A clinical study of a spasmolytic agent (cyclospasmol) in the treatment of elderly arteriosclerotic patients.

By P. J. WARD, L.R.C.P.I., L.M., L.R.C.S.I., D.P.H. Bessbrook, Newry, Co. Down THE progressive arterial deterioration which accompanies ageing, may manifest itself in a variety of symptoms-all causing distress to the patient and increased problems for the physician. Elderly patients with advanced arteriosclerosis usually present one or more predominant signs or symptoms against a background of less obvious mental and physical impairment. Whilst treating a variety of peripheral vascular disorders in the elderly, with the spasmolytic vascodilator, Cyclospasmol, one observed that in addition to its control of the presenting complaint, there was frequently a remarkable improvement in the patient's general mental and physical well-being. Similar observations have been reported by a number of workers, including Ravina 1960, 1964; van der Drift 1961; and Hornstein 1961. A more detailed investigation of Cyclospasmol was made to see if these clinical impressions could be substantiated. "Cyclospasmol is the mandelic ester of 3-5-5 trimethylcyclohexanol, and is a spasmolytic agent acting directly upon the smooth muscle of the vascular wall in a mode similar to that of papaverine, but with 5 times the activity" (Funcke 1951; Bijisma et al. 1956). The direct mechanism avoids autonomic effects or interference with circulating adrenaline. The drug has an extremely low toxicity. The approved generic name is cyclandelate. METHOD The effect of Cyclospasmol was studied in 27 patients aged from 52 and 82 (mean age 71.8 years), who showed some degree of senility, reflected in physical and mental symptoms. Each suffered several of the manifestations of vascular insufficiency, apart from peripheral complaints such as Raynaud's disease, intermittent claudication and leg ulcers. The vast majority of these patients also showed signs of cerebral vascular impairment. This wide variety of symptoms was also associated with a number of other severe concomitant lesions, some connected with vascular insufficiency and some not. These included 5 cases of coronary thrombosis, 3 cases of cerebral haemorrhage, and 2 cases of peptic ulceration. These conditions were all presented against a background of general senility. At the commencement of this trial, the subjects were divided into two groups, the first group receiving Cyclospasmol and the second a placebo. The conditions of four patients in the control group deteriorated to such an extent that they were transferred to active treatment after one month. The three groups existing at the completion of the trial are shown' in table I.