The Treatment of Hydrocephalus with Isosorbide, an Oral Hyperosmotic Agent

¹ University of Washington, School of Medicine, Seattle, Wash.

This report describes preliminary experience in treating hydrocephalus and myelodysplasia with isosorbide (Hydronol), an oral hyperosmotic agent. Ninety-seven drug trials were conducted in 45 patients, most of whom were infants. Isosorbide, administered orally in daily doses averaging 10 Gm/kg for up to 54 days, was judged to be therapeutically effective in 53 trials, indeterminate in six trials, and not effective in 38 trials. Thirty (66 per cent) of the 45 patients experienced at least one effective trial without toxicity. Toxicity manifested either clinically or by elevated serum sodium or blood urea nitrogen levels, was observed in 26 trials but was always reversed by dosage adjustments.

Chi-square analyses showed that the frequencies of therapeutic effectiveness were increased in patients with either communicating or partially communicating hydrocephalus and in patients without significant isosorbide toxicity. There was a suggestion that patients with cerebral mantles of 2-cm thickness or more and no history of previous central nervous system infection responded more favorably. Toxicity was significantly related to dose levels.

On the basis of these preliminary observations, seven possible indications for the use of isosorbide were established.

Note:

The authors wish to express their appreciation to John Curtis, M.D., F.A.A.P., Great Falls, Montana, who cared for two cases; Col. Robert G. Scherz, M.D., and Capt. Erroll Alden, M.D., who cared for another case with indirect consultation with the authors; Drs. Eldon Foltz, Robert DeVito, and Lowell White who provide surgical consultation and care.

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