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Case Report | DOI: https://doi.org/10.31579/2690-4861/018
*Corresponding Author: Aamir Jalal Al Mosawi, Advisor in Pediatrics and Pediatric Psychiatry Children Teaching Hospital of Baghdad Medical City.
Citation: Aamir Jalal A, M., (2020) Recent uses of piracetam in pediatric neurology. International Journal of Clinical Case Reports and Reviews. 2(4); DOI: 10.31579/2690-4861/018
Copyright: ©2020 Aamir Jalal Al Mosawi, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 06 March 2020 | Accepted: 12 June 2020 | Published: 18 June 2020
Keywords: colpocephaly; Corpus callosum; cerebrolysin; citicoline
Piracetam (2-oxo-1-pyrrolidine acetamide) is a cyclical derivative of GABA (gamma-aminobutyric acid). It was first synthesized during the 1950s by Corneliu E. Giurgea. There are reports of its use for epilepsy in the 1950s. Piracetam can beneficially influence impaired brain function by improving neuronal and cognitive functions without acting as a sedative or stimulant, increasing blood flow and oxygen consumption in the brain, and improving the function of the neurotransmitters and brain neurotransmission. The modes of action of piracetam has been attributed to differential effects on subtypes of glutamate receptors without GABAergic actions Piracetam has no significant side effect nor has acute toxicity at the doses used in human studies. The LD50 is 5.6 g/kg in rats and 20 g/kg in mice, indicating extremely low acute toxicity [1-4].
Piracetam has been used in the treatment of various neuropsychiatric disorders including senile involution [5], geriatric memory impairment [6], post-concussional syndrome [7], spasticity in cerebral palsy [8], acute cerebral ischemia [9,10], organic dementia [11,12,13] , anxiety [14,15], dyslexia [16], schizophrenia [17], vertigo [18], epilepsy and seizures including myoclonus epilepsy [19,20] ,cognition and memory deficit [21], acute and chronic consciousness disturbances caused by clinical syndromes of cerebrovascular disease (strokes, syndromes of dementia) [22], rehabilitative treatment of the middle-aged and elderly with a stroke[23], management of neuroleptic side effects and neuroleptic-induced akathisia [42,25,26,27],and learning disability [28].Table-1 summarizes piracetam experimental and clinical research findings during the 1970s, and Table-2 summarizes piracetam experimental and clinical research findings during the 1980s.
Recent uses of piracetam in pediatric neurology include brain atrophy,
Piracetam has been recently used as a part of multi-factorial therapies in the treatment of brain atrophy has been recently reported. Multi-factorial therapies including intramuscular piracetam, intramuscular cerebrolysin, citicoline (oral and intramuscular), oral pyritinol, and intramuscular nandrolone decanoate was used with a beneficial effect in a very severe form of spastic cerebral palsy associated with evidence of significant brain atrophy [1].
Piracetam was used in the treatment of a boy with idiopathic mental retardation which is a heterogeneous condition. Treatment included a new combination of interventions consisting of the use of intramuscular piracetam, intramuscular cerebrolysin, intramuscular citicoline, and oral pyritinol. Treatment was successful in advancing the mental function of the boy with moderately severe idiopathic mental retardation who was uneducable, but became perfectly educable after treatment [2].
Piracetam was used in the treatment of cerebral palsy which is a heterogeneous condition associated with a non-progressive lesion, but permanent disorder of movement with limited mobility. Cerebral palsy is generally associated with gross motor developmental delay. In moderate to severe cases motor developmental milestones such as walking may never be achieved [3].
In a retrospective observational study, patients with spastic cerebral palsy were treated with individualized treatment plans providing a new combination of interventions including nutritional support, muscle relaxants and the use of oral pyritinol, intramuscular piracetam ,intramuscular cerebrolysin, citicoline (oral and intramuscular), and intramuscular nandrolone decanoate. Treatment aimed primarily at improving motor development particularly standing and walking. Six patients (3 girls and 3 boys) with spastic cerebral palsy and marked motor disability were treated. The patients’ age ranged from 22 months to three years. All patients were unable to stand or walk, and had poor speech development. Four patients had severe cerebral palsy and were even unable to sit. The other two patients had moderately severe disorder and were unable to stand or walk. All the patients were not saying any word or were saying only few words. After treatment, all the treated patients experienced improvement in motor development without the occurrence of any side effect. Five patients were able to stand with support, and four of them were also able to walk few steps with support. The sixth patient remained unable to stand and the limited benefit of treatment was attributed to some degree of deformity and muscle contracture. In all patients treatment was associated with initiation of speech development or improved speech. It was possible to demonstrate improvement in fine motor skills in three patients. This study suggested that treatment of patients with spastic cerebral palsy (moderate and severe) with this individualized treatment plans was associated with a beneficial effect on motor development particularly standing and walking [3].
Corpus callosum is a large nerve tract consisting of a flat bundle of commissural fibers that runs below the brain cerebral cortex. It connects the left and right cerebral hemispheres. Absence of the corpus callosum because of failure of development is a rare congenital defect called “Agenesis of the corpus callosum” [4]. In a recent study, two Iraqi infants with non-syndromic agenesis of the corpus callosum were observed. One infant had the isolated type and the second infant had agenesis of the corpus callosum associated with colpocephaly. Both infants had the clinical features of the syndrome resulting from the associated failure of neuronal migration including hypotonia with poor head control, no response to voice, not recognizing faces, and they didn’t show any eye contact. They have never smiled and had poor spontaneous movements. The patient with colpocephaly was a girl and, she was treated with courses of intramuscular piracetam and cerebrolysin for three months with aim of improving brain functions and accelerating her development. The second patient was a boy and he didn’t receive any specific therapy. Treatment was not associated with any side effects, and after three months of treatment, the patient experienced improvements in feeding, muscle tone, alertness and response to voice, and movements. The untreated patient didn’t show any obvious improvement despite he didn’t have colpocephaly [35].
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