Open Access Case Study

Antihistamine Drug Misuse and Dependency in Headache Patients: A Case Series in a Tertiary Care Headache Center

Zuhal Ergonul, Michael J. Marmura

International Neuropsychiatric Disease Journal, Page 9-12
DOI: 10.9734/INDJ/2015/12216

Aims: To report antihistamine abuse at a tertiary headache center including 6 patients who meet the criteria for substance abuse for intramuscular diphenhydramine (DPH).

Presentation of the Cases: Six patients were identified who were prescribed intramuscular DPH and developed escalating drug use. All patients were female, with a mean age of 40.6 (32-53), with diagnosis of medication overuse headache. Five had chronic migraine and 1 new daily persistent headache.  All 6 patients were disabled. Three patients had history of misuse of other drugs including benztropine, hydromorphone and clonazepam. Comorbid psychiatric disorders included 3 patients with major depressive disorder, 2 with ADHD, 1 with post-traumatic stress disorder and social phobia. All of these patients had a history of receiving intravenous DPH as part of their migraine treatment to avoid complications from neuroleptics.

Discussion and Conclusion: A literature search revealed eight case reports of DPH abuse including a total of nine patients, published between 1986 and 2014. Medical charts were reviewed at Jefferson Headache centre and identified 6 patients with intramuscular DHP abuse. Clinicians treating migraine should be aware of potential risk for DPH abuse. Intramuscular and intravenous forms of the drug should be limited to inpatient use, if possible, and should be avoided in patients with history of drug abuse and medication overuse.


Open Access Case Study

Cholinesterase Inhibitors in Non-age Related Neurodegenerative Dementias

Esther G. Ebenezer

International Neuropsychiatric Disease Journal, Page 13-18
DOI: 10.9734/INDJ/2015/12752

Aims: Dementia is common among the elderly but it can also affect the younger age group. Cholinesterase inhibitors (ChEI) in Alzheimer Dementia (AD) are extensively studied and widely used. This case report aims to illustrate the usefulness of ChEIs in other non–age related neurodegenerative dementias apart from AD.

Presentation of Cases: Four cases in which ChEIs was found to be useful in improving the cognition following Traumatic Brain Injury, Nipah Encephalitis, Cerebral Malaria and Meningo-encephalitis. All the four cases were prescribed ChEIs and were followed up in a Memory Clinic. All of them showed substantial and sustained cognitive improvement.

Discussion: Traumatic brain injury causes axonal swelling with accumulation of beta-amyloid and alters progranulin metabolism. Nipah Virus infection of brain parenchyma causes vasculitis, endothelial damage and micro-infarction. While in cerebral malaria, infected and non-infected erythrocytes within the cerebral vessels reduces microvascular flow and initiates inflammatory cascade. Infective encephalitis causes neurotoxin production and inflammatory process. These pathological processes reduce cerebral neurotransmitters concentration including acetylcholine. Cholinesterase inhibitors enhance cognitive function by increasing the amount of acetylcholine at the neuronal synaptic cleft. This clinical significance may be extended to patients with cognitive impairments other than AD.      

Conclusion: This report highlights the usefulness of ChEI in non–age related neurodegenerative dementias. Off label use of ChEI in non-AD dementias warrant proper clinical trials to recommend for clinical practice.


Open Access Short Research Article

Childhood Onset Familial Nemaline Rod Myopathy: A Report of Two Siblings

Geetanjali Sharma, Sushma Sood

International Neuropsychiatric Disease Journal, Page 1-8
DOI: 10.9734/INDJ/2015/12813

Aims: Nemaline rod myopathy (NRM) is a rare form of congenital myopathy characterized by slowly progressive or non progressive muscle weakness and pathognomonic rod-like structures within the muscle fibers. Muscle weakness and hypotonia are apparent from the neonatal period. We report a rare presentation of NRM seen in two siblings with similar symptoms. Both had slender physique, delayed motor milestones including delayed walking, normal language and cognitive milestones, difficulty in fast movements and change of posture, difficulty in getting to standing from sitting posture and slowly progressive weakness and positive family history.

Study Design: Two siblings i.e. a brother and sister with provisional diagnosis of Nemaline Rod Myopathy were tested for all relevant diagnostic protocol with results analysed and discussed.

Place and Duration of Study: Department of Physiology, Pt. B.D. Sharma Post-Graduate Institute of medical Sciences, University of Health Sciences, Rohtak, Haryana, India.

Methodology: Investigations included CPK levels, motor-sensory conduction velocities, EMG studies, Muscle biopsy, MGT (Modified Gomori´s Trichrome) stain and histo-chemistry studies.

Results: CPK levels were raised (279U/l) with myopathic pattern of EMG with decreased motor unit potentials, recruitment with markedly decreased amplitude; mild decrease in motor conduction velocity in tibial-peroneal nerves in both with decreased ulnar nerve sensory conduction velocity in the girl and positive muscle biopsy; diagnosed as Nemaline Rod myopathy.

Conclusion: Nemaline myopathy should be suspected in children with generalized hypotonia and progressive muscle weakness along with delayed motor milestones. This report highlights the importance of EMG and conduction velocity studies along with histo-chemistry and ultra-structural examination in diagnosis of NRM in absence of availability of genetic studies.


Open Access Original Research Article

Pilot Study and Review: Physiological Differences in BDNF, a Potential Biomarker in Males and Females with Autistic Disorder

Eve G. Spratt, Ann- Charlotte Granholm, Laura A. Carpenter, Heather A. Boger, Carrie E. Papa, Sarah Logan, Humera Chaudhary, Sarah- Wade Boatwright, Kathleen T. Brady

International Neuropsychiatric Disease Journal, Page 19-26
DOI: 10.9734/INDJ/2015/12118

Aims: There is a need for more biologic research in autistic disorder (AD) to determine if biomarkers exist that would be useful for correlating to symptom severity and/or clinical improvement during treatment. Given the fact that AD is 4 times more common in males than females, gender differences in physiological biomarkers may be present. One potential biomarker that has begun to be studied is brain-derived neurotropic factor (BDNF), a peptide involved in the regulation of neuronal cell survival, differentiation, and plasticity, and possessing an ability to influence neurotransmitter systems by modulating gene expression. This pilot study examined whether serum BDNF differed according to gender in children with AD and whether differences were associated with a behavioral phenotype or severity of illness.

Study Design: Data for this investigation were collected during the participants’ baseline visit of an intervention study. Participants were males (n=29) and females (n=7), aged 5 to 12 years diagnosed with AD. Baseline serum BDNF concentration was determined for comparison to clinical ratings using an autism severity measure and the Pervasive Developmental Disorder-Behavior Inventory (PDD-BI).

Results: BDNF serum concentrations were higher in females (p<0.049). The baseline BDNF value corresponded significantly to hyperactivity in females (p<0.0002) but not in males.  BDNF did not correlate with severity of disease in either gender.

Conclusion: Although this is a small study, a better understanding of the central role of BDNF may provide insight into the pathophysiology of the disease and elucidate why gender differences exist in prevalence and behavioral phenotype of AD.


Open Access Original Research Article

Substance Use among Medical Students Attending Two Nigerian Universities

J. M. Chinawa, P. C. Manyike, H. A. Obu, O. I. Odetunde, S. Uwaezuoke, A. N. Ikefuna, A. E. Aronu, A. T. Chinawa

International Neuropsychiatric Disease Journal, Page 27-34
DOI: 10.9734/INDJ/2015/12795

Background: Medical students in Nigeria are exposed to various types of substances to enhance their academic performance .This is not without its attendant problems.

Objectives: The objectives were to identify the substances used by medical students in Nigerian universities as well as to determine the socio-demographic and gender pattern on substance use among them.

Methods: The study was carried out among medical students recruited from two medical colleges of two Nigerian universities. By a convenient sampling method, a total of 231 medical students were selected.

Results: Sixty three medical students (27.3%) took more than 8units of alcoholic drinks in the last 30 days before the study while 46 (19.9%) took up to 8 units for the previous week. About 2 (0.8%) of the students used marijuana while none used cocaine. Five (2.2%) smoked up to 4 of cigarette in the past one week while four (1.7%) smoked up to 4 cigarette in the previous 30 days. Seven (3.1%) students used sedatives with diazepam and lexotan (Benzodiazepines) being the most commonly used.

There were no association between age, social class and substance use as the observed differences in use in the different age groups  were not statistically significant P>0.05.  Conclusion: This study has shown that medical students had varying degrees of substance use; however a longitudinal study is advisable to determine the changing pattern over time.

Conclusion: This study has shown that medical students had varying degrees of substance use; however a longitudinal study is advisable to determine the changing pattern over time.