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Muscle Ion Channel Diseases Rehabilitation Article

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Muscle Ion Channel Diseases Rehabilitation Article ISSN 1473-9348 Volume 3 Issue 1 March/April 2003 ACNR Advances in Clinical Neuroscience & Rehabilitation journal reviews • events • management topic • industry news • rehabilitation topic Review Articles: Looking at protein misfolding neurodegenerative disease through retinitis pigmentosa; Neurological complications of Behçet’s syndrome Management Topic: Muscle ion channel diseases Rehabilitation Article: Domiciliary ventilation in neuromuscular disorders - when and how? WIN BOOKS: See page 5 for details www.acnr.co.uk COPAXONE® WORKS, DAY AFTER DAY, MONTH AFTER MONTH,YEAR AFTER YEAR Disease modifying therapy for relapsing-remitting multiple sclerosis Reduces relapse rates1 Maintains efficacy in the long-term1 Unique MS specific mode of action2 Reduces disease activity and burden of disease3 Well-tolerated, encourages long-term compliance1 (glatiramer acetate) Confidence in the future COPAXONE AUTOJECT2 AVAILABLE For further information, contact Teva Pharmaceuticals Ltd Tel: 01296 719768 email: [email protected] COPAXONE® (glatiramer acetate) PRESCRIBING INFORMATION Presentation Editorial Board and contributors Glatiramer acetate 20mg powder for solution with water for injection. Indication Roger Barker is co-editor in chief of Advances in Clinical Reduction of frequency of relapses in relapsing-remitting multiple Neuroscience & Rehabilitation (ACNR), and is Honorary sclerosis in ambulatory patients who have had at least two relapses in Consultant in Neurology at The Cambridge Centre for Brain Repair. He trained in neurology at Cambridge and at the the preceding two years before initiation of therapy. National Hospital in London. His main area of research is into Dosage and administration neurodegenerative and movement disorders, in particular 20mg of glatiramer acetate in 1 ml water for injection, administered sub- parkinson's and Huntington's disease. He is also the university cutaneously once daily. Initiation to be supervised by neurologist or lecturer in Neurology at Cambridge where he continues to develop his clinical experienced physician. Supervise first self-injection and for 30 minutes after. research into these diseases along with his basic research into brain repair using Children neural transplants. Not recommended under 18 years of age. Alasdair Coles is co-editor of ACNR and contributes our Elderly Anatomy Primer.He is a Wellcome Advanced Fellow working on No specific data. experimental immunological therapies in multiple sclerosis, Impaired renal function based at the Dunn School of Pathology in Oxford and No specific studies. Monitor renal function during treatment. Department of Neurology in Cambridge. Consider possibility of deposition of immune complexes. Contra-indications Stephen Kirker is the editor of the Rehabilitation section of Known allergy to glatiramer acetate or mannitol (excipient). Pregnancy. ACNR and Consultant in Rehabilitation Medicine in Special warnings and precautions Addenbrooke's NHS Trust, Cambridge. He graduated from Sub-cutaneous use only. One or more of vasodilatation, chest pain, Trinity College, Dublin in 1985 and trained in neurology in dyspnoea, palpitations or tachycardia may occur within minutes after Dublin, London and Edinburgh before moving to rehabilitation in injection. These generally resolve spontaneously after a short time. If Cambridge and Norwich. His main research has been into pos- severe, treat symptomatically. Caution in patients with pre-existing tural responses after stroke. His particular interests are in pros- thetics, orthotics, gait training and neurorehabilitation. cardiac disorders. Review such patients regularly. Rarely convulsions and/or anaphylactic or allergic reactions. Rarely, hypersensitivity David J Burn is the editor of our conference news section (bronchospasm, anaphylaxis or urticaria). If severe, treat appropriate- and Consultant and Senior Lecturer in Neurology at the ly and discontinue Copaxone. Regional Neurosciences Centre, Newcastle upon Tyne. He Interactions qualified from Oxford University and Newcastle upon Tyne Medical School in 1985. His MD was in the functional imaging No formal evaluation. Increased incidence of injection-site reactions of parkinsonism. He runs Movement Disorders clinics in with concurrent corticosteroids. Theoretical potential to affect distri- Newcastle upon Tyne and Sunderland. Research interests bution of protein-bound drugs, therefore concomitant use of these include progressive supranuclear palsy and dementia with Lewy bodies. He is should be monitored. also involved in several drugs studies for Parkinson's Disease. Pregnancy and lactation Andrew Larner is the editor of our Book Review Section. He Not to be used in pregnancy. Consider contraceptive cover. No data is a Consultant Neurologist at the Walton Centre for on excretion in human milk. Neurology and Neurosurgery in Liverpool, with a particular Undesirable effects interest in dementia and cognitive disorders. He is also an Injection-site reactions (particularly erythema, hypersensitivity, pain, Honorary Apothecaries' Lecturer in the History of Medicine at mass, pruritus, inflammation, oedema) are common and usually mild. the University of Liverpool. An immediate post-injection reaction (one or more of vasodilatation, Wojtek Rakowicz is a Specialist Registrar in Neurology.After chest pain, dyspnoea, palpitation, tachycardia) was reported at least once training in Norwich and Cambridge he worked in the in controlled trials by 41% on Copaxone and 20% on placebo. Other Neuromuscular Division at Washington University in St Louis. reactions reported from clinical trials with a frequency greater than He is currently at the National Hospital for Neurology and 1 in 10 include flu-like syndrome, asthenia, back pain, headache, Neurosurgery. constipation, diarrhoea, nausea, arthralgia, anxiety, depression, dizziness, hypertonia, rash and sweating. Rarely, anaphylactoid or allergic reactions and convulsions. Rarely shifts in white blood cell counts and elevated Alastair Wilkins is Specialist Registrar in Neurology in East Anglia. He trained in Cambridge, Sheffield and London, and has levels of liver enzymes, no evidence of clinical significance. just finished a PhD investigating potential mechanisms of axon Overdose loss in multiple sclerosis. Monitor, treat symptomatically. Pharmaceutical Precautions Store Copaxone in refrigerator (2°C to 8°C). May store in refrigerator after reconstitution for up to eight hours. Legal Category: i Package Quantity and Basic NHS Cost 28 vials of Copaxone plus 28 ampoules of water for injection: £510.14. Copaxone administration package, including syringes and needles A World Conference on living with learning difficulties supplied free of charge. Edinburgh International Conference Centre Edinburgh Scotland Product Licence Number 10921/0019 2nd & 3rd April 2003 Further Information www.mind-field.org Further medical information available on request from Aventis Pharma Limited, 50 Kings Hill Avenue, Kings Hill, West Malling, Kent, ME19 A conference designed for parents, teachers, experts – and especially to improve the 4AH. Other enquiries to: Teva Pharmaceuticals Limited, Barclays House, prospects of the 4-5 children in every class who have some form of learning difficulty. 1 Gatehouse Way, Aylesbury, Bucks, HP19 8DB. Fee deliberately low for parents and teachers (£50) and Date of Review: December 2001. even lower for students. Other professionals £195 plus VAT. Date of Preparation: August 2002. For more info contact Mindfield References: E-mail: [email protected] 1. Johnson KP et al. Multiple Sclerosis 2000; 6: 255-266. Telephone: 0131-653-6235 2. Neuhaus O et al. Neurology 2001; 56: 702-708. Web: www.mind-field.org 3. Comi CG et al. Annals Neurology 2001; 49(3): 290-297. ACNR • VOLUME 3 NUMBER 1 MARCH/APRIL 2003 3 ADJUNCTIVE THERAPY FOR PARTIAL SEIZURES IN ADULTS WITH EPILEPSY CONFIDENCE. BY KEPPRA. ADD-ON THERAPY STARTS WITH CONNECTING EFFICACY WITH TOLERABILITY IN AN EASY-TO-USE AED1 KEPPRA® Prescribing Information: daily did not affect the pharmacokinetics of oral contraceptives (ethinyl-estradiol and levonorgestrel). Levetiracetam Please read Summary of Product Characteristics (SPC) before prescribing. 2,000 mg daily did not affect the pharmacokinetics of digoxin and warfarin and prothrombin times were not mod- Presentation: Keppra 250, 500 and 1,000 mg film-coated tablets containing 250, 500 and 1,000 mg levetiracetam ified. Pregnancy and lactation: Should not be used during pregnancy unless clearly necessary. Breast-feeding respectively. Uses: Adjunctive therapy in the treatment of partial onset seizures with or without secondary gener- not recommended. Driving, etc: Caution recommended when performing skilled tasks, e.g. driving vehicles or alisation in patients with epilepsy. Dosage and administration: Adults and adolescents older than 16 years: The operating machinery. Undesirable effects: Incidence of undesirable effects considered to be at least possibly initial therapeutic dose is 500 mg twice daily which can be started on the first day of treatment. Depending upon related in controlled clinical studies: Very common (>10%): asthenia, somnolence. Common (between 1%-10%): GI clinical response and tolerability can be increased up to 1,500 mg twice daily. Dose changes can be made in 500 disturbances, anorexia, accidental injury, headache, dizziness, tremor, ataxia, convulsion, amnesia, emotional mg twice daily increments or decrements every two to four weeks. Elderly: Adjustment of the dose is recom- lability,
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