Claire Sowerbutt

Many persons with epilepsy have comorbid conditions that are treated with concomitant medications. However, patients for whom first-generation antiepileptic drugs (AEDs) are prescribed have been shown to be at high risk for drug interactions with medications that involve the cytochrome P-450 pathway, specifically antipsychotics, contraceptives, tricyclic antidepressants (TCAs), calcium channel blockers, and warfarin.

During the past decade, a great deal of research has been undertaken to better understand the pathogenesis of neurodegenerative diseases. Data from stroke models has shown that the semisynthetic tetracycline antibiotic minocycline can mediate neuroprotection in neurodegenerative diseases by inhibiting caspase-1 and inducible nitric oxide synthase (iNOS) activity.

Recurrent stroke is an important health concern not only from a patient perspective but also from clinical and public health standpoints. Many studies have shown that the risk of a second cerebral infarction is greatest immediately following the primary event. Consequently, clinical management of stroke survivors is focused on preventive therapy to minimize risk.

Organized and early acute stroke treatment has been shown to improve functional deficits, reduce the need for institutionalization after stroke, and reduce patient mortality. Today, stroke research has evolved to incorporate an integrated, multidisciplinary treatment approach. Data from a study done in 2005 in Ontario, Canada, demonstrate the utility of providing rapid and integrated acute stroke treatment in a real-world setting. The study evaluated functional outcomes associated with rehabilitation services that are part of a flagship stroke treatment program initiated by the Ontario government. The hope for the future is that this approach to patient management will reduce associated health care costs, which are anticipated to increase dramatically in the coming decades.

According to data published by the American Heart Association (AHA) in their 2006 update of heart disease and stroke statistics, "on average, someone in the United States suffers a stroke every 45 seconds."1 Furthermore, the AHA reports, approximately 700,000 persons annually experience a new or recurrent stroke, 88% of which are ischemic: however, only "8% to 12% of ischemic strokes result in death within 30 days." Because the majority of persons survive ischemic stroke, there is a need for a broader armamentarium of thrombolytic therapies than that which currently exists.

Gait deficits following stroke often are disabling and can dramatically reduce a patient's mobility. Affected patients are at high risk for debilitating falls that may result in fractures.

Although cholinesterase inhibitors (ChEIs), specifically donepezil (Aricept), galantamine (Reminyl), and rivastigmine (Exelon), are considered first-line treatment for Alzheimer disease (AD), they are not FDA-approved for use in late-stage disease.