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Ribeiro RM, da Silveira EP, Santos VC, Teixeira LL, Santos GS, Galvão IN, Hamoy MKO, da Silva Tiago AC, de Araújo DB, Muto NA, Lopes DCF, Hamoy M. Dexamethasone attenuates low-frequency brainwave disturbances following acute seizures induced by pentylenetetrazol in Wistar rats. Exp Mol Pathol 2024; 139:104921. [PMID: 39096892 DOI: 10.1016/j.yexmp.2024.104921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/09/2024] [Accepted: 07/22/2024] [Indexed: 08/05/2024]
Abstract
Seizures are neurological disorders triggered by an imbalance in the activity of excitatory and inhibitory neurotransmitters in the brain. When triggered chronically, this imbalance can lead to epilepsy. Critically, many of the affected individuals are refractory to treatment. Given this, anti-inflammatory drugs, in particular glucocorticoids, have been considered as a potential antiepileptogenic therapy. Glucocorticoids are currently used in the treatment of refractory patients, although there have been contradictory results in terms of their use in association with antiepileptic drugs, which reinforces the need for a more thorough investigation of their effects. In this context, the present study evaluated the effects of dexamethasone (DEX, 0.6 mg/kg) on the electroencephalographic (EEG) and histopathological parameters of male Wistar rats submitted to acute seizure induced by pentylenetetrazol (PTZ). The EEG monitoring revealed that DEX reduced the total brainwave power, in comparison with PTZ, in 12 h after the convulsive episode, exerting this effect in up to 36 h (p < 0.05 for all comparisons). An increase in the accommodation of the oscillations of the delta, alpha, and gamma frequencies was also observed from the first 12 h onwards, with the accommodation of the theta frequency occurring after 36 h, and that of the beta frequency 24 h after the seizure. The histopathological analyses showed that the CA3 region and hilum of the hippocampus suffered cell loss after the PTZ-induced seizure (control vs. PTZ, p < 0.05), although DEX was not able to protect these regions against cell death (PTZ vs. DEX + PTZ, p > 0.05). While DEX did not reverse the cell damage caused by PTZ, the data indicate that DEX has beneficial properties in the EEG analysis, which makes it a promising candidate for the attenuation of the epileptiform wave patterns that can precipitate refractory seizures.
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Affiliation(s)
- Rafaella Marques Ribeiro
- Laboratory of the Pharmacology and Toxicology of Natural Products, Biological Sciences Institute, Federal University of Pará, Rua Augusto Corrêa, 01, Guamá, Belém, Pará 66075-110, Brazil
| | - Esther Padilha da Silveira
- Laboratory of Experimental Neuropathology, João de Barros Barreto University Hospital, Federal University of Pará, Rua dos Munducurus, 4487, Guamá, Belém, Pará 66073-000, Brazil
| | - Vitoria Corrêa Santos
- Laboratory of Experimental Neuropathology, João de Barros Barreto University Hospital, Federal University of Pará, Rua dos Munducurus, 4487, Guamá, Belém, Pará 66073-000, Brazil
| | - Leonan Lima Teixeira
- Laboratory of Experimental Neuropathology, João de Barros Barreto University Hospital, Federal University of Pará, Rua dos Munducurus, 4487, Guamá, Belém, Pará 66073-000, Brazil
| | - Gisely Santiago Santos
- Laboratory of the Pharmacology and Toxicology of Natural Products, Biological Sciences Institute, Federal University of Pará, Rua Augusto Corrêa, 01, Guamá, Belém, Pará 66075-110, Brazil
| | - Izabela Nascimento Galvão
- Laboratory of the Pharmacology and Toxicology of Natural Products, Biological Sciences Institute, Federal University of Pará, Rua Augusto Corrêa, 01, Guamá, Belém, Pará 66075-110, Brazil
| | - Maria Klara Otake Hamoy
- Laboratory of the Pharmacology and Toxicology of Natural Products, Biological Sciences Institute, Federal University of Pará, Rua Augusto Corrêa, 01, Guamá, Belém, Pará 66075-110, Brazil
| | - Allan Carlos da Silva Tiago
- Laboratory of the Pharmacology and Toxicology of Natural Products, Biological Sciences Institute, Federal University of Pará, Rua Augusto Corrêa, 01, Guamá, Belém, Pará 66075-110, Brazil
| | - Daniella Bastos de Araújo
- Laboratory of the Pharmacology and Toxicology of Natural Products, Biological Sciences Institute, Federal University of Pará, Rua Augusto Corrêa, 01, Guamá, Belém, Pará 66075-110, Brazil
| | - Nilton Akio Muto
- Centre for the Valorization of Amazonian Bioactive Compounds (CVACBA), Federal University of Pará, Rua Augusto Corrêa, 01, Guamá, Belém, Pará 66075-110, Brazil
| | - Dielly Catrina Favacho Lopes
- Laboratory of Experimental Neuropathology, João de Barros Barreto University Hospital, Federal University of Pará, Rua dos Munducurus, 4487, Guamá, Belém, Pará 66073-000, Brazil
| | - Moisés Hamoy
- Laboratory of the Pharmacology and Toxicology of Natural Products, Biological Sciences Institute, Federal University of Pará, Rua Augusto Corrêa, 01, Guamá, Belém, Pará 66075-110, Brazil.
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Byrne JM, Mesarwi P, Edmonds KP, Atayee RS. Dexmedetomidine Continuous Infusion for Refractory Cancer Pain at End of Life: A Case Report. J Pain Palliat Care Pharmacother 2022; 36:200-206. [PMID: 35913091 DOI: 10.1080/15360288.2022.2102705] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Refractory cancer-related pain at end-of-life (EoL) is multifaceted and may require utilizing medications with different mechanism of actions beyond opioids. We report the successful use of dexmedetomidine in a 63-year old female with recurrent breast cancer and intractable left arm pain and swelling admitted to University of California, San Diego, Health (UC San Diego Health), palliative care unit. Patient's pain and agitation continued to persist and she declined clinically despite efforts to start methadone, continuous infusion opioids, continuous infusion lidocaine and intravenous chlorpromazine by the palliative care team. On hospital day (HD) 11 patient was started on dexmedetomidine continuous infusion for refractory pain per our protocol at UC San Diego Health. The next day the patient appeared much improved in terms of pain and agitation with grimacing and moaning completely resolved. She was able to have some lucid periods and interacting with her family. With the addition of dexmedetomidine to her pain regiment, the patient was able to peacefully die 5 days later. This case report highlights the clinical utility of demedetomidine in a palliative care unit for refractory pain at EoL.
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Dexamethasone prescribing for cancer pain between palliative care and radiation oncology. Support Care Cancer 2022; 30:7689-7696. [PMID: 35689675 DOI: 10.1007/s00520-022-07203-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Dexamethasone is a commonly prescribed corticosteroid by both palliative care physicians and radiation oncologists for the treatment of metastatic cancer pain. However, clinical evidence for dexamethasone dose and efficacy is lacking, and prescribing between these different specialties may be influenced by other factors. This study investigates the dexamethasone prescriptions of palliative care physicians and radiation oncologists for cancer pain and their prescription rationales. METHODS Palliative care physicians and radiation oncologists in British Columbia, Canada, were surveyed on their preferred dexamethasone prescription in response to 4 case vignettes of patients with metastatic cancer and asked to choose a rationale from a list of options which were then categorized as "habit-based," "results-based," or "evidence-based." Response frequencies between the specialties were compared with odds ratios. RESULTS The total daily dose and duration of dexamethasone prescriptions were similar between the specialties. Palliative care physicians were significantly more likely than radiation oncologists to prescribe a single daily dose of dexamethasone rather than a divided dose (OR 3.3 [95% CI 2.0-5.5]). This significant difference persisted when separately analyzing results at different total daily doses. Both specialties were more likely to select habit-based rationales rather than evidence-based rationales, with no significant difference between specialties. CONCLUSION These findings show that dexamethasone prescriptions are habit-based and that prescribing habits are different between palliative care physicians and radiation oncologists. Interventions based on these findings could potentially prevent unequal patient care. Further qualitative investigations of physician perceptions are indicated to better understand habit-based corticosteroid prescribing patterns.
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Bioinformatics Analysis of the MicroRNA-Metabolic Gene Regulatory Network in Neuropathic Pain and Prediction of Corresponding Potential Therapeutics. J Mol Neurosci 2021; 72:468-481. [PMID: 34580818 PMCID: PMC8476070 DOI: 10.1007/s12031-021-01911-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 09/02/2021] [Indexed: 11/09/2022]
Abstract
Neuropathic pain (NP) involves metabolic processes that are regulated by metabolic genes and their non-coding regulator genes such as microRNAs (miRNAs). Here, we aimed at exploring the key miRNA signatures regulating metabolic genes involved in NP pathogenesis. We downloaded NP-related data from public databases and identified differentially expressed microRNAs (miRNAs) and mRNAs through differential gene expression analysis. The miRNA target prediction was performed, and integration with the differentially expressed metabolic genes (DEMGs) was used for constructing the miRNA-DEMG network. Subsequently, functional enrichment analysis and protein–protein interaction (PPI) analysis were performed to explore the role of DEMGs in the regulatory network. The drug prediction was performed based on the DEMGs in the miRNA-DEMG network. A total of 8251 differentially expressed mRNAs (4193 upregulated and 4058 downregulated), and 959 differentially expressed miRNAs (455 upregulated and 504 downregulated) were identified. Moreover, after target gene prediction, a miRNA-DEMG network composed of 22 miRNAs and 113 mRNAs was constructed. The network was constituted of 135 nodes and 236 edges. We found that DEMGs in the network were mainly enriched in metabolic pathways and metabolic processes. A total of 1200 drugs were predicted as potential therapeutics for NP based on the differentially expressed genes, while 170 drugs were predicted for the DEMGs in the miRNA-DEMG network. Conclusively, our study predicted drugs that may be effective against the metabolic changes induced by miRNA dysregulation in NP. This information will help further reveal the pathological mechanism of NP and provide more treatment options for NP patients.
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Ismy J, Emril DR, Rizkidawati. Management of cancer pain with analgetic adjuvant and weak opioid in prostate cancer bone metastases: A case series. Ann Med Surg (Lond) 2020; 60:575-578. [PMID: 33299563 PMCID: PMC7701877 DOI: 10.1016/j.amsu.2020.10.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/27/2020] [Accepted: 10/31/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In cancer patients, cancer pain is the most common cancer complication. About 60-90% of patients with advanced stage cancer experience various levels of pain, and about 30% of patients have been suffering from persistent severe pain. Bones are the most frequent targets of metastases in patients with cancer such as breast, prostate, lung, kidney, and thyroid. In advanced prostate cancer, bone metastasis leads to bone pain, skeletal fracture, and increased mortality. At least 75% of patients with bone metastasis experience bone pain. CASE DESCRIPTION We report three cases of cancer pain, treated with primary cancer from the prostate metastasis to the spine. All three patients had lower back pain that radiated to the left and right limbs, with mixed pain and bone pain, where early hospital admission shows the Numeric Rating Scale (NRS) pain scale 9-10. Treated with administration of adjuvant therapy (Gabapentin) and weak opioids (injections of Tramadol) as well as injections of Metylprednisolone (for 3 days), the patient's pain scale was evaluated, and the average NRS obtained on days 2-4 was 5-6. On day 5-8, treatment continued with Gabapentin and Tramadol injections, and the pain scale (NRS) decreased to 2-3. All patients on the 8-9th day of treatment also received Biphosphonates to reduce pain, bone damage, fracture risk, and blood calcium levels. Patients can be discharged with an oral Gabapentin prescription only. CONCLUSION A pain scale (NRS) reduction of >50% is obtained from the initial pain scale in cancer pain patients treated using a combination of adjuvant therapy and weak opioids.
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Affiliation(s)
- Jufriady Ismy
- Urology Division, Surgery Department, Faculty of Medicine, Universitas Syiah Kuala, Zainoel Abidin General Hospital, Banda Aceh, Indonesia
| | - Dessy Rakhmawati Emril
- Pain and Headache Division, Neurology Department, Faculty of Medicine, Universitas Syiah Kuala, Zainoel Abidin General Hospital, Banda Aceh, Indonesia
| | - Rizkidawati
- Pain and Headache Division, Neurology Department, Faculty of Medicine, Universitas Syiah Kuala, Zainoel Abidin General Hospital, Banda Aceh, Indonesia
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