Burhanettin ÇİĞDEM, Aytekin AKYÜZ, Şuat TOPAKTAŞ, Şeyda GÖKÇE FİGÜL, Ertuğrul BOLAYIR

Diabetik polinöropatik hastalarda memantinin ağrı üzerine etkinliği

Diyabetik periferal nöropati (DPN) klinik pratikte en sık karşılaşılan kronik nöropatik ağrısemptomlarından birisidir. Diyabetik nöropatili hastalarda çeşitli tedavi yöntemleri denenmektedir.Son yıllarda primer afferent-spinotalamik nöron sinapslarında eksitatör transmisyonunmodülasyonu için N-methyl-D-aspartate (NMDA) reseptör antagonistleri kullanılmaktadır.NMDA reseptör antagonistlerinin kronik ağrı durumlarında opioid analjezikler kadar etkin olduğuda gösterilmiştir. Bu çalışmada diabetik polinöropatili hastalarda prospektif olarak NMDAreseptör antagonisti Memantinin farklı iki dozda, ağrı üzerine olan etkinliğini değerlendirmeyiamaçladık. Tip 2 diyabetli ve diabetik nöropatisi olan 24 hasta çalışmaya dahil edildi. Diyabetiknöropati tanısı klinik (anamnez, motor, duyusal ve refleks muayenesi) ve elektrofızyolojik testlerile konuldu. Hastaların ağrı şikayetleri tedavi öncesi ve sonrası Vizüel Ağrı Skalası (VAS) iledeğerlendirildi. Hastalara birinci hafta 10 mg, daha sonra altı hafta boyunca 20 mg memantinverildi. Yedinci hafta sonunda hastalar tekrar değerlendirildi. Tedaviye ara vermeksizin bir hafta30 mg, daha sonra altı hafta boyunca 40 mg memantin uygulandı. Her iki tedavi grubunda kontrolgrubuna kıyasla VAS değerlerinde anlamlı düzelme gözlenirken, tedavi grupları arasındaki farkdaönemli bulundu. Sonuç olarak diyabetik polinöropatide Memantin tedavisi nöropatik ağrınıntedavisinde düzelme sağlamaktadır.

Effect of memantine on painf ul in the diabetic polyneuropathic patients

Diabetic peripheral neuropathy (DPN) is one of the most frequent chronic pain symptoms. Severaltherapeutic modalities have been used for the patients with DPN. In recent years, NMDA receptorantagonists for modulation of excitatory transmission at primary afferent spino-thalamic neuronsynapses are being used. It has been shown that NMDA receptor antagonists are as effective asopioid analgesics in cases with chronic pain. The aim of this study was to investigate on the paineffectiveness of NMDA receptor antagonist Memantin at two different doses prospectively.Twenty four type 2 diabetic neuropathy patients were included into the study. The diagnosis ofdiabetic neuropathy was based on clinical signs and symptoms (history, clinical examination ofmuscle strength, sensorial and deep tendon reflexes), and electrophysiological tests. Paincomplaints of the patients were evaluated by using visual pain scala before and after the treatment.Patients were administered 10 mg Memantin for the first week followed by then 20 mg forconsecutive 6 week. Without interruption of treatment 30 mg Memantin for one week and then 40mg Memantin for 6 week were administered. There was a significant improvement in bothtreatment groups as compared to control group. Between the treatment groups was significant. Itwas concluted that; Memantin was effective in reducing neuropathic pain in patients with DPN.

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