European neurology
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Comparative Study Clinical Trial
Treatment of ataxia in cortical cerebellar atrophy with the GABAergic drug gabapentin. A preliminary study.
The aim of this work was to investigate the efficacy of the GABAergic drug gabapentin in the treatment of the cerebellar signs caused by cortical cerebellar atrophy (CCA). Ten patients with CCA received gabapentin in single doses of 400 mg in an open-label study; thereafter, daily administration of 900-1,600 mg of gabapentin was continued during at least 4 weeks. An ataxia scale based on clinical findings was used to evaluate the cerebellar signs at baseline and after administration of the drug. ⋯ An important clinical amelioration was also evident. Gabapentin has been demonstrated to be capable of improving the cerebellar signs in cases of CCA, after single doses and after continued administration of the drug during 4 weeks. GABAergic enhancement or supplementation could play an important role in the treatment of diseases of the cerebellar cortex associated with a deficit of GABA.
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Comparative Study Clinical Trial
Idiopathic stabbing headache and experimental ice cream headache (short-lived headaches).
Idiopathic stabbing headache (ISH) and ice cream headache occur due to paroxysmal firing of trigeminal pathways and a defect in pain control mechanisms. Any defect in pain control mechanisms appears to be localized to the affected areas. Therefore, we compared ISH and experimentally induced ice cream headache localizations in the same group of migraine sufferers to investigate similarities and differences between these headaches. ⋯ The percentage of ice cream headache occurrence behind the vertex was 6% and 55% for ISH. Due to the widespread distribution of ISH in the head, there might be irritation of various branches of the trigeminal nerve, while the restricted localizations of ice cream headache suggest irritation of a certain branch or branches of the trigeminal nerve, e.g. in the oropharynx. Either widespread or restricted irritation of trigeminal pathways causes either ISH or ice cream headache, in which intermittent deficits in central pain control mechanisms seem to be playing the key role.
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Comparative Study
Is cerebrospinal fluid spectrophotometry useful in CT scan-negative suspected subarachnoid haemorrage?
Missed cerebral aneurysms in CT-negative patients can have serious implications. We set out to determine the usefulness of cerebrospinal fluid (CSF) spectrophotometry and the individual significance of CSF oxyhaemoglobin, bilirubin and methaemoglobin in 463 CT scan-negative patients with suspected subarachnoid haemorrhage (SAH) and normal neurological examination. CSF spectrophotometry resulted in the diagnosis of an intracranial aneurysm in 2% (9/463) of patients with CT-negative suspected SAH. ⋯ Patients with oxyhaemoglobin alone in whom SAH is strongly suspected may benefit from angiography. Based on a small number of patients, we recommend that patients with methaemoglobin should also be investigated. Patients with negative spectrophotometry are unlikely to benefit from further investigation.
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Comparative Study
Central representation of somatic sensations in the parietal operculum (SII) and insula.
Four subjects with small restricted cerebral cortical infarcts have been examined. One had a lesion confined to the parietal operculum (SII), while in the second the SII lesion also encroached on the posterior insula; in the third subject, both banks of the sylvian fissure and the dorsal insula were involved, while in the fourth the lesion involved the upper bank of the sylvian fissure. In all cases, the postcentral gyrus (SI) was intact. ⋯ The possibility must nevertheless be considered that the presence of central pain in some way alters the cortical mechanisms for the perception of thermal stimuli. Certainly, as we had earlier observed, spontaneous pain only occurs when there is interference with thermal sensation. Functional MRI (fMRI) studies following thermal stimulation in subjects 1 and 2 showed these areas, particularly SII, to be concerned with the reception of innocuous and noxious thermal stimuli, mechanical (skinfold pinch) pain and sharpness (pinprick), implying that SI is principally concerned with the reception of low-intensity mechanical stimuli, although it was activated in 1 of our fMRI-studied subjects by innocuous cooling.
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The terms myofascial pain, fibromyalgia and fibrositis are critically examined. They constitute diagnostic labels for non-specific musculoskeletal aches and pains. Analysis of the evidence shows that none of these labels is substantiated by hard physical signs or by laboratory evidence of consistent pathological or biochemical abnormality. ⋯ They reflect no demonstrable pathology. It is therefore argued that none of these commonly used diagnoses represent distinct disease entities. A possible but unproven alternative hypothesis is that such symptoms relate to neural pain with both peripheral and central components, and in some instances psychological or wilful embellishment.