nach oben

Erschienen in:

28.07.2023 | Current Opinion

The Utilization of Low Dose Naltrexone for Chronic Pain

verfasst von: Salomon Poliwoda, Bryant Noss, Gia Thinh D. Truong, Zachary A. Creech, Sarang S. Koushik, Ivan Urits, Omar Viswanath

Erschienen in: CNS Drugs | Ausgabe 8/2023

Einloggen, um Zugang zu erhalten

Abstract

Naltrexone is a mu-opioid receptor antagonist with a long half-life compared with naloxone. Both of these drugs, along with others, were developed with the intention of reversing the effects of opioid abuse or toxicity. Evidence has also shown that naltrexone has a benefit in preventing relapse by reducing opioid cravings and reducing symptoms of opioid withdrawal. The benefits of this drug were not only shown with opioid abuse. In 1984 this drug was also approved for alcohol abuse. Naltrexone has been proven to decrease alcohol relapse by decreasing the craving. Apart from these approved indications for the use of naltrexone, with time, it has been seen that this drug has a benefit in treating chronic pain. A number of studies have shown the benefits of this drug with inflammatory bowel disease, fibromyalgia, multiple sclerosis, diabetic neuropathy, and complex regional pain syndrome, among others. More studies are needed to approve this medication for specific chronic pain conditions.

Dahlhamer J, Lucas J, Zelaya C, Nahin R, Mackey S, DeBar L, et al. Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(36):1001–6.CrossRefPubMedPubMedCentral

Pérez C, Navarro A, Saldaña MT, Wilson K, Rejas J. Modeling the predictive value of pain intensity on costs and resources utilization in patients with peripheral neuropathic pain. Clin J Pain [Internet]. 2015 Mar 13 [cited 2022 Dec 26];31(3):273–9. https://pubmed.ncbi.nlm.nih.gov/24762867/. Accessed 26 Apr 2023.

Chronic Pain and health services utilization: is there overuse of diagnostic tests and inequalities in nonpharmacologic treatment methods utilization? on JSTOR [Internet]. [cited 2022 Dec 26]. https://www.jstor.org/stable/42568827. Accessed 26 Apr 2023.

Woolf AD, Zeidler H, Haglund U, Carr AJ, Chaussade S, Cucinotta D, et al. Musculoskeletal pain in Europe: its impact and a comparison of population and medical perceptions of treatment in eight European countries. Ann Rheum Dis [Internet]. 2004 Apr [cited 2022 Dec 26];63(4):342–7. https://pubmed.ncbi.nlm.nih.gov/15020325/. Accessed 26 Apr 2023.

Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. The Lancet. 2021;397(10289):2082–97.CrossRef

A review of chronic pain impact on patients, their social environment and the health care system-PMC [Internet]. [cited 2022 Dec 26]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4935027/. Accessed 26 Apr 2023.

Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain [Internet]. 2019 Jan 1 [cited 2022 Dec 26];160(1):19–27. https://journals.lww.com/pain/Fulltext/2019/01000/Chronic_pain_as_a_symptom_or_a_disease__the_IASP.3.aspx. Accessed 26 Apr 2023.

Kim PS, Fishman MA. Low-dose naltrexone for chronic pain: update and systemic review. Curr Pain Headache Rep [Internet]. 2020 Aug 26 [cited 2022 Dec 21];24(10):64–64. https://europepmc.org/article/med/32845365. Accessed 26 Apr 2023.

Chisholm-Burns MA, Spivey CA, Sherwin E, Wheeler J, Hohmeier K. The opioid crisis: origins, trends, policies, and the roles of pharmacists. Am J Health Syst Pharm [Internet]. 2019 Mar 19 [cited 2022 Dec 26];76(7):424–35. https://academic.oup.com/ajhp/article/76/7/424/5382447. Accessed 26 Apr 2023.

10.

Bisaga A, Mannelli P, Sullivan MA, Vosburg SK, Compton P, Woody GE, et al. Antagonists in the medical management of opioid use disorders: historical and existing treatment strategies. Am J Addict [Internet]. 2018;27(3):177 (/pmc/articles/PMC5900907/).CrossRefPubMedPubMedCentral

11.

Ahrnsbrak R, Bose J, Hedden SL, Lipari RN, Park-Lee E. Key substance use and mental health indicators in the united states: results from the 2016 National Survey on Drug Use and Health [Internet]. [cited 2022 Dec 26]. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm#opioid. Accessed 28 Apr 2023.

12.

2020-12-31 08:51 | Archive of HHS.gov [Internet]. [cited 2022 Dec 26]. https://public3.pagefreezer.com/browse/HHS.gov/31-12-2020T08:51/https:/www.hhs.gov/about/news/2017/10/26/hhs-acting-secretary-declares-public-health-emergency-address-national-opioid-crisis.html. Accessed 28 Apr 2023.

13.

Srivastava AB, Gold MS. Naltrexone: A History and Future Directions. Cerebrum. 2018:cer-13-18. PMID: 30746025; PMCID: PMC6353110

14.

Julius Pohl V. Ueber das N-Allylnorcodeln, elnen Antagonisten des Morphins.

15.

Archer S. Historical perspective on the chemistry and development of naltrexone. NIDA Res Monogr [Internet]. 1981 Jan 1 [cited 2022 Dec 26];28:3–10. https://europepmc.org/article/med/6791011. Accessed 28 Apr 2023.

16.

Gold MS, Dackis CA, Pottash ALC, Sternbach HH, Annitto WJ, Martin D, et al. Naltrexone, opiate addiction, and endorphins. Med Res Rev [Internet]. 1982;2(3):211–46. https://doi.org/10.1002/med.2610020302.CrossRefPubMed

17.

Resnick RB, Volavka J, Freedman AM, Thomas M. Studies of EN-1639A (Naltrexone): a new narcotic antagonist. AJP [Internet]. 2015;131(6):646–50. https://doi.org/10.1176/ajp.131.6.646.CrossRef

18.

Brown R, Kraus C, Fleming M, Reddy S. Methadone: applied pharmacology and use as adjunctive treatment in chronic pain. Postgrad Med J [Internet]. 2004 Nov from: https://pmj.bmj.com/content/80/949/654. Accessed 28 Apr 2023.

19.

Verebey K, Mulé SJ. Naltrexone pharmacology, pharmacokinetics, and metabolism: current status. Am J Drug Alcohol Abuse [Internet]. 1975 [cited 2022 Dec 20];2(3–4):357–63. https://pubmed.ncbi.nlm.nih.gov/1227297/. Accessed 28 Apr 2023.

20.

Mannelli P, Patkar AA, Peindl K, Gorelick DA, Wu LT, Gottheil E. Very low dose naltrexone addition in opioid detoxification: a randomized, controlled trial. Addict Biol [Internet]. 2009;14(2):204–13. https://doi.org/10.1111/j.1369-1600.2008.00119.x.CrossRefPubMed

21.

Mannelli P, Patkar AA, Peindl K, Gottheil E, Wu LT, Gorelick DA. Early outcomes following low dose naltrexone enhancement of opioid detoxification. Am J Addict. 2009;18(2):109–16.CrossRefPubMedPubMedCentral

22.

Sudakin D. Naltrexone: not just for opioids anymore. J Med Toxicol [Internet]. 2016 Mar 1 [cited 2022 Dec 20];12(1):71–5. https://pubmed.ncbi.nlm.nih.gov/26546222/. Accessed 28 Apr 2023.

23.

Qeadan F, Mensah NA, Gu LY, Madden EF, Venner KL, English K. Trends in the use of naltrexone for addiction treatment among alcohol use disorder admissions in U.S. substance use treatment facilities. Int J Environ Res Public Health [Internet]. 2021;18(16):8884 (/pmc/articles/PMC8394149/).CrossRefPubMedPubMedCentral

24.

Elton A, Dove S, Spencer CN, Robinson DL, Boettiger CA. Naltrexone acutely enhances connectivity between the ventromedial prefrontal cortex and a left frontoparietal network. Alcohol Clin Exp Res [Internet]. 2019;43(5):965 (/pmc/articles/PMC6528472/).CrossRefPubMedPubMedCentral

25.

Clark RE, Baxter JD, Aweh G, O’Connell E, Fisher WH, Barton BA. Risk factors for relapse and higher costs among medicaid members with opioid dependence or abuse: Opioid agonists, comorbidities, and treatment history. J Subst Abuse Treat [Internet]. 2015 Oct 1 [cited 2022 Dec 26];57:75–80. https://pubmed.ncbi.nlm.nih.gov/25997674/. Accessed 28 Apr 2023.

26.

Toljan K, Vrooman B. Low-dose naltrexone (LDN)—Review of therapeutic utilization. Med Sci [Internet]. 2018;6(4):82 (/pmc/articles/PMC6313374/).

27.

Younger J, Parkitny L, McLain D. The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain. Clin Rheumatol [Internet]. 2014;33(4):451 (/pmc/articles/PMC3962576/).CrossRefPubMedPubMedCentral

28.

McLaughlin PJ, Zagon IS. Duration of opioid receptor blockade determines biotherapeutic response. Biochem Pharmacol. 2015;97(3):236–46.CrossRefPubMed

29.

Wang X, Zhang Y, Peng Y, Hutchinson MR, Rice KC, Yin H, et al. Pharmacological characterization of the opioid inactive isomers (+)-naltrexone and (+)-naloxone as antagonists of toll-like receptor 4. Br J Pharmacol [Internet]. 2016;173(5):856 (/pmc/articles/PMC4761092/).CrossRefPubMedPubMedCentral

30.

Lehnardt S. Innate immunity and neuroinflammation in the CNS: the role of microglia in Toll-like receptor-mediated neuronal injury. Glia [Internet]. 2010;58(3):253–63. https://doi.org/10.1002/glia.20928.CrossRefPubMed

31.

Trofimovitch D, Baumrucker SJ. Pharmacology update: low-dose naltrexone as a possible nonopioid modality for some chronic, nonmalignant pain syndromes. Am J Hosp Palliat Care [Internet]. 2019;36(10):907–12. https://doi.org/10.1177/1049909119838974.CrossRefPubMed

32.

Center for Substance Abuse Treatment. Chapter 4—oral naltrexone. Alcohol pharmacotherapies into medical practice [Internet]. 2009 [cited 2022 Dec 27];TIP series(49):30–1. https://www.ncbi.nlm.nih.gov/books/NBK64042/.

33.

Miotto K, McCann M, Basch J, Rawson R, Ling W. Naltrexone and dysphoria: Fact or myth? Am J Addict. 2002;11(2):151–60.CrossRefPubMed

34.

Wall ME, Brine DR, Perez-Reyes M. Metabolism and disposition of naltrexone in man after oral and intravenous administration. Drug Metab Dispos. 1981;9(4):369–75. PMID: 6114837.

35.

Galloway GP, Koch M, Cello R, Smith DE. Pharmacokinetics, safety, and tolerability of a depot formulation of naltrexone in alcoholics: an open-label trial. BMC Psychiatry [Internet]. 2005;5:18 (/pmc/articles/PMC1087493/).CrossRefPubMedPubMedCentral

36.

Weerts EM, Kim YK, Wand GS, Dannals RF, Lee JS, Frost JJ, et al. Differences in δ- and μ-opioid receptor blockade measured by positron emission tomography in naltrexone-treated recently abstinent alcohol-dependent subjects. Neuropsychopharmacology. 2008 33:3 [Internet]. 2007 May 9 [cited 2022 Dec 28];33(3):653–65. https://www.nature.com/articles/1301440. Accessed 28 Apr 2023.

37.

Wentland MP, Lou R, Lu Q, Bu Y, Denhardt C, Jin J, et al. Syntheses of novel high affinity ligands for opioid receptors. Bioorg Med Chem Lett. 2009;19(8):2289–94.CrossRefPubMedPubMedCentral

38.

Niciu MJ, Arias AJ. Targeted opioid receptor antagonists in the treatment of alcohol use disorders. CNS Drugs [Internet]. 2013;27(10):777 (/pmc/articles/PMC4600601/).CrossRefPubMedPubMedCentral

39.

Lutz PE, Kieffer BL. Opioid receptors: distinct roles in mood disorders. Trends Neurosci. 2013;36(3):195–206.CrossRefPubMed

40.

Okun E, Griffioen KJ, Mattson MP. Toll-like receptor signaling in neural plasticity and disease. Trends Neurosci. 2011;34(5):269–81.CrossRefPubMedPubMedCentral

41.

Croop RS, Faulkner EB, Labriola DF. The safety profile of naltrexone in the treatment of alcoholism: results from a multicenter usage study. Arch Gen Psychiatry [Internet]. 1997 Dec 1 [cited 2022 Dec 28];54(12):1130–5. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/497987. Accessed 28 Apr 2023.

42.

King AC, Volpicelli JR, Gunduz M, O’Brien CP, Kreek MJ. Naltrexone biotransformation and incidence of subjective side effects: A preliminary study. Alcohol Clin Exp Res [Internet]. 1997;21(5):906–9. https://doi.org/10.1111/j.1530-0277.1997.tb03856.x.CrossRefPubMed

43.

Edinoff AN, Nix CA, Orellana C V., Stpierre SM, Crane EA, Bulloch BT, et al. Naltrexone implant for opioid use disorder. Neurol Int. 2022, Vol 14, Pages 49-61 [Internet]. 2021 Dec 30 [cited 2022 Dec 28];14(1):49–61. https://www.mdpi.com/2035-8377/14/1/4/htm. Accessed 28 Apr 2023.

44.

Driver CN, D’Souza RS. Efficacy of low-dose naltrexone and predictors of treatment success or discontinuation in fibromyalgia and other chronic pain conditions: a fourteen-year, enterprise-wide retrospective analysis. Biomedicines. 2023;11(4):1087.CrossRefPubMedPubMedCentral

45.

Kunøe N, Lobmaier P, Ngo H, Hulse G. Injectable and implantable sustained release naltrexone in the treatment of opioid addiction. Br J Clin Pharmacol [Internet]. 2014;77(2):264–71. https://doi.org/10.1111/bcp.12011.CrossRefPubMedPubMedCentral

46.

Chris Prange-Morgan. Low-dose naltrexone offers new hope for pain sufferers. Psychol Today. 2022.

47.

Knab J, McCauley J. The Use of Low Dose Naltrexone in the Management of Chronic Pain. Pract Pain Manag. 2020;20(3).

48.

Patten DK, Schultz BG, Berlau DJ. The Safety and efficacy of low-dose naltrexone in the management of chronic pain and inflammation in multiple sclerosis, fibromyalgia, Crohn’s disease, and other chronic pain disorders. Pharmacotherapy. 2018;38:382–9.CrossRefPubMed

49.

Kim PS, Fishman MA. Low-dose naltrexone for chronic pain: update and systemic review. Curr Pain Headache Rep. 2020;24(10):64.CrossRefPubMed

50.

Toljan K, Vrooman B. Low-dose naltrexone (LDN)—review of therapeutic utilization. Med Sci. 2018;6(4):82.

51.

Hatfield E, Phillips K, Swidan S, Ashman L. Use of low-dose naltrexone in the management of chronic pain conditions: A systematic review. J Am Dent Assoc. 2020;151(12):891-902.e1.CrossRefPubMed

52.

Younger J, Noor N, McCue R, MacKey S. Low-dose naltrexone for the treatment of fibromyalgia: Findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels. Arthritis Rheum [Internet]. 2013;65(2):529–38. https://doi.org/10.1002/art.37734.CrossRefPubMed

53.

Younger J, Mackey S. Fibromyalgia symptoms are reduced by low-dose naltrexone: A pilot study. Pain Med [Internet]. 2009;10(4):663.CrossRefPubMedPubMedCentral

54.

Younger J, Mackey S. Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study. Pain Med. 2009;10(4):663–72 (/pmc/articles/PMC2891387/).CrossRefPubMed

55.

56.

Younger J, Parkitny L, McLain D. The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain. Clin Rheum. 2014;33(4):451–9.CrossRef

57.

Lie MRKL, van der Giessen J, Fuhler GM, de Lima A, Peppelenbosch MP, van der Ent C, et al. Low dose Naltrexone for induction of remission in inflammatory bowel disease patients. J Transl Med [Internet]. 2018;16(1):55 (/pmc/articles/PMC5845217/).CrossRefPubMedPubMedCentral

58.

Smith JP, Bingaman SI, Ruggiero F, Mauger DT, Mukherjee A, McGovern CO, et al. Therapy with the opioid antagonist naltrexone promotes mucosal healing in active Crohn’s disease: A randomized placebo-controlled trial. Dig Dis Sci. 2011;56(7):2088–97.CrossRefPubMedPubMedCentral

59.

Smith JP, Field D, Bingaman SI, Evans R, Mauger DT. Safety and tolerability of low-dose naltrexone therapy in children with moderate to severe Crohn’s disease: A pilot study. J Clin Gastroenterol. 2013;47(4):339–45.CrossRefPubMedPubMedCentral

60.

Cree BAC, Kornyeyeva E, Goodin DS. Pilot trial of low-dose naltrexone and quality of life in multiple sclerosis. Ann Neurol [Internet]. 2010;68(2):145–50. https://doi.org/10.1002/ana.22006.CrossRefPubMed

61.

Gironi M, Martinelli-Boneschi F, Sacerdote P, Solaro C, Zaffaroni M, Cavarretta R, et al. A pilot trial of low-dose naltrexone in primary progressive multiple sclerosis. Mult Sclre J. 2008;14(8):1076–83. https://doi.org/10.1177/1352458508095828.CrossRef

62.

Yin H, Zhang F, Yu M, Cheng H, Lin J, Gao Y, et al. Beta-endorphin ameliorates synovial cell hyperfunction in the collagen-induced arthritis rat model by specific downregulation of NF-kappa B activity. Neuroendocrinology. 2005;81(1):10–8.CrossRefPubMed

63.

Ludwig MD, Turel AP, Zagon IS, McLaughlin PJ. Long-term treatment with low dose naltrexone maintains stable health in patients with multiple sclerosis. Mult Scler J Exp Transl Clin [Internet]. 2016. https://doi.org/10.1177/2055217316672242.CrossRefPubMed

64.

Chopra P, Cooper MS. Treatment of complex regional pain syndrome (CRPS) using low dose naltrexone (LDN). J Neuroimm Pharm [Internet]. 2013;8(3):470 (/pmc/articles/PMC3661907/).CrossRef

65.

Chopra P, Cooper MS. Treatment of complex regional pain syndrome (CRPS) using low dose naltrexone (LDN). J Neuroimm Pharm. 2013;8:470–6.CrossRef

66.

Polo O, Pesonen P, Tuominen E. Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Fatigue [Internet]. 2019 Oct 2 [cited 2022 Dec 26];7(4):207–17. https://www.tandfonline.com/action/journalInformation?journalCode=rftg20. Accessed 28 Apr 2023.

67.

Neuman DL, Chadwick AL. Utilization of low-dose naltrexone for burning mouth syndrome: A case report. A A Pract [Internet]. 2021;15(5): e01475.CrossRefPubMedPubMedCentral

68.

Gurvits GE, Tan A. Burning mouth syndrome. World J Gastroenterol [Internet]. 2013;19(5):665 (/pmc/articles/PMC3574592/).CrossRefPubMedPubMedCentral

69.

Ibrahim O, Hogan SR, Vij A, Fernandez AP. Low-dose naltrexone treatment of familial benign Pemphigus (Hailey–Hailey disease). JAMA Dermatol [Internet]. 2017;153(10):1015 (/pmc/articles/PMC5817587/).CrossRefPubMed

70.

Webster LR, Butera PG, Moran L V., Wu N, Burns LH, Friedmann N. Oxytrex minimizes physical dependence while providing effective analgesia: a randomized controlled trial in low back pain. J Pain [Internet]. 2006 Dec 1 [cited 2022 Dec 27];7(12):937–46. http://www.jpain.org/article/S1526590006007875/fulltext. Accessed 28 Apr 2023.

71.

Chindalore VL, Craven RA, Yu KP, Butera PG, Burns LH, Friedmann N. Adding ultralow-dose naltrexone to oxycodone enhances and prolongs analgesia: a randomized, controlled trial of oxytrex. J Pain [Internet]. 2005 Jun 1 [cited 2022 Dec 27];6(6):392–9. http://www.jpain.org/article/S1526590005004128/fulltext. Accessed 28 Apr 2023.

72.

Rivera V, DeCicco J, Espiritu S. Proceedings #47: Low dose naltrexone: a viable alternative for long term chronic pain? Brain Stimul [Internet]. 2019 Mar 1 [cited 2022 Dec 28];12(2):e118–20. http://www.brainstimjrnl.com/article/S1935861X1830634X/fulltext. Accessed 28 Apr 2023.

73.

Zagon IS, Mclaughlin PJ. Naltrexone modulates tumor response in mice with neuroblastoma. Science (1979). 1983;221(4611):671–3.

74.

Donahue RN, McLaughlin PJ, Zagon IS. Low-dose naltrexone targets the opioid growth factor-opioid growth factor receptor pathway to inhibit cell proliferation: Mechanistic evidence from a tissue culture model. Exp Biol Med. 2011;236(9):1036–50.CrossRef

75.

Li Z, You Y, Griffin N, Feng J, Shan F. Low-dose naltrexone (LDN): A promising treatment in immune-related diseases and cancer therapy. Int Immunopharmacol. 2018;1(61):178–84.CrossRef

Titel: The Utilization of Low Dose Naltrexone for Chronic Pain
verfasst von: Salomon Poliwoda
Bryant Noss
Gia Thinh D. Truong
Zachary A. Creech
Sarang S. Koushik
Ivan Urits
Omar Viswanath
Publikationsdatum: 28.07.2023
Verlag: Springer International Publishing
Erschienen in: CNS Drugs / Ausgabe 8/2023
Print ISSN: 1172-7047
Elektronische ISSN: 1179-1934
DOI: https://doi.org/10.1007/s40263-023-01018-3

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Wartezeit nicht kürzer, aber Arbeit flexibler

Psychotherapie Medizin aktuell

Fünf Jahren nach der Neugestaltung der Psychotherapie-Richtlinie wurden jetzt die Effekte der vorgenommenen Änderungen ausgewertet. Das Hauptziel der Novellierung war eine kürzere Wartezeit auf Therapieplätze. Dieses Ziel wurde nicht erreicht, es gab jedoch positive Auswirkungen auf andere Bereiche.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

The Utilization of Low Dose Naltrexone for Chronic Pain

Abstract

Leitlinien kompakt für die Neurologie

Neu im Fachgebiet Neurologie

Wartezeit nicht kürzer, aber Arbeit flexibler

„Restriktion auf vier Wochen Therapie bei Schlaflosigkeit ist absurd!“

Stuhltransfusion könnte Fortschreiten von Parkinson-Symptomen bremsen

Frühe Tranexamsäure-Therapie nützt wenig bei Hirnblutungen

Update Neurologie

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2023

Amyloid-Lowering Monoclonal Antibodies for the Treatment of Early Alzheimer’s Disease

GABA-ergic Modulators: New Therapeutic Approaches to Premenstrual Dysphoric Disorder

Efficacy and Safety of Esketamine Nasal Spray in Patients with Treatment-Resistant Depression Who Completed a Second Induction Period: Analysis of the Ongoing SUSTAIN-3 Study

Acute Valproate-Induced Encephalopathy in Status Epilepticus: A Registry-Based Assessment

Effectiveness and Safety of Switching from Oral Antipsychotics to Once-Monthly Paliperidone Palmitate (PP1M) in the Management of Schizophrenia: A Systematic Review and Meta-Analysis

Leitlinien kompakt für die Neurologie

Neu im Fachgebiet Neurologie

Wartezeit nicht kürzer, aber Arbeit flexibler

„Restriktion auf vier Wochen Therapie bei Schlaflosigkeit ist absurd!“

Stuhltransfusion könnte Fortschreiten von Parkinson-Symptomen bremsen

Frühe Tranexamsäure-Therapie nützt wenig bei Hirnblutungen

Update Neurologie