediatric neurology (other than anti-epileptic drugs)
Al9
Abstracts findings of hypoxic-ischaemic symptoms of the central nervous system were the indications for introducing Cavinton. Contraindications for using that drug were IVH/PVH or coagulation disturbances. Cavinton in the dose of l-2mg/kg was administered intravenously for 14-21 days. The treatment was continued orally and 24mg/kg of Cavinton were given for at least 6 months. The earliest intravenous infusions of Cavinton were introduced on the 2nd day of life. In newborns with low and very low birthweight (4843.1% of studied children) intravenous infusions were given at 34 weeks corrected age at the earliest. Results: Hepatic and renal function as well as red and white blood cell counts during several months of administering the drug were normal. Adverse events in the form of allergic reactions were stated in 1 (0.7%) patient. In all infants rehabilitation was introduced. Psychomotor development was evaluated in the studied group. Cerebral palsy was diagnosed in 33 (22.9%) children treated with Cavinton. Cavinton is a safe drug for preterm and term newborns and can be given in treatment of periventricular leucomalacia and hypoxic-ischaemic encephalopathy. Conclusion:
345 New drugs in paediatric anti-epileptic drugs)
neurology
(other than
0 EEC-OLOFSSON Department Paediatrics, Sweden
of Women’s and Children’s Health, Section for University Children’s Hospital, Uppsala,
The panorama of paediatric neurology disorders is dominated by epilepsies and other seizure manifestations (3040%), and the last decade has shown a number of new drugs on the market. The offer is not quantitatively the same for the remaining paediatric neurology disorders. These comprise diseases affecting the central nervous system as malformations including dysgenesias, infections, trauma and tumours, and conditions which are symptoms of an underlying central nervous system disorder. In the last-mentioned group cerebral palsy, mental retardation, learning difficulties, dyslexia, attention-deficit hyperactivity disorder/disorder of attention, motor control and perception, and pervasive developmental disorders including autism can be mentioned. A rather frequent condition of the paediatric neurology panorama is chronic headache of migraine and tension type, and neuromuscular disorders including periodic paralyses are not rare. Less frequent conditions are cerebrovascular, neurometabolic and neurodegenerative disorders. This review of new drugs will consider mainly chronic headache, behavioural disorders, pervasive developmental disorders and neuromuscular disorders, but some of the other conditions will also be mentioned. Finally some words concerning ongoing drug trials will be presented.
392 Protection of the developing white matter by systemic injection of melatonin I HUSSON,
P EVRARD, P CRESSENS
Laboratoire de Neurologie du De’veloppement, H6pital Robert Deb&, Paris, France
Periventricular leukomalacia, occurs often in premature newborns and still remains one of the main causes of cerebral palsy. The pathophysiology of perinatal white matter lesions remains unclear but may involve glutamate excitotoxicity and free radical production. The glutamatergic analogue ibotenate injected intracerebrally into newborn mice induces cortical plate lesions and white matter cysts that mimic human periventricular leukomalacia. We used this murine model to test the neuroprotective effect of melatonin, a well known free radical scavenger. Intraperitoneal injection of melatonin (5 pg-5 mg/kg) protected the white matter but not the cortical plate against ibotenate-induced lesions. Although melatonin did not prevent the initial appearance of white matter lesion, it promoted a secondary repair of this lesion. Demonstration of axonal re-growth confirmed the repair phenomenon. Luzindole, a competitive melatonin receptor antagonist, completely abolished the neuroprotective effect of melatonin, suggesting a key role of melatonin receptors in the present study. In the same excitotoxic model, the administration of N-acetylcysteine, a pure anti-oxidant drug, yielded a protection of both the cortical plate and the white matter. These data further support the hypothesis that, in the present model, anti-oxidant properties of melatonin are not playing a major role in its neuroprotective properties. Altogether, the present data demonstrate that systemic administration of melatonin protects the periventricular white matter against excitotoxic damage in a mouse model of human periventricular leukomalacia. Melatonininduced neuroprotection seemed to be mediated by specific melatonin receptors and involved a mechanism of white matter repair. Further studies will have to determine the involved receptor subtype as well as the underlying molecular mechanisms. Melatonin, which is widely used in several countries without any reported serious side-effects, may have therapeutic potential in premature babies at high risk of periventricular leukomalacia.
408 Thalamic pain syndrome treated with gabapentin F PLAISANT, D SAMARA, N LEMARECHAL, P CASTELNAU Service de Neurologie Pe’diatrique et des Maladies Me’taboliques CAP-HP), Faculte’ de Mt5decine XavierBichat, H6pital Robert Debre Paris, France
Anti-epileptic drugs usually show remarkable efficacy for the treatment of peripheral neuropathic pain syndrome. In contrast results are rather poor in cases of central post-stroke pain syndromes. We report the case of a 14-year-old girl who presented a typical DejerineRoussy syndrome, probably related to an episode of hypertension, that responded only to gabapentin.
Abstracts findings of hypoxic-ischaemic symptoms of the central nervous system were the indications for introducing Cavinton. Contraindications for using that drug were IVH/PVH or coagulation disturbances. Cavinton in the dose of l-2mg/kg was administered intravenously for 14-21 days. The treatment was continued orally and 24mg/kg of Cavinton were given for at least 6 months. The earliest intravenous infusions of Cavinton were introduced on the 2nd day of life. In newborns with low and very low birthweight (4843.1% of studied children) intravenous infusions were given at 34 weeks corrected age at the earliest. Results: Hepatic and renal function as well as red and white blood cell counts during several months of administering the drug were normal. Adverse events in the form of allergic reactions were stated in 1 (0.7%) patient. In all infants rehabilitation was introduced. Psychomotor development was evaluated in the studied group. Cerebral palsy was diagnosed in 33 (22.9%) children treated with Cavinton. Cavinton is a safe drug for preterm and term newborns and can be given in treatment of periventricular leucomalacia and hypoxic-ischaemic encephalopathy. Conclusion:
345 New drugs in paediatric anti-epileptic drugs)
neurology
(other than
0 EEC-OLOFSSON Department Paediatrics, Sweden
of Women’s and Children’s Health, Section for University Children’s Hospital, Uppsala,
The panorama of paediatric neurology disorders is dominated by epilepsies and other seizure manifestations (3040%), and the last decade has shown a number of new drugs on the market. The offer is not quantitatively the same for the remaining paediatric neurology disorders. These comprise diseases affecting the central nervous system as malformations including dysgenesias, infections, trauma and tumours, and conditions which are symptoms of an underlying central nervous system disorder. In the last-mentioned group cerebral palsy, mental retardation, learning difficulties, dyslexia, attention-deficit hyperactivity disorder/disorder of attention, motor control and perception, and pervasive developmental disorders including autism can be mentioned. A rather frequent condition of the paediatric neurology panorama is chronic headache of migraine and tension type, and neuromuscular disorders including periodic paralyses are not rare. Less frequent conditions are cerebrovascular, neurometabolic and neurodegenerative disorders. This review of new drugs will consider mainly chronic headache, behavioural disorders, pervasive developmental disorders and neuromuscular disorders, but some of the other conditions will also be mentioned. Finally some words concerning ongoing drug trials will be presented.
392 Protection of the developing white matter by systemic injection of melatonin I HUSSON,
P EVRARD, P CRESSENS
Laboratoire de Neurologie du De’veloppement, H6pital Robert Deb&, Paris, France
Periventricular leukomalacia, occurs often in premature newborns and still remains one of the main causes of cerebral palsy. The pathophysiology of perinatal white matter lesions remains unclear but may involve glutamate excitotoxicity and free radical production. The glutamatergic analogue ibotenate injected intracerebrally into newborn mice induces cortical plate lesions and white matter cysts that mimic human periventricular leukomalacia. We used this murine model to test the neuroprotective effect of melatonin, a well known free radical scavenger. Intraperitoneal injection of melatonin (5 pg-5 mg/kg) protected the white matter but not the cortical plate against ibotenate-induced lesions. Although melatonin did not prevent the initial appearance of white matter lesion, it promoted a secondary repair of this lesion. Demonstration of axonal re-growth confirmed the repair phenomenon. Luzindole, a competitive melatonin receptor antagonist, completely abolished the neuroprotective effect of melatonin, suggesting a key role of melatonin receptors in the present study. In the same excitotoxic model, the administration of N-acetylcysteine, a pure anti-oxidant drug, yielded a protection of both the cortical plate and the white matter. These data further support the hypothesis that, in the present model, anti-oxidant properties of melatonin are not playing a major role in its neuroprotective properties. Altogether, the present data demonstrate that systemic administration of melatonin protects the periventricular white matter against excitotoxic damage in a mouse model of human periventricular leukomalacia. Melatonininduced neuroprotection seemed to be mediated by specific melatonin receptors and involved a mechanism of white matter repair. Further studies will have to determine the involved receptor subtype as well as the underlying molecular mechanisms. Melatonin, which is widely used in several countries without any reported serious side-effects, may have therapeutic potential in premature babies at high risk of periventricular leukomalacia.
408 Thalamic pain syndrome treated with gabapentin F PLAISANT, D SAMARA, N LEMARECHAL, P CASTELNAU Service de Neurologie Pe’diatrique et des Maladies Me’taboliques CAP-HP), Faculte’ de Mt5decine XavierBichat, H6pital Robert Debre Paris, France
Anti-epileptic drugs usually show remarkable efficacy for the treatment of peripheral neuropathic pain syndrome. In contrast results are rather poor in cases of central post-stroke pain syndromes. We report the case of a 14-year-old girl who presented a typical DejerineRoussy syndrome, probably related to an episode of hypertension, that responded only to gabapentin.