Baptist Health Systems - Baptist Neurology
 
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Medications

photo of pills in a circleAt Baptist Neurology Group, our physicians rely on a growing list of sophisticated medications as part of an overall approach to treating our patients. Depending on the patient's condition, medication might be used on a short- or long-term basis for a variety of purposes.

Among them:

  • Managing or relieving chronic or short-term pain
  • Reducing inflammation
  • Treating infections
  • Stimulating the body's natural response
  • Arresting or slowing a disease process
  • Preventing future episodes

Just as each patient is different, each medication has different properties that can vary from one patient to another. It may be necessary to try similar drugs or various dosing options before arriving at the combination that provides the best results. With persistence, we can find what works best for each patient.

Medications come in a wide range of classifications. The types of neurological conditions listed below provide a framework for understanding many of the medication options available.

Vascular disorders affect the blood vessels (arteries and veins) of the circulatory system. For neurologists, the most significant kind of vascular disease is stroke, which occurs when blood supply to the brain is interrupted.

Emergency treatment: Neurologists use a variety of medications to treat patients with stroke. Initially, when the patient first arrives in the Emergency Room, medications can help restore blood flow to the brain and prevent further damage in a number of ways.

  • Clot-busters: Thrombolytic medications such as tissue Plasminogen Activator (tPA) help dissolve clots that could be causing the stroke.
  • Drugs that reduce swelling: Corticosteroids such as cortisone and hydrocortisone help reduce dangerous swelling in the brain that can be caused by a stroke.
  • Protective Drugs: Neuroprotective agents might be administered to minimize damage that occurs from an interruption in oxygen supply.

Ongoing treatment: Once the patient is stable and out of immediate danger, more long-range treatment can begin. The Stroke Centers at Baptist Health is designed to help stroke patients recover as fully as possible. Ongoing treatment for stroke patients might include medications such as:

  • Anticoagulants to thin the blood and prevent formation of another blood clot like the one that caused the stroke in the first place. Examples: warfarin (Coumadin), enoxaparin (Lovenox) and heparin.
  • Antiplatelet drugs to prevent platelets in the blood from sticking to each other and forming a clot. Examples: aspirin, clopidogrel (Plavix) and dipyridamole (Aggrenox)
  • Drugs for associated conditions to treat conditions that could increase the risk of another stroke. Examples: Sulfonylureas and Biguanides (for diabetes), ACE Inhibitors and Digoxin (for heart disease) and Beta Blockers (for hypertension)

Movement disorders affect the ability of the brain and spinal cord to control muscle movement throughout the body. Some may cause involuntary movements and others may make it difficult to initiate or control voluntary movement.

While there are many examples (including Ataxia, Distonia, Essential Tremor, Huntington's disease and Tourette's syndrome), Parkinson's disease is one of the movement disorders of great interest to neurologists. Parkinson's disease is a degenerative, progressive brain disorder that causes a loss of muscle control due to a lack of dopamine in the brain.

Neurologists treat patients with Parkinson's disease with several kinds of medications. Many of these can mimic the benefits of dopamine, the natural chemical that the patient's brain can no longer produce. Some of the medications available to treat Parkinson's disease include:

  • Levodopa is converted by the body into dopamine, in effect replacing the naturally occurring brain chemical that is lacking in Parkinson's disease patients. Levodopa is combined with carbidopa and sold in the U.S. as Sinemet.
  • Dopamine agonists imitate the effects of dopamine but are less effective and produce side effects. Examples: pramipexole (Mirapex), ropinirole (Requip), rotigotine (Neupro, a patch form of the drug) and apomorphine (Apokyn, an injectible form for fast relief of symptoms).
  • Catechol O-methyltransferase (COMT) inhibitors make levodopa work more consistently and last longer. Example: Entacapone (Comtan), added to carbidopa and levodopa and marketed as Stalevo.
  • MAO B inhibitors make the effects of dopamine last longer by altering how quickly it is metabolized. Examples: selegiline (Eldepryl) and rasagiline (Azilect).
  • Antivirals provide short-term relief of Parkinson's disease symptoms. Example: amantadine (Symmetrel).
  • Anticholinergics help control tremors. Examples: include trihexyphenidyl and benztropine (Cogentin).

Degenerative nerve disorders are marked by progressive deterioration of nerve cells throughout the body. Some examples include Amyotrophic Lateral Sclerosis (ALS, or Lou Gherig's disease), Parkinson's disease, Lewy Body disease, Huntington's disease and others.
One of the most widely known degenerative nerve disorders is Alzheimer's disease, an irreversible form of dementia. Treatment for patients with Alzheimer's disease involves a variety of options, including a broad range of medications. These include:

  • Cholinesterase inhibitors to maintain or improve cognitive functioning. Examples: galantamine (Reminyl), rivastigmine (Exelon) and donepezil (Aricept).
  • Memantine (Namenda) to help slow the progression of the disease, especially in the later stages.
  • Antidepressants to treat symptoms of depression that are commonly experienced by Alzheimer's patients. Examples: fluoxetine (Prozac) and citalopram (Celexa).
  • Antipsychotic medications to relieve severe symptoms such as hallucinations, aggression, agitation and anxiety. Examples: Zyprexa and Risperdal.

Functional disorders disrupt the body's ability to perform one or more of its normal functions. In a neurological sense, functional disorders refer to disruptions in the normal functioning of the brain. Many conditions can affect brain functioning. Of these, Epilepsy is a major type. Epilepsy is one of many causes of seizures, which are characterized by unprovoked surges in electrical energy in the brain.

Treating Epilepsy spans a wide rage of options, including surgery and other choices. But the primary treatment option for patients with Epilepsy is anticonvulsant drug therapy. This classification of medication prevents seizures from occurring or reduces their severity and frequency. There are many drug choices available.

Some drugs are used for specific types of seizures, others are used more generally. Each has its own list of side effects. Because most side effects are dosage-related, it may be necessary to adjust the dosage and frequency of any new drug until side effects are minimized without sacrificing effectiveness.

Some of the most common drugs used to control Epileptic and other types of seizures include:

Generic Name Brand Name
clonazepam Klonopin
clorazepate Tranxene
ethosuximide Zarontin
carbamazepine Tegretol
felbamate Felbatol
fosphenytoin Cerebyx
gabapentin Neurontin
lacosamide Vimpat
lamotrigine Lamictal
levetiracetam Keppra
oxcarbazepine Trileptal
phenobarbital Luminal
phenytoin Dilantin
pregabalin Lyrica
primidone Mysoline
tiagabine Gabitril
topiramate Topamax
valproate semisodium Depakote
valproic acid Depakene
zonisamide Zonegran

Clinical Trials

Powerful new medications are constantly in development for a wide range of neurological and other medical conditions. As integral members of the Baptist Health system, we are plugged into a wide professional network for clinical trials of these promising new medications.

As a result, we are often able to offer this important alternative to patients whose conditions do not respond to existing available drugs. If you've been diagnosed with a neurological disorder and you and your neurologist are not satisfied with the results of your current drug regimen, contact us at 904.398-5405 to see if you qualify for participation in a clinical drug trial.