Carbella (carbamazepine IV) / Ligand, Lundbeck - LARVOL DELTA

"@Lundbeck Is carnexiv injection still available in market?" (@MalikHa625)

Trigeminal Neuralgia Crisis - Intravenous Phenytoin as Acute Rescue Treatment. (PubMed, Headache) - "We recommend IV PHT as acute rescue treatment in TN crisis."

Journal • Neuralgia • Pain • Peripheral Neuropathic Pain

[VIRTUAL] Levetiracetam in Management of Bilateral Trigeminal Neuralgia Due to Large Glomus Tumor (AHS 2020) - "She was initially placed on ketamine and lidocaine drip which were later discontinued due to intolerable hallucinations...She was offered dronabinol by APMS, but refused it...Her pain was well controlled with this regimen and she was discharged on carbamazepine, levetiracetam and gabapentin... Large space occupying lesions, such as a glomus tumor in our case can cause bilateral TN that is hard to treat. Levetiracetam may be an option in treatment of trigeminal neuralgia who either are not improved on first line treatments or are unable to tolerate them. Relatively low side effect profile and availability of intravenous formulations are advantages for this medication during exacerbation periods."

CNS Disorders • Epilepsy • Multiple Sclerosis • Neuralgia • Pain

[VIRTUAL] Paroxysmal Sympathetic Hyperactivity in Glioblastoma Multiforme (ATS-I 2020) - "Due to low prevalence and complex pathophysiology, this syndrome is not well understood and often presents as a diagnostic dilemma.A 44-year-old male with a history of glioblastoma multiforme status-post right hemicraniectomy presented to the emergency department with acute encephalopathy and episodic seizure like activity despite being on carbamazepine and levetiracetam...Patient was started on IV labetalol and clonidine maintaining strict control for paroxysmal episodes...Having a high index of suspicion among patients with traumatic brain injury can aid in detecting the presence of this syndrome early in progression of disease. Timely identification can help in preventing delays in receiving appropriate treatment due to repetitive lab testing and might lead to better outcomes."

Brain Cancer • Cardiovascular • CNS Disorders • Critical care • Dystonia • Epilepsy • Glioblastoma • Hematological Disorders • Hypertension • Movement Disorders • Oncology • Solid Tumor • Vascular Neurology

EAN guideline on trigeminal neuralgia. (PubMed, Eur J Neurol) - "Compared with previous TN guidelines, there are important changes regarding diagnosis and imaging. These allow better characterization of patients and help in decision making regarding the planning of medical and surgical management. Recommendations on pharmacological and surgical management have been updated. There is a great need for future research on all aspects of TN, including pathophysiology and management."

Journal • Neuralgia • Pain

"Voriconazole, Ziprasidone mesylate IM, Maropitant, Aripiprazole IM, Posaconazole IV, Carbamazepine IV, Melphalan IV, Carfilzomib IV, Amiodarone premix" (@dfmunozp)

[VIRTUAL] Parry Romberg: neurological manifestations after 20 years (EAN 2020) - "Pain remitted with carbamazepine...She was treated with intravenous methylprednisolone, with no clinical benefit. To our knowledge, this is the 1st PR case with neurological symptoms presenting 20 years after disease onset, when skin atrophy was already stable for the previous 10 years. In our patient, the autoimmune background (thyroiditis) and the presence of oligoclonal bands suggest that an autoimmune mechanism may contribute to the PR pathogeny."

CNS Disorders • Endocrine Disorders • Epilepsy • Immunology • Migraine • Neuralgia • Pain • Strabismus • MRI

Intravenous and Intramuscular Formulations of Antiseizure Drugs in the Treatment of Epilepsy. (PubMed) - CNS Drugs - "The current ASDs were not developed for use in emergency situations, but were adapted from ASDs approved for chronic oral use. New approaches for bringing drugs from experimental models to treatment of human SE are needed."

Journal • Biosimilar • Depression • Epilepsy

Management of Psychotropic Drug-Induced DRESS Syndrome: A Systematic Review. (PubMed) - Mayo Clin Proc - "Based on our review of the literature, we outline management principles that include prompt withdrawal of the causative drug, hospitalization, corticosteroid therapy, and novel treatments, including intravenous immunoglobulin, cyclophosphamide, and cyclosporine, for corticosteroid-resistant DRESS. Finally, we outline strategies for treating comorbid psychiatric illness after a DRESS reaction to the psychotropic medication."

Journal • Review • Biosimilar • Epilepsy

[VIRTUAL] Noninfectious Central Nervous System involvement in Late-Onset Combined Immune Deficiency mimicking Multiple Sclerosis (EAN 2020) - "Carbamazepine treatment obtained pain control... CNS involvement in inmune deficiencies is rare, usually of infectious, granulomatosus cause, or vitamine E deficiency. There are very few cases reported suggestive of autoinmune etiology, mainly spinal cord disease, T-cell defect probably implied. This case mimicks Multiple Sclerosis, with immune involvement supported by mirrored oligoclonal bands."

CNS Disorders • Dyslipidemia • Hypertension • Immunology • Multiple Sclerosis • Neuralgia • Pain • Primary Immunodeficiency

Tocilizumab in New Onset Refractory Status Epilpeticus (NORSE) - A Report of the First Case from India. (AAN 2020) - "Continuous EEG monitoring showed generalized theta range slowing of the background with highly recurrent generalized and multifocal epileptic discharges.Epidemiology-based Mortality Score in Status Epilepticus (EMSE score) was 52.The patient received early and aggressive anticonvulsants including phenytoin,phenobarbitone,valproate,carbamazepine,lacosamide,perampenel,levitiracetam,lamotrigine and topiramate.Immunomodulatory therapy including IV methylprednisolone and IV Immunoglobulin were used.At 62 days of ICU admission,seizures continued despite high doses of intravenous midazolam,thiopentone,ketamine and propofol.Tocilizumab was given at two doses of 200 mg intravenous injection one week apart.Patient's seizures stopped two days after first dose of Tocilizumab.Despite the protracted course of NORSE, patient had a favourable outcome.Presently,at 5 months of follow-up, patient is seizure-free,has subtle memory impairment, no speech problems and no physical..."

Clinical • Alzheimer's Disease • CNS Disorders • MRI

Captisol(R) licensee Lundbeck announces FDA acceptance of NDA submission for carbamazepine IV (The Wall Street Journal) - "Captisol(R) licensee Lundbeck...announced that the U.S. Food and Drug Administration (FDA) has accepted for review a New Drug Application (NDA) for its investigational therapy intravenous carbamazepine...An action letter is anticipated before the end of 2014. Carbella(TM) (carbamazepine) Injection is the proposed U.S. trade name. With acceptance of the NDA filing, Ligand earns a $200,000 milestone payment."

Anticipated PDUFA date • Commercial • NDA • Epilepsy

"Scarbella, baby...." (@DrDavidWarriner)

[Acute Drug Poisoning: Focus on Psychotropic Drugs]. (PubMed) - Seishin Shinkeigaku Zasshi - "To eliminate lithium, hemodialysis is an option. As an antidote to tricyclic antidepressants, the intravenous administration of sodium bicarbonate may be effective."

Journal • Review • Biosimilar • Immunology • Inflammation

Effect of Pterostilbene, a Natural Analog of Resveratrol, on the Activity of some Antiepileptic Drugs in the Acute Seizure Tests in Mice. (PubMed, Neurotox Res) - "The present study was undertaken to assess the effect of PTE on the activity of antiepileptic drugs in the acute seizure tests in mice, i.e., the intravenous pentetrazole (iv PTZ) seizure threshold, maximal electroshock (MES), and 6 Hz-induced psychomotor seizure tests. Our study revealed that PTE enhanced the anticonvulsant effect of clonazepam but did not change the activity of tiagabine in the iv PTZ test. In the MES test, PTE increased the effect of carbamazepine but did not affect the protective properties of topiramate, while in the 6-Hz test, we noted a significant enhancement of the activity of oxcarbazepine, but there were no changes in the activity of valproate...Other studied antiepileptic drugs and their combinations with PTE did not change these parameters. Further studies are required to evaluate the influence of PTE on the activity of anticonvulsant drugs to estimate the safety of using PTE by patients with epilepsy."

Journal • Preclinical • CNS Disorders

An Evaluation of Metabolite Profiling of Six Drugs Using Dried Blood Spot. (PubMed, Xenobiotica) - "In the present study, we investigated the use of DBS for metabolite profiling of genistein, carbamazepine, losartan, sunitinib, sildenafil and zoniporide representing a range of Phase I and Phase II biotransformations following oral and intravenous dosing to rats...3. In summary, this study showed that in addition to PK bioanalytical analysis, DBS samples may also be utilized for metabolite profiling and a comparison of plasma and DBS metabolite profiling can also provide partitioning/association of major circulating metabolites compared to the parent drug even in the absence of a metabolite standard."

Journal

The effect of reamberin on the antioxidant status in children with epilepsy (PubMed, Zh Nevrol Psikhiatr Im S S Korsakova) - "Reamberin significantly reduces the plasma levels of lipid hydroperoxides by 16%, conjugated dienes by 12%, and malondialdehyde by 25% compared with the patients of the control group. An analysis of the effect of succinate-containing drugs on the activity of the antioxidant system components has shown that blood concentrations of ceruloplasmin, vitamin E and catalase are by 35, 14% and 15%, respectively, higher than those in the control group. Thus, the addition of reamberin into the treatment of children with epilepsy should be considered pathogenetically justified, clinically reasonable, and promising."

Clinical • Journal • CNS Disorders • Epilepsy • CAT • CP

Paroxysmal Sympathetic Hyperactivity in Glioblastoma Multiforme (ATS 2020) - "Due to low prevalence and complex pathophysiology, this syndrome is not well understood and often presents as a diagnostic dilemma.A 44-year-old male with a history of glioblastoma multiforme status-post right hemicraniectomy presented to the emergency department with acute encephalopathy and episodic seizure like activity despite being on carbamazepine and levetiracetam...Patient was started on IV labetalol and clonidine maintaining strict control for paroxysmal episodes...Having a high index of suspicion among patients with traumatic brain injury can aid in detecting the presence of this syndrome early in progression of disease. Timely identification can help in preventing delays in receiving appropriate treatment due to repetitive lab testing and might lead to better outcomes."

Evaluation of the anticonvulsant effect of novel melatonin derivatives in the intravenous pentylenetetrazol seizure test in mice. (PubMed, Eur J Pharmacol) - "We aimed further to explore the effect of these melatonin derivatives and the role of melatonin receptors on seizure threshold measured by the timed intravenous pentylenetetrazole (iv PTZ) infusion test in mice. Carbamazepine (CBZ) and melatonin were used as positive controls...Also docking study of 3c, 3f and 3e in the melatonin-binding site of melatonin receptor confirm the possible mechanism of action of these compounds involving melatonin receptors. Our previous and present results suggest that 3c, 3f, and 3e can be considered promising agents with anticonvulsant activity on melatonin receptors in the brain."

Journal • Preclinical

Efficacy and tolerability of mycophenolate mofetil in a pediatric Rasmussen syndrome. (PubMed, Epilepsy Behav Rep) - "A treatment with corticosteroids, intravenous immunoglobulin, and the antiseizure medication (carbamazepine and levetiracetam) did not completely control the seizures. Therefore, the patient was treated with mycophenolate mofetil (MMF), showing a good clinical response, with reduction of the seizures, and stability of the radiological findings. This case suggests the potential utility of MMF in the immune approach to RS."

Clinical • Journal

Mechanisms of Severe Cutaneous Adverse Reactions and a New Treatment Strategy (PubMed, Yakugaku Zasshi) - "Many suspected drugs such as acetaminophen, lamotrigine, allopurinol, and carbamazepine have been reported...Additionally, because the epidermal necrosis has characteristics similar to those of organ rejection after transplantation, the administration of cyclosporine, an immunosuppressant that inhibits helper T cell activation, has been attempted. Further, the administration of the TNF-α inhibitor etanercept has also been reported. This review summarizes current knowledge on the mechanisms of onset of SJS/TEN and their treatments."

Journal • Review

Systemic administration of local anesthetic agents to relieve neuropathic pain. (PubMed, Cochrane Database Syst Rev) - "Lidocaine and oral analogs were safe drugs in controlled clinical trials for neuropathic pain, were better than placebo, and were as effective as other analgesics. Future trials should enroll specific diseases and test novel lidocaine analogs with better toxicity profiles. More emphasis is necessary on outcomes measuring patient satisfaction to assess if statistically significant pain relief is clinically meaningful."

Journal • Review

The number and kind of antiepileptics affect propofol dose requirement for anesthesia: observational study. (PubMed, Odontology) - "Patients were categorized according to the number of antiepileptics (none, single agent, two kinds, and three or more kinds of antiepileptics) and the kind of antiepileptic (carbamazepine, valproate, phenobarbital, phenytoin, zonisamide, clobazam, or topiramate) being received...In particular, valproate and clobazam reduce the propofol dose requirement, while phenobarbital increases this.Clinical trial registration UMIN No. UMIN000014179."

Clinical • Journal • Observational data

Retrospective study of 213 cases of Stevens-Johnson syndrome and toxic epidermal necrolysis from China. (PubMed, Burns) - "The mortality of patients in this study was lower than that predicted by SCORTEN, although there was no significant difference between them. Hyperglycemia, high-dose corticosteroid, and the TBSA were closely related to the infections of patients with SJS/TEN."

Journal • Retrospective data

Efficacy of Intensive Treatment for Intractable Seizures in a Case of Adult-Onset Rasmussen Syndrome (AES 2019) - "Base on the diagnosis, oral corticosteroid, tacrolimus, and repeated infusions of immunoglobulin (IVIg) were administrated...Intravenous methyl prednisolone (IVMP) was also administrated when she exhibited status epilepticus several times a year...Her former AEDs were phenytoin, carbamazepine (CBZ), zonisamide (ZNS), lamotrigine (LTG), and levetiracetam. We challenged cessation of ZNS, dose increase of CBZ and LTG, and addition of clobazam...Conclustions This case highlights the importance of intensive treatment including oral corticosteroid, T-cell inactivating drugs, IVIG, IVMP, VNS, and AEDs for seizure reduction in therapy of patients with adult-onset RS. Especially, in addition to basic immunotherapy, VNS along with the best-adjusted AEDs should be considered in progressive cases."

Clinical • MRI