Tehran University Medical Journal

---

Background: Calcium-antagonists (CA) are heterogeneous group of drugs with different efficacy in migraine prophylaxis. Several studies have firmly demonstrated flunarizine (FLU), and verapamil as the proven calcium-antagonists for migraine prophylaxis. Cinnarizine (CIN), is another CA with less complications and less antihistaminic action. There is very few studies to show the effect of this drug on migraine. The current study evaluates the efficacy and safety of cinnarizine on migraine in comparison to sodium valproate, an acceptable drug in migraine prophylaxis.

Methods: The current study is a randomized double blind clinical trial on 133 participants with intractable migraine headache to evaluate the positive effect of cinnarizine in comparison to sodium valproate. The data was collected and analized by SPSS software.

Results: The mean age of cases was 34.3±10 years in Cinnarizine group and 33.4±11 in Sodium Valproate users. The headache frequency decreased to about 50% and its severity to about 30% in both groups. Although the effect of Cinnarizine was started earlier than sodium valproate , there was no significant difference between two groups of cases in improvement of headache attacks. Statistically significant difference was noted in drug’s complication led to discontinuation of treatment, 5.2% in Cinnarizine users in respect to 14% in valproate group.

Conclusion: The patients who received Cinnarizine, similar to the patients on sodium valprote showed significant improvement in headache attacks, frequency, duration and severity. Cinnarizine such as sodium valproate is an effective drug in migraine prophylaxis even in intractable headache, but with lesser severe complication.

---

Background: The prognosis of chronic dialysis patients is poor, in part due to the high incidence of cardiovascular disease and malnutrition. It has been recognized that 30-50% of hemodialysis patients have serological evidence of an activated inflammatory response. Chronic inflammation may cause malnutrition and progressive atherosclerotic cardiovascular disease. It would be obvious interest to study prevalence of inflammatory factors particularly CRP as prominent components of inflammatory syndrome in dialysis patients. The objective of this study was to study prevalence of inflammatory factors particularly C-reactive protein (CRP) in hemodialysis patients.
Methods: We studied 125 dialysis patients in a cross sectional study during summer of 2001 in two university hospitals. Serum CRP (agglutination method), albumin (bromocresol green method) and ferritin (ELISA) were measured in all patients.
Results: One hundred and twenty five patients including 53 (44.1%) men and 72 (55.9%) women were enrolled in this study. Fourteen patients (11.2%) had hypoalbuminemia, 81 (64.8%) had high serum ferritin, and 57 subjects (45.6%) were CRP positive.
Conclusion: According to high prevalence of inflammatory factors especially C-reactive protein in dialysis patients, CRP and other inflammatory factors should be screened in this group of patients routinely because of their prognostic importance.

---

 Background: Approximately 5-10% of epileptic patients do not respond to antiepileptic drugs. Adenosine has an inhibitory effect on the nervous system and its metabolism is prevented as a side effect of allopurinol, a xanthine oxidase inhibitor. The current study evaluates the efficacy of allopurinol in intractable epilepsy.

Methods: In this double-blind case-control clinical trial, of the 38 epileptics with intractable seizures, 18 received 300 mg allopurinol daily and 20 received a placebo as adjuvant treatment to their previous antiepileptic drugs. The patients were first examined two weeks after initiation of the treatment and then monthly for a total of six months, during which they were evaluated for seizure control and possible side effects.

Result: Of the 38 participants, 32 patients completed the study. There were significant differences between the two groups in terms of reduction in the total number of seizures over the entire six-month trial. A seizure reduction of 30% observed in 66% of the patients, 50% in 55%, and 60% in 44% of the cases in the allopurinol group was achieved after two months and persisted throughout the study. Furthermore, a significant difference in seizure duration was found between the two groups in month four of the trial. In the allopurinol group, two patients had transient rashes, two patients had mild nausea, and two experienced dizziness however, only one patient discontinued the drug due to dizziness. In the placebo group, one patient had rash and one had nausea. In addition, no significant hematological or hepatic changes were found during the trial in either group.

Conclusions: The results suggest that allopurinol is a safe and effective adjuvant agent in refractory epilepsy. Based on this study, we suggest that purine metabolic pathways and the specific use of allopurinol should be further investigated for the treatment of refractory epilepsy.