Um...Sir...? Are you aware you are leaking CSF at an alarming rate?

Well, here we are again. Has it really been a week? In some ways it feels much shorter, but in many other ways it feels A LOT LONGER.

This is the first installment in the 'Drug of the Week' feature. And we will begin by tackling a big one, Diamox or acetazolamide. Here is a skeletal structure of the organic molecule:And here is a space filling model:
Diamox is used mostly to treat edemas, seizure disorders, glaucoma or altitude sickness.
As I work primarily with Hydrocephalic children, this drug is of particular interest to me because of its effectiveness in pharmaceutically treating Hydrocephalus.
'...medical treatment with a medication which decreases the production of the cerebrospinal fluid may be tried to improve some of the symptoms of hydrocephalus.'
(http://www.nervous-system-diseases.com/obstructive-hydrocephalus.html)

'Hydrocephalus is an excess accumulation of cerebrospinal fluid in or around the brain that can be produced by a broad spectrum of disorders. It can develop at any age and its incidence is increasing, both in infants and adults. Although the standard treatment of hydrocephalus is cerebrospinal fluid shunting, there are certain circumstances in which medical treatment, alone or in combination with shunting, has been suggested as an alternative. Carbonic anhydrase inhibitors, loop diuretic agents, osmotic agents and fibrinolytic therapy are discussed. The most suitable drug seems to be acetazolamide [Diamox], alone or in combination...'
(http://www.ncbi.nlm.nih.gov/sites/entrez)

Diamox works as as an inhibitor of the enzyme carbonic anhydrase. Essentially, it acts as a diuretic and causes the body to lose water. This loss of water also affects the production of cerbrospinal fluid causing a decrease and therefore a decrease in intercranial pressure.

'Diamox blocks an enzyme in the kidney and makes the blood acidic which is interpreted by the brain as a signal to breathe more. Diamox therefore, enhances the physiological response to altitude by increasing the rate and depth of breathing and it ... acts as a mild diuretic...'
(http://www.lycos.com/info/diamox--drugs.html)

It appears at this time, however that, 'The safety and effectiveness of acetazolamide [Diamox] in pediatric patients has not been established.'
(http://www.rxlist.com/acetazolamide-drug.htm)

There are, however, studies which show the effectiveness of this drug for children, some dating all the way back to 1958 and some - such as the abstract quoted just above this line - as recent as 2005.

Quoting from PEDIATRICS Vol. 22 No. 5 November 1958, pp. 875: 'Observations in a Case of Hydrocephalus Treated with Diamox®

The effect of Diamox® on the formation of cerebrospinal fluid was studied in a patient with noncommunicating internal hydrocephalus over a period of 1 year. During the administration of Diamox® the frequency of ventricular aspiration was markedly reduced, with long periods when no aspirations were necessary. Percutaneous aspiration of the shunt tube was performed only after signs of increased intracranial pressure developed. Each time the drug was discontinued, signs of increased intracranial pressure soon became evident.' 'Confirmation of this observation would be desirable since satisfactory management of this pediatric problem is usually difficult or impossible.'
(http://pediatrics.aappublications.org/cgi/content/abstract/22/5/875-a)

The finer points of these articles are outside the scope of this discussion, but prove to make the point rather well. These are only two of the abstracts from medical journals I chose to include, other date exists; further enhancing the idea and proof of clinical effectiveness in the pediatric patient.

So, why did I spend the last several hours of my life discussing and compiling data on Diamox? And why does this matter to you, my reader? With all of the trial data and information that shows that this drug can have a postive effect on adults with Hydrocephalus I think that more consideration should be taken towards using it in the pediatric patient as well. I have shown several instances in which it has had a beneficial effect, and I think that more people should become aware of this disorder, and alternative treatments to surgery.