Common Epilepsy Drug Taken During Pregnancy Might Raise Spina Bifida Risk

Pregnant women with epilepsy who are taking carbamazepine (Tegretol) to control seizures may be at a slightly increased risk of having an infant with spina bifida, a new study finds. Spina bifida is a condition in which the bones of the spine do not close but the spinal cord remains in place, usually with skin covering the defect. Most children will need lifelong treatment for problems arising from damage to the spinal cord and spinal nerves.

"For women with epilepsy, seizure control during pregnancy is very important," said lead researcher Lolkje de Jong van den Berg, from the division of pharmacy at the University of Groningen in the Netherlands. "Our study can help in decisions regarding whether carbamazepine should be the drug of choice in pregnancy." However, the best option regarding treatment can be chosen only on an individual basis by the woman and her neurologist before pregnancy, weighing the benefits of epilepsy control against the risk of birth defects, de Jong-van den Berg said.

The report is published in the Dec. 3 online edition of the BMJ. For the study, de Jong-van den Berg's team reviewed existing research to determine the risk of birth defects among women taking Tegretol. The researchers found that infants of women taking Tegretol were 2.6 times more likely to have spina bifida, compared with women not taking any anti-epileptic medication.

Injections May Relieve Drooling in Nerve-Damaged Kids

Botulinum toxin injections may temporarily relieve drooling in children with certain neurological conditions, a new European study has found. Depending on its severity, drooling can lead to stigmatization and social neglect, numerous daily clothing changes, skin irritation around the mouth, aspiration pneumonia and dehydration, Dr. Arthur Scheffer of Radboud University Medical Center in Nijmegen, the Netherlands, and colleagues noted in a news release about their study. In the study, Scheffer's team gave botulinum toxin injections to 131 children, average age 10.9 years, with cerebral palsy or other non-progressive neurological conditions, as well as moderate to severe drooling.

The injections were confined to the submandibular glands, which are responsible for 70 percent of saliva production while a person is resting. Two months after the injections, the average drooling quotient had fallen to 15.5 (on a scale of zero to 100) from 28.8 at the start of the study. And, the study authors noted, 61 patients achieved a 50 percent reduction in drooling. At the eight-month follow-up, the average drooling quotient was 18.7, according to the report in the September issue of the journal Archives of Otolaryngology Head & Neck Surgery.

The findings "indicate that most patients who initially respond well to injection can expect an effect to last between 19 and 33 weeks. Although the 46.6 percent success rate might appear low, its safety and efficacy make botulinum toxin a useful first-line invasive treatment if conservative measures have failed," the researchers concluded in the news release from the journal's publisher. Botulinum toxin injections have been used safely for years, according to the American Academy of Pediatrics. Side effects can include rash, whole-body muscle soreness, difficulty swallowing and weakness in the injected muscles, but they usually go away quickly, the AAP notes.

Smoked Marijuana May Ease Chronic Nerve Pain

Smoking cannabis, also known as marijuana, reduced pain in patients with nerve pain stemming from injuries or surgical complications, new research shows. Twenty-one adults with chronic nerve pain were taught to take a single inhalation of 25 milligrams of cannabis through a pipe, three times a day, for five days. The cannabis contained one of three levels of potency of tetrahydrocannabinol (THC), the active ingredient in marijuana, as well as a placebo dosage containing no THC.All of the patients rotated through each of the four dosages, with nine days of no smoking in between. Patients smoking the highest potency marijuana reported less pain than those smoking samples containing no THC. Patients also reported better sleep and less anxiety, according to the Canadian study.

On an 11-point scale, the average daily pain intensity was 6.1 for those smoking 9.4 percent THC concentration, compared to 5.4 for those smoking cannabis containing no THC."Patients have repeatedly made claims that smoked cannabis helps to treat pain, but the issue for me had always been the lack of clinical research to support that claim," said Dr. Mark Ware, director of clinical research at the Alan Edwards Pain Management Unit of the McGill University Health Centre in Montreal. In this small but randomized, controlled trial, "the pain reductions were modest, but significant," he said. "And it was in people for whom nothing else worked."

The study is published in the Aug. 30 issue of the Canadian Medical Association Journal. Persistent nerve pain, clinically known as neuropathy, can be very difficult to treat, Ware said. These patients had tried other treatments for neuropathy, such as opioids, anticonvulsants, antidepressants and local anesthetics, with little relief, Ware said. In addition, the THC potency levels used in the study were kept at 2.5 percent, 6 percent and 9 percent considerably less than the 12 percent to 15 percent often found in marijuana sold on the street, Ware said. Researchers kept the levels low for two reasons, Ware explained. One was to minimize the psychoactive effects, such as feeling lightheaded, dizzy, detached, nauseous or euphoric.