Rita Levi-Montalcini (1986 Nobel Prize in Medicine) said “in the 19th century and at the beginning of the 20th century, brain research belonged to many different areas that differed in methodology and targets: the morphological, the physiological, and the psychological. Due to prolonged aging, neurodevelopmental disorders are growing and a much deeper knowledge of the brain is necessary”. Drugs can play an important role in diagnosis, treatment, or prevention of neurological disorders.
As per World Health Organization, neurological disorders are one of the greatest threats to mankind. Drug therapy is cornerstone of the treatment.
NEUROLOGICAL DRUGS: CHALLENGES AND OPPORTUNITIES
Parkinson disease is a common neurodegenerative disease. The drug treatment is quite effective and Levodopa is the most effective drug treatment. However, its chronic use is associated with dyskinesia, motor fluctuations, and hallucinations.1 Hence, in neurology, like in any other clinical specialty, there is a need to develop treatment strategies that allow stratification of therapies to optimize efficacy and minimize toxicity.2 Patients always have expectations from the doctors, especially in neurology as the nature of disease/s may be protracted (Fig. 1.1).
Drug-induced neurologic conditions may result from single-agent drug regimens, but they are more likely to occur when multiple agents that confer risk are administered concomitantly. Educating patients about these risks and remaining vigilant in clinical investigations of unusual adverse effects are key elements to increasing the safety of drug management.3
Newer drugs may be safe but may not always be effective so one would have to manage drug therapy carefully.4
Fig. 1.1: Patients often have unrealistic expectations and may land up after having been seen by many doctors. A neurologist is always confronted with such patients and a combination of counseling, assurance, and delicate handling avoiding false reassurances helps.
Doctors often get puzzling neurological problems in general practice for many of which there is no effective medical treatment. However, effective drugs are available for many of the most common conditions like headache, neuralgia, seizure disorders, movement disorders, facial palsy, dementias, cerebrovascular accidents, and meningitis etc. One of the most effective ways to use proper medications is to ensure proper selection based upon pharmacological profile of drugs.
- Jankovic J. Complications and limitations of drug therapy for Parkinson's disease. Neurology. 2000;55(12 Suppl 6):S2–6.
- Chan A, Pirmohamed M, Comabella M. Pharmacogenomics in neurology: current state and future steps. Ann Neurol. 2011;70(5):684–97.
- Medscape. (2017). Drug-induced neurologic conditions. [online] Available from www.medscape.com/viewarticle/822551. [Accessed May, 2018].
- Kane JM. Newer antipsychotic drugs. A review of their pharmacology and therapeutic potential. Drugs. 1993;46(4):585–93.