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(Continued from page 99)
There are other medications in addition to Nimodipine that improve vasospasms. Studies such as Naidu, et. al., "British Journal of OB/GYN," 1996, 103:111-116, demonstrate that magnesium sulfate relieves cerebral vasospasms and platelet activating factor antagonist intravenously prevents vasospasm as demonstrated by Hiroshima, et. al., "Journal of Neurosurgery," 1996, 84:826-30. There is a wealth of knowledge demonstrating the beneficial effects of magnesium with regards to arterial vasospasms. In countless studies it has been shown to improve the spasms of coronary artery disease. However, in the largest phase I clinical trial in coronary artery spasms, there is no significant difference in individuals who had normal levels of magnesium and were treated with magnesium for coronary artery vasospasms compared to placebo. Serum ionized magnesium has been shown to be decreased in patients with certain types of migraine disease. Magnesium has been shown to reduce the arterial vasospasms associated with eclampsia, pre-eclampsia, cerebral and ocular vasospasms. Hydroxyl radical scavengers as demonstrated in a multi-center placebo controlled double blind trial, by Asano, et. al., "Journal of Neurosurgery," 1996, 84:792-803, and Tirilazad mesylate in doses up to 6 mg/kg/day for 10 days, as demonstrated in a phase II trial by Haley, et. al., "Journal of Neurosurgery," 1995, 82:786-90 relieve vasospasms. Histidine, because of its free radical scavenging characteristics, particularly its ability to reduce oxygen as demonstrated by Fidel, et. al., "Surgical Neurology," 1995, 43:52-7, reverses cerebral vasospasms.
Nitroglycerin has been shown to have a clinical effect of preventing or relaxing cerebral vasospasms. Sasanuma, et. al., "No Shinkei Geka," 1991, 19:227-232, demonstrated a significant decrease in continuous infusions of nitroglycerin 0.5 to 1.0 mcg/kg/minute treated cerebral vasospasms. Kanamaru, et. al., "Journal of Neurosurgery," 1989, 71:909-915, demonstrated that cerebral vasospasms which were induced in monkeys were fully relaxed by nitroglycerin. Nitroglycerine has been documented to reverse vasospasms. It is widely known that sublingual nitroglycerin quiets the pain associated with cardiac vasospasms. Tegler, et. al., "Journal of Neuro-Imaging," 1996,6:81-86, demonstrated that sublingual nitroglycerin significantly decreased middle cerebral artery velocities in that the middle cerebral artery vasodilation is what may be the cause of the nitroglycerin induced clinical headaches. These increased velocities were demonstrated with transcranial Dopplers. Many different medications can reduce cerebral vasospasms in addition to the tried and true triple H therapy. Vitamin C has been shown to suppress the cerebral vasospastic actions of oxyhemoglobin as demonstrated by Kawakami, et. al., "Neurosurgery," 1991, 28:33-40. They suggest that vitamin C should be used in the cisternal irrigation after subarachnoid hemorrhage to prevent the development of cerebral vasospasms. These studies were done in monkey, dog and cow (Continued on page 101)
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