Central post-stroke pain (CPSP) is a chronic pain disorder resulting from a lesion or dysfunction of the central nervous system. Previously known as the “thalamic syndrome”, CPSP has been shown in early post-mortem studies and modern imaging techniques to also occur in extrathalamic lesions.
Frequent co-existing pain in stroke patients and variability in onset, presentation and intensity of CPSP, as well as the lack of diagnostic criteria, makes diagnosis of this disorder complex. Currently, the Western Australian Therapeutic Advisory Group recommends tricyclic antidepressants as the first line treatment for CPSP and lamotrigine as the second line approach.
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The 2009 RGH E-Bulletins are archived here.
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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
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The first of the RGH E-Bulletins for 2010 is now out.
Recent evidence shows that the maximum risk is within the first few days after a TIA. One study has shown that for a period of 90 days after a TIA, the risk of stroke is 10.5%, with half of these patients suffering stroke within 48 hours.
Rapid initiation of treatment leads to better outcomes.
The EXPRESS observational study of specialist outpatient TIA management demonstrated that early pharmacotherapy (reducing the median delay to first prescription from 20 days to 1 day) as part of urgent assessment and treatment was associated with a significant lowering of the risk of recurrent stroke at 90 days from 10.3% to 2.1%.
Patients with TIA and associated high -grade carotid stenoses receiving early surgical intervention within two weeks have better secondary stroke prevention outcomes than those receiving later surgery.
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The impact of statins in stroke risk in patients with a history of cerebrovascular disease had been recently evaluated in the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol) trial which was published in 2006. A total of 4731 patients with a stroke or TIA within one to six months were included, other inclusion criteria included LDL levels of 2.6 to 4.9 mmol/L, and absence of coronary heart disease. Patients were randomly assigned to atorvastatin 80mg or placebo and were followed up for a median of 4.9 years with a primary end point being the first nonfatal or fatal stroke.
The SPARCL trial has found that statins exert beneficial effects in reducing occurrence of overall stroke. When subtypes of strokes were analysed, statins were associated with a reduction of ischemic stroke but also a significant increase in haemorrhagic stroke risk. Similar results were observed in a subgroup of patients with a history of cerebrovascular disease in the Heart Protection Study in which the use of statins increased the occurrence of haemorrhagic stroke without an effect on overall stroke incidence.
The rest of the RGH E-Bulletin can be read here.
A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.
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