Pulse cyclophosphamide therapy in CIDP

Abstract

To the Editor: The Quality Standards Subcommittee of the American Academy of Neurology has endorsed guidelines for management of concussion in sports. 1 This practice parameter represented a consolidation and modification of previous concussion guidelines in sports. 2,3 A major limitation and criticism of most management guidelines for concussion in sports has been that the determination of criteria for return to play has been arbitrarily established, based on theoretical considerations and limited clinical investigation.In the absence of loss of consciousness, clinical grading scales for concussion in sports have focused on amnesia or confusion as possible criteria for assessing the severity of concussion. During the evaluation of concussion on the athletic field, the clinical distinction between amnesia and confusion is not practical. Posttraumatic amnesia is a clinical entity that features normal immediate recall and the inability to learn new material. 4 During posttraumatic amnesia, there is relatively well-preserved retrieval of previously learned information except in cases associated with retrograde amnesia. Confusion is characterized by impaired immediate recall; reduced ability to learn new information; inability to retrieve already learned information; and incoherence secondary to inattention, distractibility, or the inability to obtain, maintain, or shift set. 4 Because memory function is disrupted during amnesia and confusion, the determination of the specific type of memory impairment is beyond the scope of the athletic trainer or health care provider who is not trained in neuropsychology or neurology. Accordingly, any athlete exhibiting impairment in orientation, concentration, immediate memory, or delayed recall on the standardized assessment of concussion (SAC) 5 or other test of neuropsychological function should be considered to be experiencing cognitive dysfunction.Studies utilizing baseline neuropsychological testing 6 or the SAC 5 indicate that athletes who experience cognitive dysfunction after concussion do not recover immediately. According to a prospective investigation of concussion among college football players, 6 the recovery period for an athlete who exhibited cognitive dysfunction without loss of consciousness was approximately 1 week. McCrea et al. 5 observed that concussed athletes without impaired consciousness scored significantly lower than their preinjury baseline scores on the SAC and returned to their preinjury scores within 48 hours.Based on the above-mentioned clinical information, the following considerations are advocated. First, the clinical distinction between amnesia and confusion on the playing field is unrealistic and unnecessary because both of these conditions are indicative of cognitive dysfunction. Secondly, it is recommended that any athlete who experiences cognitive dysfunction after a concussion in sports should not be allowed to return to competition that same day. Athletes that could be allowed to return to competition on the same day of a concussion are ...

Management of Chronic Peripheral Neuropathy

“…31 Others have reported the successful treatment of some patients with cyclosporin A 32-34 or cyclophosphamide. 35,36 In the renal transplant field the purine synthesis inhibitor, mycophenolate mofetil, is supplanting azathioprine and would be worth testing in CIDP. 37 Determining which agents offer real benefit will require large multicentre trials because CIDP is heterogeneous, variable in outcome and uncommon.…”