Effects of the implantation of Ommaya reservoir in children with tuberculous meningitis hydrocephalus: a preliminary study

Jiang, Lin; Zhou, Hui; Zhang, Nu; Yin, Bo; Sheng, Hang-song

doi:10.1007/s00381-012-1748-2

Cited by 15 publications

(14 citation statements)

References 27 publications

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“…The most direct route to the CNS is to inject the drug into the intraventricular, intracavitary, or interstitial system. For example, intracerebroventricular (ICV) administration is considered as an intrathecal delivery via an ICV port implanted under the scalp of the patient and is used for treating various types of CNS diseases, such as infections [231,232], chronic pain [233,234], and types of brain cancer [235]. This local delivery ensures high drug concentrations in the CNS while the peripheral exposure is minimal.…”

Section: Direct Central Deliverymentioning

confidence: 99%

Overcoming the Blood–Brain Barrier. Challenges and Tricks for CNS Drug Delivery

2019

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Treatment of certain central nervous system disorders, including different types of cerebral malignancies, is limited by traditional oral or systemic administrations of therapeutic drugs due to possible serious side effects and/or lack of the brain penetration and, therefore, the efficacy of the drugs is diminished. During the last decade, several new technologies were developed to overcome barrier properties of cerebral capillaries. This review gives a short overview of the structural elements and anatomical features of the blood–brain barrier. The various in vitro (static and dynamic), in vivo (microdialysis), and in situ (brain perfusion) blood–brain barrier models are also presented. The drug formulations and administration options to deliver molecules effectively to the central nervous system (CNS) are presented. Nanocarriers, nanoparticles (lipid, polymeric, magnetic, gold, and carbon based nanoparticles, dendrimers, etc.), viral and peptid vectors and shuttles, sonoporation and microbubbles are briefly shown. The modulation of receptors and efflux transporters in the cell membrane can also be an effective approach to enhance brain exposure to therapeutic compounds. Intranasal administration is a noninvasive delivery route to bypass the blood–brain barrier, while direct brain administration is an invasive mode to target the brain region with therapeutic drug concentrations locally. Nowadays, both technological and mechanistic tools are available to assist in overcoming the blood–brain barrier. With these techniques more effective and even safer drugs can be developed for the treatment of devastating brain disorders.

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Section: Direct Central Deliverymentioning

confidence: 99%

Overcoming the Blood–Brain Barrier. Challenges and Tricks for CNS Drug Delivery

2019

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“…This route of administration, also referred to as intraventricular administration, has been used for several decades to provide treatments for pediatric and adult patients who suffer from a broad range of diseases, including infectious meningitis, intractable pain, and various types of cancer. [1][2][3][4][5] In addition to the ICV route, intrathecal delivery methods include single or repeated intrathecal lumbar (IT-L) injections, in which agents are directly administered into the cerebrospinal fluid (CSF) by puncturing the membranes surrounding the spinal cord (Fig 1). Intrathecal routes of administration allow therapies to bypass the bloodebrain barrier (BBB) and are commonly used to treat a variety of diseases in pediatric and adult patients.…”

Section: Introductionmentioning

confidence: 99%

Intracerebroventricular Delivery as a Safe, Long-Term Route of Drug Administration

Cohen‐Pfeffer

Gururangan

Lester

et al. 2017

Pediatric Neurology

124

102

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Intrathecal delivery methods have been used for many decades to treat a broad range of central nervous system disorders. A literature review demonstrated that intracerebroventricular route is an established and well-tolerated method for prolonged central nervous system drug delivery in pediatric and adult populations. Intracerebroventricular devices were present in patients from one to 7156 days. The number of punctures per device ranged from 2 to 280. Noninfectious complication rates per patient (range, 1.0% to 33.0%) were similar to infectious complication rates (0.0% to 27.0%). Clinician experience and training and the use of strict aseptic techniques have been shown to reduce the frequency of complications.

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“…Another study reported 12 serious TBM cases, in pediatric age group, presenting with hydrocephalus and disturbed consciousness. All of them received IT injection of INH and dexamethasone, and a successful recovery was observed in 9 out of 12 patients [25]. In another study, Swift et al treated 18 TBM patients with IT isoniazid.…”

Section: Discussionmentioning

confidence: 99%

Intrathecal therapy for tuberculous meningitis: propensity-matched cohort study

Wang

Wen

et al. 2021

Neurol Sci

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ObjectiveThe study aimed to determine the safety and efficacy of intrathecally administered isoniazid (INH) and prednisolone in addition to systemic anti-TB therapy and compare it with systemic anti-TB therapy alone in adult patients with tuberculous meningitis (TBM). Methods In this retrospective study, patients were categorized into two groups: Group A patients received systematic anti-TB therapy alone, Group B patients received IT INH (50 mg) and prednisolone (25 mg) twice a week together with the same standard systemic anti-TB therapy as Group A, in addition to the standard systemic anti-TB therapy. Functional outcomes were compared between the two groups in a prosperity-matched cohort using propensity score matching (PSM) method. Results A total of 198 patients with TBM were enrolled. After PSM, 30 patients from each group were analyzed, so that there was no significant difference in the characteristics of the two groups. Mortality at follow-up was significantly lower among patients receiving additional IT therapy (4/30, 13.3%) compared with matched patients receiving systemic anti-TB therapy alone (11/30, 36.7%, P value = 0.037). Conclusions In this propensity score-matched cohort, the addition of IT INH and prednisolone to systemic anti-TB therapy could be effective for the better outcome among adult TBM patients. Further large-scale, prospective, and randomized controlled trials are warranted to the best timing and indication of IT therapy.

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Effects of the implantation of Ommaya reservoir in children with tuberculous meningitis hydrocephalus: a preliminary study

Cited by 15 publications

References 27 publications

Overcoming the Blood–Brain Barrier. Challenges and Tricks for CNS Drug Delivery

Overcoming the Blood–Brain Barrier. Challenges and Tricks for CNS Drug Delivery

Intracerebroventricular Delivery as a Safe, Long-Term Route of Drug Administration

Intrathecal therapy for tuberculous meningitis: propensity-matched cohort study

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