Nissim Razon

Objective To establish the safety of intravenous dexanabinol in severe head injury. Design Prospective, randomized, double-blind, placebo- (vehicle) controlled, multicenter, escalating dose study of a single administration of drug (48 or 150 mg) or vehicle (1 or 3 mL). Setting All Israeli neurosurgical intensive care units (a total of six units). Patients Sixty-seven patients, aged 16–65 yrs, Glasgow Coma Scale score of 4–8, injured within 6 hrs of treatment. Measurements and Main Results Intracranial pressure, cerebral perfusion pressure, blood pressure, and heart rate were measured continuously in the intensive care unit. Adverse medical events were recorded and clinical outcome was assessed by the Glasgow outcome scale throughout a 6-month follow-up period. A highly significant reduction in the percentage of time with intracranial pressure >25, cerebral perfusion pressure <50, and systolic blood pressure <90 mm Hg was observed in the drug-treated group. The nature and incidence of adverse medical events were similar in the two groups. The percentage of patients achieving good neurologic outcome on the Glasgow outcome scale was 21% and 14% higher in the drug-treated group at 3 and 6 months, respectively. Statistical analysis of these differences by a logistic model using dose, entry Glasgow coma scale score, and computed tomograph as covariates yielded p values for the effect of treatment of .03 and .14 at 3 and 6 months, respectively. Conclusions Dexanabinol was safe and well tolerated in severe head injury. The treated patients achieved significantly better intracranial pressure/cerebral perfusion pressure control without jeopardizing blood pressure. A trend toward faster and better neurologic outcome was also observed.

The expression of epidermal growth factor (EGF) receptor in brain tumours of glial origin was studied at the protein, mRNA and genomic levels. Four out of 10 glioblastomas that overexpress EGF receptor also have gene amplification. The amplified genes appear to be rearranged, generating an aberrant mRNA in at least one of these tumours. Such receptor defects may be relevant to tumorigenesis of human glioblastomas.

Injury to a mammalian peripheral nerve is accompanied by a restorative process that is manifested after a delay. This process is expressed morphologically by the emergence of new nerve fibers. Restoration of function occurs when the regenerating fibers reconnect with the target organ. Because of the low rate of fiber elongation, the denervated target is partially degenerated by the time that the regenerating fibers approach it. To prevent such an atrophy, one must find a way to prevent the degeneration of the nerve, to speed up regeneration, or to maintain the target during the period of nerve degeneration. In the present work, we examined the potential of treatment with low energy laser radiation for improving regeneration or preventing degeneration of mammalian peripheral nerve after injury. After repeated injury for 20 consecutive days, treatment of the sciatic nerve of the rat with low energy laser (He-Ne, 17 mW) caused a significant increase in the amplitude of the action potential recorded in the corresponding gastrocnemius relative to the action potential of injured but not treated nerves. The action potential of the injured sciatic nerves that were laser-irradiated increased to values close to that of a noninjured nerve. The studies include follow-up for 1 year after the injury. This electrophysiological manifestation of the effect of laser treatment on injured nerves was accompanied by a diminution of the size of the scar tissue from these nerves. Yet to be resolved is whether these two phenomena (i.e., electrophysiological and morphological responses) coincide or whether they relate to each other.(ABSTRACT TRUNCATED AT 250 WORDS)

BACKGROUND: Spasticity is a common neurologic disorder with adverse effects on the patient's function. Conservative management is unsuccessful in a significant proportion of patients and neurosurgical intervention should be considered. The mainstay of surgical treatment of spasticity is selective posterior rhizotomy, i.e., section of sensory nerve roots of the cauda equina. OBJECTIVE: To report our experience with selective posterior rhizotomy in the treatment of spasticity. METHODS: We retrospectively reviewed our experience in 154 patients who underwent SPR during 30 years. The indication for surgery was spasticity that significantly hindered the patient's function or care and was resistant to conservative treatment. All patients were evaluated for spasticity in the lower and upper limbs, the presence or absence of painful spasms, and sphincter disturbances. The decision as to which roots to be sectioned, and to what extent, was based mainly on clinical muscle testing. RESULTS: Reduction of spasticity in the lower limbs was obtained in every case, with improvement in movements in 86% of cases. Painful spasms were alleviated in 80% of cases. Amelioration of neurogenic bladder was observed in 42%. A minority of the patients also showed improvement in speech and cognitive performance. There was no perioperative mortality or major complications. CONCLUSION: SPR is a safe and effective method for the treatment of spasticity with long-lasting beneficial effects. We suggest that this method be considered more frequently for patients with spasticity that interferes with their quality of life.