News
Oklahoma Democrats try hard line on autism treatment coverageNo Viagra without autism coverage. That was the new rallying cry taken up by Senate Democrats on Wednesday. Insurance companies that do not offer coverage for treatment of autism spectrum disorders should be prohibited from providing coverage for treatment of erectile dysfunction, said the Democrat leadership in the state Senate. "We think it's grossly unfair that insurance companies will cover something like ED but they're not willing to cover autism treatments," said Senate Democratic Leader, Sen. Charlie Laster, D-Shawnee. All 22 Democrat senators signed a Feb. 25 letter asking the Oklahoma State and Education Employees Group Insurance Board to prepare a financial impact statement and cost-savings analysis for a proposal to prohibit insurance companies from offering erectile dysfunction benefits without also offering autism benefits. No legislation has been filed regarding the matter, said Laster, but lawmakers are within their authority to ask for the study. "You can't get it if you don't ask," said Laster. The letter also asks the Insurance Board to explain the methodology used to make their determination. Laster said he didn't know how soon the board would be able to conclude the study. Laster said Senate Democrats have been informed that many health insurance providers cover erectile dysfunction treatment. National studies published by industry analysts estimated that private employer health plans cover between 40 percent and 70 percent of prescriptions for erectile dysfunction, usually if the ED results from a documented medical condition. In 2005, federal administrators announced the Medicare prescription drug benefit would cover impotence drugs. Senate Democrats have a press conference planned for Thursday to accuse the Republican majority of "using their new power to protect insurance companies," according to a media advisory for the event. Though the Republican majority has already defeated legislation to require health insurance companies to cover autism treatments, effectively putting the issue to rest for this year's session and next year's as well, Senate Democrats say they plan to use the amendment process to bring insurance reform to a vote on the Senate floor. SOURCE: Regional Business News, 2009 | |
| 26 Feb, 2009 | |
Sildenafil and transient global amnesiaSir, Sildenafil, an inhibitor of phosphodiesterase type 5, is widely prescribed for erectile dysfunction. A few cases of cardiac complications have been described with sildenafil use, and the combined administration with organic nitrates in subjects suffering from ischemic cardiopathy is particularly dangerous [1]. Rare cases of neurological complications have also been reported: one case of palsy of cranial nerve III, two cases of tonic-clonic seizures, one case of intracerebral hematoma, and one case of transient global amnesia (TGA) [2]. Side effects of sildenafil, such as flushing, dizziness, headache, nausea, nasal congestion, nose-bleeds and visual disturbances, are much more common. They are usually of less relevance, but prove that the vasodilating effect of sildenafil is not confined to the corpus cavernosum. We observed, in the span of one year, two cases of TGA occurring closely after the first-ever assumption of sildenafil (25 mg) and sexual intercourse. Both patients underwent an exhaustive clinical and laboratory work-up in order to identify the possible precipitating factors of TGA. The clinical characteristics fulfilled the criteria validated by Hodges and Warlow [3]. In these patients, no causal cerebral lesion was found and the final diagnosis was idiopathic TGA, possibly associated with sexual activity under the effect of sildenafil The main hypotheses on TGA pathogenesis have been summarized in a recent paper [4]. We can suppose that sildenafil may precipitate a TGA attack. In first instance, the vasodilating effect of the drug is not restricted to the corpus cavernosum, but also acts at the level of cerebral vessels. Moreover, sexual intercourse may cause enhancement of sympathetic activity leading to increased central venous return, with higher venous pressure picks during Valsalvalike maneuvers. These two combined effects may cause venous stasis and ischemia in hippocampal regions leading to TGA [4]. Another hypothesis may be formulated on the basis of the effect of sildenafil on NO pathway. A widely accepted theory recognizes NO as causal factor of migraine. On the other hand, cortical spreading depression (CSD) has been recently demonstrated in human occipital cortex during migraine aura, by means of functional magnetic resonance imaging [5, 5, 6]. NO donors may precipitate migraine with aura We speculate that sildenafil could precipitate a CSD-like phenomenon in hippocampal regions leading to TGA, possibly facilitated by cerebral vasoconstriction due to hyperventilation. Of course, we cannot exclude that the use of sildenafil could be randomly associated with TGA and that the precipitating factor, in the present cases, was only sexual intercourse. Nevertheless, we believe that the hypothesis of a connection between sildenafil and TGA is intriguing, particularly in light of the previously mentioned two main recent hypotheses on pathogenesis of TGA (venous ischemia in hippocampal regions and CSD). Finally, since TGA is a benign syndrome, even if the relationship between sildenafil and TGA is real, the risk/benefit profile of the drug is not modified, in our opinion 1. Feenstra J, van Drie-Pierik RJ, Lacle CF, Stricker BH (1998) Acute myocardial infarction associated with sildenafil. Lancet 352:957-958 2. Savitz SA, Caplan LR (2002) Transient global amnesia after sildenafil (Viagra) use. Neurology 59:778 3. Hodges JR, Warlow CP (1990) Syndromes of transient global amnesia: towards a classification. A study of 153 cases. J Neurol Neurosurg Psychiatry 53:834-843 4. Lewis SL (1998) Aetiology of transient global amnesia. Lancet 352:1557-1558 5. Hadjikhani N, Sanchez del Rio M, Wu O, Schwartz D, Bakker D, Fischi B, Kwong KK, Cutrer FM, Rosen BR, Tootell RBH, Sorensen AG, Moskowitz MA (2001) Mechanisms of migraine aura revealed by functional MRI in human visual cortex. Proc Natl Acad Sci USA 98:4687-4692 6. Pantoni L, Lamassa M, Inzitari D (2000) Transient global amnesia: a review emphasizing pathogenic aspects. Acta Neurol Scand 102:275-283 SOURCE: Letter: C. Gandolfo , A. Sugo , M. Del Sette | |
| 12 May, 2003 | |