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LETTER TO EDITOR
Year : 2004  |  Volume : 52  |  Issue : 3  |  Page : 392-393

Nimodipine in severe head injury


Department of Neurological Sciences, Christian Medical College Hospital, Vellore, Tamilnadu - 632 004, India

Date of Acceptance31-Jul-2004

Correspondence Address:
Department of Neurological Sciences, Christian Medical College Hospital, Vellore, Tamilnadu - 632 004, India
[email protected]m



How to cite this article:
Kumar S. Nimodipine in severe head injury. Neurol India 2004;52:392-3


How to cite this URL:
Kumar S. Nimodipine in severe head injury. Neurol India [serial online] 2004 [cited 2020 Oct 26];52:392-3. Available from: https://www.neurologyindia.com/text.asp?2004/52/3/392/12750


Sir,
I read with interest the recent article by Pillai SV et al.[1] Based on an excellent randomized controlled trial, they conclude that nimodipine does not improve the outcome in patients with severe diffuse head injury. However, I would like to make certain comments.
1. Patient selection: This trial included patients on the basis of Glasgow Coma Scale (8 or less) and CT scan findings (diffuse head injury with absence of any operable mass lesion). As nimodipine is proposed to act by ameliorating traumatic vasospasm, it would be prudent to perform Trans Cranial Doppler (TCD) studies at admission to identify the subset of patients with evidence of vasospasm. In a recent study, early treatment with nimodipine was found to improve outcome in a group of patients with concussion who had cerebral spasm confirmed by TCD.[2]
2. Dose & mode of administration of nimodipine: Patients in this trial received only one-third of the standard dose (30 mg Q6H as compared to the standard 60 mg Q4H). Could the lack of effect be partly related to inadequate dose?
Moreover, after emptying the contents of nimodipine capsule directly into Ryle's tube, flushing of the tube with 30 ml 0.9% saline is recommended for facilitating delivery of the entire dose. In addition, contents of capsule should not be admixed with any other solution prior to administration due to the risk of decomposition.[3] Failure to observe these precautions could result in incomplete drug delivery.
3. Finally, as Pillai SV et al point out, this study does not have enough power to address the efficacy of nimodipine in traumatic subarachnoid hemorrhage (tSAH). In a recent systematic review of all published RCTs on this subject, nimodipine showed a beneficial effect in the subgroup of brain injury patients with tSAH.[4] 

  References Top

1.Pillai SV, Kolluri VR, Mohanty A, Chandramouli BA. Evaluation of nimodipine in the treatment of severe diffuse head injury: A double-blind placebo-controlled trial. Neurol India 2003;51:361-3.  Back to cited text no. 1    
2.Xiao X, Guo X, Wang D, Xue G. Mechanism and treatment principle for cerebral vessel spasm caused by concussion. Chin J Traumatol 2002;5:380-4.  Back to cited text no. 2    
3.http://www.medscape.com/druginfo (Accessed on 2 January, 2004).  Back to cited text no. 3    
4.Langham J, Goldfrad C, Teasdale G, Shaw D, Rowan K. Calcium channel blockers for acute traumatic brain injury (Cochrane Methodology Review). In: The Cochrane Library, Issue 4, 2003. Chichester, UK: John Wiley & Sons, Ltd.  Back to cited text no. 4    

 

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Online since 20th March '04
Published by Wolters Kluwer - Medknow