topiramate and Spinal-Cord-Injuries

Painful ejaculation (PE) is an uncommon condition and it is usually associated with prostatitis, chronic pelvic pain syndrome, benign prostatic hyperplasia, ejaculatory duct obstruction, radical prostatectomy, and prostate radiation. Topiramate (TPM) is a new antiepileptic drug with recognized efficacy in neuropathic pain.. The study is aimed to evaluate TPM efficacy in ejaculation pain.. Following a spinal cord injury, a 53-year-old man was referred to our institute for persistent PE. Neurological examination showed mild hypoesthesia of the genital area. Urogenital examination, neurophysiological tools, and computed tomography of the dorso-lumbar spine were normal.. The main outcome measure was the visual analogue scale.. Since pain was refractory to conventional neuropathic pharmacological therapies, TPM was introduced up to 150 mg daily with a dramatic improvement of PE.. TPM may be considered as a valid therapeutic option for the treatment of PE.

Topics: Anticonvulsants; Ejaculation; Fructose; Humans; Male; Middle Aged; Neuralgia; Spinal Cord Injuries; Topiramate

Excess glutamate release and associated neurotoxicity contributes to cell death after spinal cord injury (SCI). Indeed, delayed administration of glutamate receptor antagonists after SCI in rodents improves tissue sparing and functional recovery. Despite their therapeutic potential, most glutamate receptor antagonists have detrimental side effects and have largely failed clinical trials. Topiramate is an AMPA-specific, glutamate receptor antagonists that is FDA-approved to treat CNS disorders. In the current study we tested whether topiramate treatment is neuroprotective after cervical contusion injury in rats. We report that topiramate, delivered 15-minutes after SCI, increases tissue sparing and preserves oligodendrocytes and neurons when compared to vehicle treatment. In addition, topiramate is more effective than the AMPA-receptor antagonist, NBQX. To the best of our knowledge, this is the first report documenting a neuroprotective effect of topiramate treatment after spinal cord injury.

Topics: Analysis of Variance; Animals; Apoptosis; Cervical Vertebrae; Excitatory Amino Acid Antagonists; Female; Fructose; Grooming; Histological Techniques; Movement; Neuroprotective Agents; Oligodendroglia; Quinoxalines; Rats; Rats, Long-Evans; Spinal Cord Injuries; Topiramate

Pain following spinal cord injury (SCI) has proved difficult to treat. Although the use of antiepileptic drugs to treat SCI-related pain has been studied previously, topiramate has not been investigated in this population. Our recent experience suggests that topiramate may be efficacious in the treatment of SCI-related pain.. Case Studies Findings: This report presents the clinical histories of two people with pain following SCI who reported beneficial effects of treatment with the new antiepileptic drug topiramate, even after failing treatment with standard analgesic medications. Topiramate was well tolerated in these patients.. For post-SCI pain, topiramate appears to be an effective treatment in some patients. Based on the present anecdotal findings, larger controlled studies comparing topiramate with standard treatment for SCI-related pain are warranted.

Topics: Adult; Anticonvulsants; Cauda Equina; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Fructose; Humans; Male; Middle Aged; Pain Measurement; Pain, Intractable; Spinal Cord Injuries; Topiramate; Treatment Outcome

To report a case of possible clonidine-induced hypertension (by Naranjo score) in a patient with a C4 spinal lesion.. Clonidine is a medication long used to treat hypertension, and it is still used in the treatment of refractory hypertension. Although effective, clonidine use is hindered by adverse effects and its dual mechanism of action.. A 39-year-old white, quadriplegic man with poorly controlled pain displayed many characteristics consistent with autonomic dysfunction (e.g., C4 spinal lesion, orthostatic hypotension, hypertension). The patient was routinely receiving transdermal clonidine and also received transdermal nitroglycerin paste as needed for control of acute hypertensive episodes. On the recommendation of the home healthcare pharmacists, clonidine was discontinued. Since that time, the patient's blood pressure and the use of emergent antihypertensive treatment have decreased significantly (maximum systolic and diastolic BP by approximately 50 and 25 mm Hg, respectively).. Many of the characteristics of autonomic dysfunction, such as refractory hypertension, can seem selective for the use of clonidine and, because of its reliance on central alpha(2)-activity for its hypotensive effects, clonidine may induce hypertension in patients with autonomic dysfunction. Clonidine should be used with great caution when autonomic dysfunction is suspected.

Topics: Adrenergic alpha-Agonists; Adult; Blood Pressure; Chronic Disease; Clonidine; Fructose; Humans; Hypertension; Male; Neuroprotective Agents; Pain; Pain Measurement; Paraplegia; Spinal Cord Injuries; Topiramate