Questions or comments about this article may be directed to Deborah Downey, MN RN CNRN CNS ANP, at firstname.lastname@example.org. She is a nurse practitioner in neurology service at the Cleveland VA Medical Center, Cleveland, OH. She is also a member of the Journal of Neuroscience Nursing Editorial Board.
Each 2008 issue of the Journal of Neuroscience Nursing includes an anniversary feature in which we celebrate the vision, determination, and challenges that have marked 4 decades of neuroscience nursing practice and publishing excellence. We will highlight our past and begin to envision our future as we examine the changes we have witnessed.
As we look back through 40 years of neuroscience nursing and the treatment of neurological disease, it is incredible to note how far we have come. Since the beginning of the Decade of the Brain1 in 1990, there has been an explosion of new drug treatments for neurological disease, from new looks at old drugs (aspirin/extended‐release dipyridamole [Aggrenox]) to new, monoclonal antibody treatments for multiple sclerosis (MS). In the paragraphs below, we'll take a look at how new drugs have changed neuroscience nursing and how we have followed those changes in the pages of the Journal of Neuroscience Nursing (JNN).
The article “Multiple Sclerosis, Adrenocorticotropic Hormone, and Nursing Implications” (Brand, 1980) was published in the June 1980 JNN issue. Adrenocorticotropic hormone (ACTH) was the treatment of choice for MS at that time, but it did little to change the course of the disease, nor did it reduce disability. In JNN's December 1983 issue, “Viral and Immunopathology in Multiple Sclerosis” (Lewis, 1983) was published and we began to see evidence of the growing importance of the immunologic basis of MS. We now have disease‐modifying agents that clearly influence the course of the disease and good evidence for their impact on disability outcomes. The interferon‐beta drugs (Avonex, Betaseron, and Rebif) and glatiramer acetate (Copaxone) have changed not only MS treatment, but also the ways nurses teach patients about the course of MS and their long‐term prognosis. As a monoclonal antibody, the newest drug, natalizumab (Tysabri), is further evidence of our growing understanding of the immunologic basis of MS.
In June 1985, we published “Nursing Update on Alzheimer's Disease” (Ridder, 1985). In 1985 and still today, relatives caring for family members with Alzheimer disease (AD) dealt with the realities of behavior management, incontinence, and sundowning. Since 1985, four drugs have been approved for dementia. There are three acetylcholinesterase inhibitors: galantamine (Razadyne), rivastigmine (Exelon), and donepezil (Aricept), which recently received additional approval for severe AD. The N‐methyl‐D‐aspartate receptor antagonist memantine (Namenda) is approved for moderate and severe AD. Although these drugs have been used for several years for mild‐to‐moderate dementia, research recently revealed they improve cognition in patients with severe dementia and also help these patients maintain activities of daily living (ADLs). For families that are living with AD, the maintenance of ADLs significantly improves quality of life at home.
There were multiple articles on epilepsy and the use of anticonvulsants during JNN's early years. In December 1979, “Clinical Evaluation of Anticonvulsants: One Role of the Epilepsy Nurse Specialist in Research” (Lipe, 1979) discussed nursing roles for epilepsy nurses in research. Since then, several new generations of drugs have been introduced to treat epilepsy: lamotrigine (Lamictal), levetiracetam (Keppra), topiramate (Topamax), and gabapentin (Neurontin). These new drugs have fewer side effects and are well‐tolerated for the most part (leading to improved compliance). Exciting new uses for these drugs are being introduced. Examples of expanded uses for neurological drugs that have been discovered through research are topiramate for migraine, which has significantly changed migraine prophylaxis, and gabapentin for pain.
“Alterations in Movement: Nursing Assessment and Implications” (Konikow, 1985) in JNN's February 1985 issue demonstrates that perhaps nowhere have changes in drug therapy become more apparent than in the movement disorders field. Carbidopa/levodopa (Sinemet), which was the mainstay of Parkinson disease (PD) treatment, has been replaced in some instances with the dopamine agonists pramipexole (Mirapex) and ropinirole (Requip) as the drugs of choice for early treatment to help forestall disabling dyskinesias. Apomorphine (Apokyn) is a dopamine agonist available in injectible form for acute “off” episodes in advanced PD. Entacapone (Comtan), given with Sinemet, inactivates an enzyme responsible for breaking down the levodopa component before it can reach the target, potentially enhancing and prolonging the dopamine effect. Novel drug delivery routes have resulted in the new dopamine agonist rotigotine (Neupro) being made available as a transdermal patch, and carbidopa/levodopa (Parcopa) now is available as an orally disintegrating tablet. Finally, rasagiline (Azilect) is a nonselective monoamine oxidase type B (MAO‐B) inhibitor approved as monotherapy for early PD.
As we review the last 40 years, it is fitting to look at our first article, “Neurosurgical Nursing: Yesterday, Today and Tomorrow” (Therrien, 1969), which was in the October 1969 issue of JNN. The article, which was authored by Barbara Therrien, could be retitled for today: “Neuroscience Nursing: Yesterday, Today, and Tomorrow.” It is likely that 40 years into the future, the things that are cutting‐edge today will be old, or maybe recycled, and there will be another explosion of drugs for neurological diseases. As we adjust and teach our patients new care paradigms, however, our continuity of nursing care will remain steadfast amid the changes.
1An initiative sponsored by the Library of Congress and the National Institute of Mental Health of the National Institutes of Health “to enhance public awareness of the benefits to be derived from brain research” (Library of Congress, 2000).
Brand, K. P. (1980). Multiple sclerosis, adrenocorticotropic hormone, and nursing implications. Journal of Neurosurgical Nursing, 12
Konikow, N. S. (1985). Alterations in movement: Nursing assessment and implications. Journal of Neurosurgical Nursing, 17
Lewis, S. M. (1983). Viral and immunopathology in multiple sclerosis. Journal of Neurosurgical Nursing, 15
Library of Congress (2000). Project on the Decade of the Brain.
Retrieved December 19, 2007, from www.loc.gov/loc/brain
Lipe, H. (1979). Clinical evaluation of anticonvulsants: One role of the epilepsy nurse specialist in research. Journal of Neurosurgical Nursing, 11
Ridder, M. (1985). Nursing update on Alzheimer's disease. Journal of Neurosurgical Nursing, 17
Therrien, B. (1969). Neurosurgical nursing: Yesterday, today and tomorrow. Journal of Neurosurgical Nursing, 1