Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0012833 (dizziness)
 9,689 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The dihydroketo and dihydromonohydroxy analogues of carbamazepine (GP 47680 and GP 47779) were tested against carbamazepine for efficacy and tolerability in 13 patients (6 male and 7 female, mean age 69 years) and 11 patients (5 male and 6 female, mean age 64 years), respectively, all of whom were suffering from trigeminal neuralgia. Both derivatives brought about freedom from symptoms or a marked reduction in the pain in all patients. Onset of effect was observed within 48 h in most cases. For both analogues the effective dose was between 10 and 20 mg/kg body weight in most patients. There was a linear relationship, with a correlation coefficient of 0.83 (n = 36; p less than 0.001), between the doses and the serum level. Doses almost twice as high as those of carbamazepine are needed in order to achieve freedom from symptoms with the carbamazepine analogues. Since unwanted effects, in the form of dizziness and ataxia, occur much less frequently than with carbamazepine, the analogues can be administered in higher doses.
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PMID:Trigeminal neuralgia: its treatment with two new carbamazepine analogues. 354 16

Patients taking anticonvulsant drugs display a broad spectrum of side-effects. Particularly, in the beginning of treatment and with increasing doses of carbamazepine, side effects such as dizziness, ataxia, drowsiness and reduction of alertness occur, which improve some days after the dose has reached a stable level. Our aim was to find objective parameters for grading these side effects and to differentiate between neurophysiological and neuropsychological side effects of carbamazepine in a clinical situation. Twenty-two patients with trigeminal neuralgia were included for a follow-up study with increasing carbamazepine doses (0 mg to 600 mg). The effect of carbamazepine on postural stability was quantified by posturography. Different neuropsychological tests to study cognitive effects of carbamazepine were performed. The composite equilibrium score showed a significant reduction of postural stability with increasing doses of carbamazepine. In sensory analysis the somatosensory ratio was significantly influenced by increased doses of carbamazepine during the study. Mean reaction time of tonic alertness and physical alertness varied significantly with different doses of carbamazepine. There was a significant influence in patients attention during trail making tests and divided attention tests with increase in carbamazepine. In conclusion our observations show that the rate of change of carbamazepine doses is an important determinant of cognitive and motor functions in the phase of increasing doses.
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PMID:Side effects from increased doses of carbamazepine on neuropsychological and posturographic parameters of humans. 921 81

Carbamazepine is a commonly prescribed anticonvulsant medication that affects various levels of the nervous system. We report a case of temporary sensorineural hearing loss in a patient after overdosing with 36 g of carbamazepine. Six days after the overdose, the patient complained of bilateral hearing loss and tinnitus. Audiograms revealed a 30- to 40-dB sensorineural hearing loss bilaterally. Another audiogram 2 weeks later showed a complete recovery in both ears accompanied by a clinical resolution in audiovestibular symptoms. Carbamazepine is used to treat partial and generalized seizures, trigeminal neuralgia, and bipolar illness. Adverse effects are not common but most frequently include dizziness, drowziness, nausea, and skin rashes; rare complications are agranulocytosis, bradycardia, and heart block. Documented hearing loss as a side effect of carbamazepine has not been reported, to our knowledge.
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PMID:Carbamazepine-induced sensorineural hearing loss. 1003 90

This case report first reviews the intracranial tumors associated with symptoms of trigeminal neuralgia (TN). Among patients with TN-like symptoms, 6 to 16% are variously reported to have intracranial tumors. The most common cerebellopontine angle (CPA) tumor to cause TN-like symptoms is a benign tumor called an acoustic neuroma. The reported clinical symptoms of the acoustic neuroma are hearing deficits (60 to 97%), tinnitus (50 to 66%), vestibular disturbances (46 to 59%), numbness or tingling in the face (33%), headache (19 to 29%), dizziness (23%), facial paresis (17%), and trigeminal nerve disturbances (hypesthesia, paresthesia, and neuralgia) (12 to 45%). Magnetic resonance imaging with gadolinium enhancement or computed tomography with contrast media are each reported to have excellent abilities to detect intracranial tumors (92 to 93%). This article then reports a rare case of a young female patient who was mistakenly diagnosed and treated for a temporomandibular disorder but was subsequently found to have an acoustic neuroma located in the CPA.
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PMID:Trigeminal neuralgia due to an acoustic neuroma in the cerebellopontine angle. 1120 49

A 29-year-old woman with symptoms suggestive of trigeminal neuralgia is presented. Because of her age, an intracranial tumor was suspected, but images of a brain computerized tomography scan revealed nothing in particular. A magnetic resonance imaging was scheduled 2 weeks later. However, as the pain increased and occurred more frequently, the patient returned to the hospital 2 days later. After a stellate ganglion block with transient nausea and dizziness, the pain was noticeably relieved. Using magnetic resonance scanning, a tumor in the cerebellopontine angle was discovered, and at surgical resection was diagnosed as an epidermoid tumor. Stellate ganglion block may provide pain relief to some patients who are suspected to have symptomatic trigeminal neuralgia.
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PMID:Pain relief by stellate ganglion block in a case with trigeminal neuralgia caused by a cerebellopontine angle tumor. 1538 97

Topiramate was administered to eight patients with classical trigeminal neuralgia with or without previous symptomatic therapy with other antiepileptic drugs. The topiramate doses ranged from 50 to 100 mg a day, according to the clinical response and the reported side effects. Three patients had complete symptoms remission, three reported moderate improvement, and the treatment was not effective in two. The most frequently registered side effects were dizziness, somnolence and weight loss. Topiramate can be considered an alternative treatment for patients with trigeminal neuralgia.
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PMID:Treatment of trigeminal neuralgia with low doses of topiramate. 1795 82

A 72-year-old male with liver cirrhosis and hepatocellular carcinoma experienced general fatigue. Four days later he was admitted to our hospital because of dizziness, dysbasia and left facial palsy (day 1). On day 6, a neurological examination revealed left trigeminal neuralgia, left medial longitudinal fasciculus (MLF) syndrome, skew deviation, hypacusia, tongue deviation and left limb ataxia. Magnetic resonance imaging of the brain including diffusion-weighted imaging showed previous lacunar infarctions at the left thalamus and pons. The immunological investigation for viral infection in his serum samples showed high titers of IgM antibody against cytomegalovirus (CMV). Cerebrospinal fluid (CSF) investigation revealed mononuclear pleocytosis, elevated protein levels and high titers of IgG antibody against the varicella-zoster virus (VZV). Anti-CMV antibody measurement and CMV-DNA detection by the polymerase chain reaction in CSF revealed that the central nervous system (CNS) was not infected by CMV. We diagnosed this case as brainstem encephalitis following multiple cranial neuropathy associated with CMV and VZV infections. The neurological symptoms gradually improved with aciclovir and prednisolone therapy. The titers of antibody for CMV in his serum samples normalized 4 months later after onset. Although there was no evidence of CMV infection in the CNS was obtained, parainfection or autoimmune mediated responses followed by viral infections might have led to brainstem encephalitis with multiple cranial nerve involvements in our patient.
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PMID:[A case of brainstem encephalitis following multiple cranial neuropathy in a hepatocellular carcinoma patient--association with cytomegalovirus and varicella-zoster virus infection]. 1804 5

Adjuvant analgesics are drugs that are not primarily used as analgesics but can produce analgesia in certain types of pain. Adjuvant analgesics can be administered together with non-opioid and opioid analgesics on each step of the WHO analgesic ladder. They should be given when an additional or specific indication exists, but should not be used as a substitute for a thorough treatment with opioids and nonopioids. Adjuvant analgesics can be classified into groups according to the type of pain to be treated: continuous neuropathic pain or lancinating neuropathic pain, sympathetically maintained pain, bone pain and those for multipurpose use. Adjuvant drugs used for continuous neuropathic pain include local anaesthetics, clonidine, capsaicin, and antidepressants. Tricyclic antidepressants are the group that have been best investigated, and are therefore the drugs of choice. An analgesic effect is probably produced via enhancement of transmitter concentrations in pain-modulating pathways. This occurs at lower doses than those necessary to treat depression. Anticholinergic actions, acute glaucoma, constipation, orthostatic hypotension and cardiac arrhythmias are adverse effects that are seen predominantly with teritiary amine drugs and less often with secondary amine compounds. Initial doses should be small to avoid these adverse effects. Local anaesthetics are used less often, because of the high incidence of side effects (especially with tocainide, flecainide). An analgesic effect has been described in neuropathic pain, however, probably due to membrane stabilization and reduction of aberrant signal conduction. Mexiletine is considered to be the safest local anaesthetic, and should be used initially in small doses (100-150 mg/d). If side effects do not occur, doses can be increased step-wise up to 900 mg/d. Local anaesthetics are indicated for the treatment of severe neuropathic pain; this treatment is contraindicated in patients with cardiac arrhythmias. Systemic or intrathecal clonidine can be tried in neuropathic pain refractory to opioid therapy. The same stands for the topical application of capsaicin in certain types of pain. Lancinating neuropathic pain is an indication for anticonvulsant drugs. Carbamazepine, clonazepam, valproate and phenytoin seem to reduce aberrant signal conduction in damaged nerves in a manner similar to the supression of epileptiform activities in the brain. Common side effects include sedation, dizziness and nausea. Of greater concern are the more severe side effects, such as bone marrow depression (carbamazepine) and hepatotoxicity (phenytoin, valproate). Low initial doses and stepwise increases in dosage, repeated blood counts, and monitoring of plasma levels are helpful in recognizing and avoiding these adverse effects. Baclofen, a GABA agonist primarily used for spasticity, is effective in the treatment of trigeminal neuralgia and is often used in the management of lancinating pain of unspecific origin. The initial dosage is 10-15 mg/d, increasing to 30-90 mg/d, or higher. If neural blockade fails to reduce sympathetically maintained pain sufficiently specific adjuvants can be used. Sympatholytic drugs, e.g. phenoxybenzamine (60-120 mg/d) or prazosin, can be administered to patients without major cardiovascular dysfunction. There is experimental evidence of the involvement of calcium channels in nociception, and a beneficial clinical effect of nifidepine in reflex sympathetic dystrophy (RDS) has been demonstrated. Bone pain is common in tumor patients and can often be treated effectively with non-steroidal anti-inflammatory drugs. Biphosphonates (etidronate, clodronate, pamidronate derivates) also produce analgesic effects in patients with bone metastases. However, differences among the various compounds have not been clearly evaluated yet. Potent and specific radioisotopes are still under development and the use of calcitonin in bone pain is considered controversial.
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PMID:[Pharmacotherapy of cancer pain. 3. Adjuvant drugs.]. 1841 35

A 47-year-old woman developed intermittent shooting pain around the right side of the nose and eyes. A neurologist initially diagnosed trigeminal neuralgia, but carbamazepine did not improve the pain. Two months later, she presented with a pus-like eye discharge and was referred to us for further examination. Poor saline irrigation from the lacrimal puncta and computed tomography findings of a swollen lacrimal sac indicated a diagnosis of lacrimal dacryostenosis. At this point, the pain and dizziness as a side effect of carbamazepine had become intolerable. Endoscopic intranasal dacryocystorhinostomy confirmed stenosis of the nasolachrymal duct and a thickened lacrimal sac. The postoperative course was uneventful, and the facial pain disappeared. This experience suggests the importance of recognizing lacrimal dacryostenosis as a differential diagnosis of facial pain around the eyes and nose. We also recommend a review of an original diagnosis of trigeminal neuralgia if carbamazepine fails to relieve facial pain.
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PMID:Lacrimal dacryostenosis with severe facial pain misdiagnosed as trigeminal neuralgia. 2157 63

Most patients suffering from trigeminal neuralgia (TN) benefit from medical therapy, for example carbamazepin, gabapentin, and pregabalin, individually or in combination. Nonetheless, some patients experience severe and intractable pain despite such medication, or the medication eliminates their pain but they experience intolerable side effects sufficient to warrant discontinuation. Intravenous magnesium and lidocaine have been used for management of intractable neuropathic pain. We treated nine patients with TN by using an intravenous infusion of a combination of 1.2 g magnesium and 100 mg lidocaine for 1 hour, once a week for 3 weeks. All patients experienced sound pain relief after the combined intravenous infusion therapy. Two patients experienced short and mild dizziness after the therapy, but no severe side effects were reported.
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PMID:Intravenous lidocaine and magnesium for management of intractable trigeminal neuralgia: a case series of nine patients. 2371 13


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