Nature reviews. Neurology
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Nature reviews. Neurology · Oct 2013
ReviewReappraising neuropathic pain in humans--how symptoms help disclose mechanisms.
Neuropathic pain--that is, pain arising directly from a lesion or disease that affects the somatosensory system--is a common clinical problem, and typically causes patients intense distress. Patients with neuropathic pain have sensory abnormalities on clinical examination and experience pain of diverse types, some spontaneous and others provoked. Spontaneous pain typically manifests as ongoing burning pain or paroxysmal electric shock-like sensations. ⋯ Paroxysmal sensations can be caused by several mechanisms; for example, electric shock-like sensations probably arise from high-frequency bursts generated in demyelinated non-nociceptive Aβ fibres. Most human and animal findings suggest that brush-evoked allodynia originates from Aβ fibres projecting onto previously sensitized nociceptive neurons in the dorsal horn, with additional contributions from plastic changes in the brainstem and thalamus. Here, we propose that the emerging mechanism-based approach to the study of neuropathic pain might aid the tailoring of therapy to the individual patient, and could be useful for drug development.
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Nature reviews. Neurology · Oct 2013
CommentStroke: a new CHANCE for combination antiplatelet therapy?
Patients with transient ischaemic attack or minor ischaemic stroke have a high risk of early recurrence. A new study in Chinese patients suggests that this risk is reduced following treatment with clopidogrel plus aspirin compared with aspirin alone. However, whether the findings can be extrapolated to other populations remains unclear.
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Nature reviews. Neurology · Sep 2013
Review Historical Article25 years of neuroimaging in amyotrophic lateral sclerosis.
Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease for which a precise cause has not yet been identified. Standard CT or MRI evaluation does not demonstrate gross structural nervous system changes in ALS, so conventional neuroimaging techniques have provided little insight into the pathophysiology of this disease. ⋯ Given their potential for investigation of both brain structure and function, advanced neuroimaging methods offer important opportunities to improve diagnosis, guide prognosis, and direct future treatment strategies in ALS. In this article, we review the contributions made by various advanced neuroimaging techniques to our understanding of the impact of ALS on different brain regions, and the potential role of such measures in biomarker development.