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Evidence of some short‐term benefit of nimodipine for people with dementia

The efficacy of nimodipine, a calcium channel blocker, has been tested in randomized controlled trials for the treatment of dementia, particularly Alzheimer's disease and multi‐infarct dementia, the commonest forms of dementia in older people. The rationale for its use is to restrict the influx of calcium ions into neurons, and, by vasodilatation, to improve blood flow to the brain. This review found evidence of some short‐term benefit attributable to nimodipine, mainly in measures of cognitive function and global impression, but not in activities on daily living, for patients with degenerative and multi‐infarct dementia, and mixed dementia. Nimodipine is well tolerated with a low rate of adverse effects similar to that associated with placebo.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Calcium antagonists for aneurysmal subarachnoid haemorrhage

A subarachnoid haemorrhage is a bleed in the so‐called subarachnoid space, which is the very small space between the brain and the skull, and which contains blood vessels that supply the brain. The cause of the bleeding usually is a rupture of a bulge in one of these vessels. This bulging or blister on a vessel is called an aneurysm. A subarachnoid haemorrhage is a relatively uncommon type of stroke; it accounts for about one in 20 (5%) of all strokes. Subarachnoid haemorrhage often occurs at a relatively young age: half the patients are younger than 55 years old. The outcome of patients after subarachnoid haemorrhage is generally poor: half the patients die within one month after the haemorrhage, and of those who survive the initial month, half remain dependent on someone else for help with activities of daily living (e.g. walking, dressing, bathing). One of the causes of poor outcome is a complication of subarachnoid haemorrhage called secondary ischaemia (ischaemia means lack of blood). This complication occurs four to 10 days (hence secondary) after the haemorrhage. The cause is not exactly known, but one of the factors involved is narrowing of blood vessels in the brain. Calcium antagonists are a type of drug that block calcium channels in cells and are often used for the treatment of high blood pressure. They have also been shown to counteract the narrowing of blood vessels after subarachnoid haemorrhage and to protect the brain against periods of ischaemia. This review of 16 trials, involving 3361 patients, has found that the outcome after subarachnoid haemorrhage, in terms of survival and being independent in activities of daily living, is improved by treatment with calcium channel blockers (antagonists). If the largest trial is excluded from the analysis, the results are no longer statistically significant, and therefore the evidence is not beyond all doubt. However, given the high likelihood of benefits and the modest risks associated with this treatment, the review authors conclude that calcium antagonists, in the form of oral nimodipine 60 mg every four hours, are useful in patients with subarachnoid haemorrhage from a ruptured aneurysm. Magnesium is another calcium antagonist with promising results, but larger trials with this drug are needed before we can be certain about a beneficial effect.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Calcium antagonists as an add‐on therapy for drug‐resistant epilepsy

There is no evidence to suggest that calcium antagonists have a useful effect on seizures.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Tirilazad for aneurysmal subarachnoid haemorrhage

Subarachnoid haemorrhage (SAH) is a life‐threatening type of stroke caused when a small blood vessel near the surface of the brain bursts. The bleeding usually comes from an aneurysm (a weakness in the blood vessel wall). The blood enters the fluid‐filled space around the brain called the subarachnoid space, which lies between the outer surface of the brain and the inner surface of the skull. Thus, the condition is called aneurysmal SAH. Approximately one‐third of patients develop a complication of the bleeding in which narrowing of the blood vessels occurs. In turn, this may cause the blood supply to parts of the brain to be reduced or stopped. The resulting brain damage is called delayed cerebral ischaemia. It happens most often four to 10 days after SAH, and it can cause disability or even death. In animal studies, the drug tirilazad appeared to reduce brain damage after SAH. We reviewed the evidence from randomised controlled trials of tirilazad in patients with SAH to see if it could reduce the risk of death or disability. The review did not show any evidence of benefit from tirilazad in patients with aneurysmal SAH.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Steroids for acute spinal cord injury

Every year, about 40 million people worldwide suffer a spinal cord injury. Most of them are young men. The results are often devastating. Various drugs have been given to patients in attempts to reduce the extent of permanent paralysis. Steroids have probably been used more for this purpose than any other type of drug. The review looked for studies that examined the effectiveness of this treatment in improving movement and reducing the death rate. Nearly all the research, seven trials, has involved just one steroid, methylprednisolone. The results show that treatment with this steroid does improve movement but it must start soon after the injury has happened, within no more than eight hours. It should be continued for 24 to 48 hours. Different dose rates of the drug have been given and the so‐called high‐dose rate is the most effective. The treatment does not, however, give back the patient a normal amount of movement and more research is necessary with steroids, possibly combining them with other drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Drugs for treatment of very high blood pressure during pregnancy

Pregnant women with very high blood pressure (hypertension) can reduce their blood pressure with antihypertensive drugs, but the most effective antihypertensive drug during pregnancy is unknown. The aim of antihypertensive therapy is to lower blood pressure quickly but safely for both the mother and her baby, avoiding sudden drops in blood pressure that can cause dizziness or fetal distress.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Calcium channel blockers for neuroleptic‐induced tardive dyskinesia

Antipsychotic medication is associated with adverse effects, including tardive dyskinesia which is characterised by abnormal, repetitive, involuntary facial movements. Calcium channel blockers, originally developed for use in cardiovascular disorders, have been experimentally used as a treatment for tardive dyskinesia. There is currently no good quality evidence to support their use.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Does a group of drugs known as calcium channel blockers reduce mortality and unfavourable complications in patients with traumatic brain injury?

Acute traumatic brain injury is a major cause of death and disability. Not all damage to the brain occurs at the moment of injury; reduction of blood flow and oxygen supply to the brain can occur afterwards and cause further brain damage, which is an important cause of avoidable death and disability. In the early stages after injury it is therefore important that efforts are made to minimise secondary brain damage and to provide the best chances of recovery from established brain damage.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Calcium antagonists for acute ischemic stroke

The majority of ischemic strokes are due to blockage of an artery in the brain by a blood clot. The area of brain supplied by that artery rapidly becomes damaged. Some of the damage to brain cells occurs because of a build‐up of calcium ions inside the cells. Calcium antagonists might reduce the damage by preventing calcium ions entering the cells. We searched for trials which assessed the effects of calcium antagonists (given either by mouth or by intravenous injection) in patients with ischemic stroke. We found 34 studies, including 7731 patients, that were suitable for inclusion in the review. There was no difference in deaths or survival free of disability between patients who received calcium antagonists and those who did not. Patients who received calcium antagonists by intravenous injection were slightly worse overall than those who received the drugs by mouth. In conclusion, the authors of this Cochrane review found no evidence that giving calcium antagonists after acute ischemic stroke could save lives or reduce disability.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Magnesium sulphate and other anticonvulsants for women with pre‐eclampsia

Magnesium sulphate helps prevent eclamptic fits in pregnant women with pre‐eclampsia ('toxaemia').

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

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