KramesPerruchoudDuring the morning of the second day of the Targeted Drug Delivery Conference, Dr. Elliot Krames gave a wonderful presentation entitled, “Neurobiology of the Spinal Cord: Why is it a Good Target for TDD?” To begin, he stated the descriptors of the neurobiology of pain: transduction, transmission, pain processing, perception, and modulations.

It was interesting to hear that the transmission velocities of nociceptive impulses are determined by the degree of myelination. He discussed the details of transmission and tracts for conduction of sensory. Overall, he concluded that it’s a very complex system of numerous neurotransmitters and modulators.

Following Dr. Krames’ lecture was one by Dr. Christophe Perruchoud entitled, “CSF Dynamics and Clinical Implications for Intrathecal Drug Delivery.” During his presentation, Dr. Perruchoud reviewed some of the pharmacokinetic work conducted by Dr. Christophe Bernards – specifically citing that the CSF flow is not circulatory of the flow oscillates cephalo-caudal motion. Dr. Perruchoud concurred with previous speakers regarding injection flow rate affecting clinical effect, namely that an increase in flow rate will cause an increase in clinical effect. He also discussed how baracity might affect drug distribution.

Dr. Perruchoud continued his presentation with a slide of the commonly used intraspinal drugs, denoting their density and baracity. He stated that the physical and chemical properties of the drug affect the drug’s diffusion and, therefore, its clinical effects. There was much discussion from attendees, as well as the presenter, regarding this complex issue. The spinal cord is a matrix of neurons, and in some cases we are not finding answers to several questions.

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