ROLE OF PIRACETAM IN POST-CONCUSSION SYNDROME A PROSPECTIVE RANDOMIZED STUDY

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ROLE OF PIRACETAM IN POST-CONCUSSION SYNDROME A
PROSPECTIVE RANDOMIZED STUDY

• Deepak Agrawal, K Naveen, CS Bal, AK Mahapatra
• Departments of Neurosurgery and Nuclear
  medicine,
• ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW
  DELHI, INDIA

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PIRACETAM IN MINOR HEAD INJURY

• INTRODUCTION
• Post-concussion syndrome remains a poorly
  understood and treated condition
• We describe a trial with piracetam, a drug
  which has beneficial effects on the CBF by
  decreasing the adhesivity, aggregation, and
  deformability of erythrocytes along with flow
  thrust tension of the blood

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PIRACETAM IN MINOR HEAD INJURY
PREVIOUS STUDIES ON PIRACETAM IN MINOR HEAD
INJURY WERE BASED ONLY ON SUBJECTIVE CRITERIA
FIRST STUDY OF ITS KIND BASED ON AN OBJECTIVE
PARAMETER LIKE BRAIN SPECT
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PIRACETAM IN MINOR HEAD INJURY
SENSTIVITY

• CT scan 4.6
• (Nedd K et al, 1993)
• MRI 60
• (Kant R et al, 1997)
• SPECT 81
• (Present study)

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PIRACETAM IN MINOR HEAD INJURY

• OBJECTIVE
• To correlate the symptomatic improvement with
  Single Photon Emission Computed Tomography
  (SPECT) findings, in patients with
  post-concussion syndrome (PCS), following
  administration of Piracetam (Cerecetam)

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PIRACETAM IN MINOR HEAD INJURY

• MATERIALS AND METHODS
• PROSPECTIVE STUDY
• PERIOD- JAN 2002 TO DEC 2002

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PIRACETAM IN MINOR HEAD INJURY
MINOR HEAD INJURY

• 1. Loss of consciousness lt30 minutes.
• 2. GCS score 13 to 15.
• 3. Posttraumatic amnesia lt24 hours.

criteria published by the members of the Mild
Traumatic brain injury Interdisciplinary Special
Interest Group (BISIG) Kay T, Harrington DE,
et al. Definition of mild traumatic brain injury.
J Head Trauma Rehabil 1993886
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PIRACETAM IN MINOR HEAD INJURY

• POST CONCUSSION SYNDROME
• (2 or more of the following)

• Headache
• Dizziness and vertigo
• Memory deficits
• Behavioral and emotional disturbances.

DSM IV criteria based on recommendation of Brown
et al. Brown SJ, Fann JR, Grant I Postconcussion
disorder time to acknowledge a common source of
neurobehavioural morbidity. J Neuropsychiatry
Clin Neurosci 615-22, 1994
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PIRACETAM IN MINOR HEAD INJURY MATERIALS AND
METHODS (Contd.)
INVESTIGATION

• NCCT head

• SPECT scan brain
• Within 72 hours of injury

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PIRACETAM IN MINOR HEAD INJURY
SPECT

• SPECT scanning was done using 99Tcm-ECD on a
  dual headed GE 'Varicam' scanner.
• The final data was displayed on a 10 grade color
  scale and semi quantitative analysis performed.

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PIRACETAM IN MINOR HEAD INJURY
ABNORMAL SPECT SCAN

• Regional cerebral perfusion lt10 of
  contralateral lobe, or in case of bilateral
  involvement, less than 20 of cerebellum

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PIRACETAM IN MINOR HEAD INJURY MATERIALS AND
METHODS (Contd.)
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PIRACETAM IN MINOR HEAD INJURY

• RESULTS

• Significant rise in the post treatment ratio in
  the piracetam group (mean 0.959) as compared to
  the controls (mean 0.013)
• (p lt.001
• 95 CI -0.0114, -0.038 ).

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PIRACETAM IN MINOR HEAD INJURY

• RESULTS

Plt0.05
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PIRACETAM IN MINOR HEAD INJURY

• RESULTS

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PIRACETAM IN MINOR HEAD INJURY

• SPECT have been found to persist for as long as
  one year following minor head injury (Jocobs A,
  et al, 1996)

• Serial SPECT scanning can therefore provide an
  ideal platform to test the efficacy of various
  drugs in reversing these perfusion abnormalities
  in PCS.

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PIRACETAM IN MINOR HEAD INJURY

• Piracetam
• More than 12 g of piracetam has been given as
  daily dose in acute stroke (De Deyn PP et al,
  1997) without significant side effects

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PIRACETAM IN MINOR HEAD INJURY

• CONCLUSIONS
• Cerebral perfusion defects occur in majority of
  the cases of postconcussion syndrome following
  minor head injury.

• Piracetam reverses cerebral perfusion deficits
  and may result in accelerated symptomatic
  improvement in patients with postconcussion
  syndrome.

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PIRACETAM IN MINOR HEAD INJURY
CONCLUSIONS (Contd.)

• THIS PRELIMINARY STUDY SHOWS THAT LOW DOSE
  PIRACETAM CAN BENEFIT PATIENTS WITH
  POSTCONCUSSION SYNDROME COST-EFFECTIVELY
  WITHOUT APPRECIABLE SIDE EFFECTS.

A RANDOMISED CONTROLLED TRIAL IS PRESENTLY
UNDERWAY FOR MORE DEFINITIVE RESULTS
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THANK YOU