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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 1998-4022
Vol. 52, Num. 3, 2004, pp. 392-393
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Neurology India, Vol. 52, No. 3, July-September, 2004, pp. 392-393
Letter To Editor
Nimodipine in severe head injury
Kumar Sudhir
Department of Neurological Sciences, Christian Medical College Hospital, Vellore, Tamilnadu - 632 004
Correspondence Address:Department of Neurological Sciences, Christian
Medical College Hospital, Vellore, Tamilnadu - 632 004 drsudhirkumar@yahoo.com
Code Number: ni04130
Sir,
I read with interest the recent article by Pillai
SV et al.[1] Based
on an excellent randomized controlled trial, they conclude that nimodipine
does not improve the outcome in patients with severe diffuse head injury.
However, I would like to make certain comments.
1. Patient selection: This trial included patients on the basis of Glasgow Coma Scale (8 or less) and CT scan findings (diffuse head injury with absence of any operable mass lesion). As nimodipine is proposed to act by ameliorating traumatic vasospasm, it would be prudent to perform Trans Cranial Doppler (TCD) studies at admission to identify the subset of patients with evidence of vasospasm. In a recent study, early treatment with nimodipine was found to improve outcome in a group of patients with concussion who had cerebral spasm confirmed by TCD.[2]
2. Dose & mode of administration of nimodipine: Patients in this trial received only one-third of the standard dose (30 mg Q6H as compared to the standard 60 mg Q4H). Could the lack of effect be partly related to inadequate dose?
Moreover, after emptying the contents of nimodipine capsule directly into Ryle′s tube, flushing of the tube with 30 ml 0.9% saline is recommended for facilitating delivery of the entire dose. In addition, contents of capsule should not be admixed with any other solution prior to administration due to the risk of decomposition.[3] Failure to observe these precautions could result in incomplete drug delivery.
3. Finally, as Pillai SV et al point out, this study does not have enough power to address the efficacy of nimodipine in traumatic subarachnoid hemorrhage (tSAH). In a recent systematic review of all published RCTs on this subject, nimodipine showed a beneficial effect in the subgroup of brain injury patients with tSAH.[4]
REFERENCES
| 1. |
Pillai SV, Kolluri VR, Mohanty A, Chandramouli BA. Evaluation of nimodipine
in the treatment of severe diffuse head injury: A double-blind placebo-controlled
trial. Neurol India 2003;51:361-3. Back to cited
text no. 1 [BIOLINE] |
| 2. | Xiao X, Guo X, Wang D, Xue G. Mechanism and treatment principle for cerebral vessel spasm caused by concussion. Chin J Traumatol 2002;5:380-4. Back to cited text no. 2 |
| 3. | http://www.medscape.com/druginfo (Accessed on 2 January, 2004). Back to cited text no. 3 |
| 4. | Langham J, Goldfrad C, Teasdale G, Shaw D, Rowan K. Calcium channel blockers for acute traumatic brain injury (Cochrane Methodology Review). In: The Cochrane Library, Issue 4, 2003. Chichester, UK: John Wiley & Sons, Ltd. Back to cited text no. 4 |
Copyright 2004 - Neurology India
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