Öz
Diabetic peripheral neuropathy (DPN) is one of the most frequent chronic pain symptoms. Several therapeutic modalities have been used for the patients with DPN. In recent years, NMDA receptor antagonists for modulation of excitatory transmission at primary afferent spino-thalamic neuron synapses are being used. It has been shown that NMDA receptor antagonists are as effective as opioid analgesics in cases with chronic pain. The aim of this study was to investigate on the pain effectiveness of NMDA receptor antagonist Memantin at two different doses prospectively. Twenty four type 2 diabetic neuropathy patients were included into the study. The diagnosis of diabetic neuropathy was based on clinical signs and symptoms (history, clinical examination of muscle strength, sensorial and deep tendon reflexes), and electrophysiological tests. Pain complaints of the patients were evaluated by using visual pain scala before and after the treatment. Patients were administered 10 mg Memantin for the first week followed by then 20 mg for consecutive 6 week. Without interruption of treatment 30 mg Memantin for one week and then 40 mg Memantin for 6 week were administered. There was a significant improvement in both treatment groups as compared to control group. Between the treatment groups was significant. It was concluted that; Memantin was effective in reducing neuropathic pain in patients with DPN.
Anahtar Kelimeler
Kaynakça
- Harati Y. Diabetic neuropathies: Unanswered questions. Neurol Clin 2007; 25: 303-17.
- Charnogursky G, Lee H, Lopez N. Diabetic neuropathy. Handb Clin Neurol 2014; 120: 773-85.
- Said G. Diabetic neuropathy. Handb Clin Neurol 2013; 115: 579-89.
- Benbow SJ, MacFarlane IA. Painful diabetic neuropathy. Baillieres Best Pract Res Clin Endocrinol Metab 1999; 13: 295-308.
- Martin CL, Albers JW. Pop-Busui R; DCCT/EDIC Research Group. Neuropathy and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care 2014; 37: 31-8.
- Thomas P, Tomlinson D. Diabetic and hypoglycemic neuropathy. In Dyck P, Thomas P, editors: Peripheral Neuropathy. 3rd ed. Philadelphia: W. B. Saunders Company 1993: 1219-50.
- The Diabetes Control and Complications Trial Research Group. The effect of intensive diabetes therapy on the development and progression of neuropathy. Ann Intern Med 1995; 122: 561-8.
- Lipton SA. Failures and successes of NMDA receptor antagonists: Molecular basis for the use of open-channel blockers like memantine in the treatment of acute and chronic neurologic insults. NeuroRx 2004; 1: 101-10.
- Villetti G, Bergamaschi M, Bassani F. Antinociceptive activity of the N-methyl- D-aspartate receptor antagonist N-(2-Indanyl)-glycinamide hydrochloride (CHF3381) in experimental models of inflammatory and neuropathic pain. J Pharmacol Exp Ther 2003; 306: 804-14.
- Gordon DB, Love G. Pharmacologic management of neuropathic pain. Pain Manag Nurs 2004; 5: 19-33.
- Wang S, Lim G, Zeng Q, Sung B, Yang L, Mao J. Central glucocorticoid receptors modulate the expression and function of spinal NMDA receptors after peripheral nerve injury. J Neurosci 2005; 25: 488-95.
- Jensen TS. Anticonvulsants in neuropathic pain: rationale and clinical evidence. Eur J Pain 2002; 6: 61-8.
- Sang CN. NMDA-receptor antagonists in neuropathic pain: Experimental methods to clinical trials. J Pain Symptom Manage 2000; 19: 21-5.
- Lipton SA, Choi Y-B, Takahashi T. Cysteine regulation of protein functionas exemplified by NMDA-receptor modulation. Trends Neurosci 2002; 25: 474-80.
- Sang CN, Booher S, Gilron I, Parada S, Max MB. Dextromethorphan and memantine in painful diabetic neuropathy and postherpetic neuralgia: Efficacy and dose-response trials. Anesthesiology 2002; 96: 1053-61.
- Kirby LC. Memantine in the treatment of diabetics with painful peripheral neuropathy: A placebo-controlled trial. 18th Annual Meeting of the American Academy of Pain Medicine, Feb 26-March 3, San Francisco, California 2002.
Öz
Diyabetik periferal nöropati (DPN) klinik pratikte en sık karşılaşılan kronik nöropatik ağrı semptomlarından birisidir. Diyabetik nöropatili hastalarda çeşitli tedavi yöntemleri denenmektedir. Son yıllarda primer afferent-spinotalamik nöron sinapslarında eksitatör transmisyonun modülasyonu için N-methyl-D-aspartate (NMDA) reseptör antagonistleri kullanılmaktadır. NMDA reseptör antagonistlerinin kronik ağrı durumlarında opioid analjezikler kadar etkin olduğu da gösterilmiştir. Bu çalışmada diabetik polinöropatili hastalarda prospektif olarak NMDA reseptör antagonisti Memantin’in farklı iki dozda, ağrı üzerine olan etkinliğini değerlendirmeyi amaçladık. Tip 2 diyabetli ve diabetik nöropatisi olan 24 hasta çalışmaya dahil edildi. Diyabetik nöropati tanısı klinik (anamnez, motor, duyusal ve refleks muayenesi) ve elektrofızyolojik testler ile konuldu. Hastaların ağrı şikayetleri tedavi öncesi ve sonrası Vizüel Ağrı Skalası (VAS) ile değerlendirildi. Hastalara birinci hafta 10 mg, daha sonra altı hafta boyunca 20 mg memantin verildi. Yedinci hafta sonunda hastalar tekrar değerlendirildi. Tedaviye ara vermeksizin bir hafta 30 mg, daha sonra altı hafta boyunca 40 mg memantin uygulandı. Her iki tedavi grubunda kontrol grubuna kıyasla VAS değerlerinde anlamlı düzelme gözlenirken, tedavi grupları arasındaki farkda önemli bulundu. Sonuç olarak diyabetik polinöropatide Memantin tedavisi nöropatik ağrının tedavisinde düzelme sağlamaktadır
Anahtar Kelimeler
Kaynakça
- Harati Y. Diabetic neuropathies: Unanswered questions. Neurol Clin 2007; 25: 303-17.
- Charnogursky G, Lee H, Lopez N. Diabetic neuropathy. Handb Clin Neurol 2014; 120: 773-85.
- Said G. Diabetic neuropathy. Handb Clin Neurol 2013; 115: 579-89.
- Benbow SJ, MacFarlane IA. Painful diabetic neuropathy. Baillieres Best Pract Res Clin Endocrinol Metab 1999; 13: 295-308.
- Martin CL, Albers JW. Pop-Busui R; DCCT/EDIC Research Group. Neuropathy and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care 2014; 37: 31-8.
- Thomas P, Tomlinson D. Diabetic and hypoglycemic neuropathy. In Dyck P, Thomas P, editors: Peripheral Neuropathy. 3rd ed. Philadelphia: W. B. Saunders Company 1993: 1219-50.
- The Diabetes Control and Complications Trial Research Group. The effect of intensive diabetes therapy on the development and progression of neuropathy. Ann Intern Med 1995; 122: 561-8.
- Lipton SA. Failures and successes of NMDA receptor antagonists: Molecular basis for the use of open-channel blockers like memantine in the treatment of acute and chronic neurologic insults. NeuroRx 2004; 1: 101-10.
- Villetti G, Bergamaschi M, Bassani F. Antinociceptive activity of the N-methyl- D-aspartate receptor antagonist N-(2-Indanyl)-glycinamide hydrochloride (CHF3381) in experimental models of inflammatory and neuropathic pain. J Pharmacol Exp Ther 2003; 306: 804-14.
- Gordon DB, Love G. Pharmacologic management of neuropathic pain. Pain Manag Nurs 2004; 5: 19-33.
- Wang S, Lim G, Zeng Q, Sung B, Yang L, Mao J. Central glucocorticoid receptors modulate the expression and function of spinal NMDA receptors after peripheral nerve injury. J Neurosci 2005; 25: 488-95.
- Jensen TS. Anticonvulsants in neuropathic pain: rationale and clinical evidence. Eur J Pain 2002; 6: 61-8.
- Sang CN. NMDA-receptor antagonists in neuropathic pain: Experimental methods to clinical trials. J Pain Symptom Manage 2000; 19: 21-5.
- Lipton SA, Choi Y-B, Takahashi T. Cysteine regulation of protein functionas exemplified by NMDA-receptor modulation. Trends Neurosci 2002; 25: 474-80.
- Sang CN, Booher S, Gilron I, Parada S, Max MB. Dextromethorphan and memantine in painful diabetic neuropathy and postherpetic neuralgia: Efficacy and dose-response trials. Anesthesiology 2002; 96: 1053-61.
- Kirby LC. Memantine in the treatment of diabetics with painful peripheral neuropathy: A placebo-controlled trial. 18th Annual Meeting of the American Academy of Pain Medicine, Feb 26-March 3, San Francisco, California 2002.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Dahili Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Ekim 2014 |
| Yayımlandığı Sayı | Yıl 2014Cilt: 36 Sayı: 4 |