Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Jun 2009
Comparative StudyLong-term effects of the concomitant use of memantine with cholinesterase inhibition in Alzheimer disease.
Patients using cholinesterase inhibitors (ChEIs) have a delay in nursing home (NH) admission compared with those who were not using the medication. There are no long-term studies of the effects of memantine in combination with ChEIs use in Alzheimer disease (AD). This study was conducted to examine the effects of ChEIs and memantine on time to death and time to NH admission. ⋯ This observational study revealed that the addition of the NMDA receptor antagonist memantine to the treatment of AD with ChEI significantly altered the treated history of AD by extending time to nursing home admission.
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J. Neurol. Neurosurg. Psychiatr. · Jun 2009
Deep brain stimulation activation volumes and their association with neurophysiological mapping and therapeutic outcomes.
Despite the clinical success of deep brain stimulation (DBS) for the treatment of Parkinson's disease (PD), little is known about the electrical spread of the stimulation. The primary goal of this study was to integrate neuroimaging, neurophysiology and neurostimulation data sets from 10 patients with PD, unilaterally implanted with subthalamic nucleus (STN) DBS electrodes, to identify the theoretical volume of tissue activated (VTA) by clinically defined therapeutic stimulation parameters. ⋯ Our results are consistent with previous studies suggesting that therapeutic benefit is associated with electrode contacts near the dorsal border of the STN, and provide quantitative estimates of the electrical spread of the stimulation in a clinically relevant context.
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J. Neurol. Neurosurg. Psychiatr. · Jun 2009
Use of antidepressants and the risk of Parkinson's disease: a prospective study.
Individuals with depression have a higher risk of Parkinson's disease (PD) but the timing of the association is unknown. Therefore, the relationship between initiation of antidepressant therapy and PD risk was assessed in a large population based database from the UK and the timing of this association was explored. ⋯ Initiation of any antidepressant therapy was associated with a higher risk of PD in the 2 years after the start of treatment, which suggests that depressive symptoms could be an early manifestation of PD, preceding motor dysfunction.
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J. Neurol. Neurosurg. Psychiatr. · Jun 2009
Cognitive visual perceptual deficits in patients with delirium.
Delirium is a neuropsychiatric disorder characterised by severe cognitive impairment, but the specific neuropsychological profile of this condition has not yet been clearly delineated. Psychiatric symptoms of perceptual disturbance--such as hallucinations, illusions and misperceptions--are common in delirium, suggesting that patients may have deficits in the cognitive systems underlying visual perception. ⋯ Patients with delirium have specific visual perceptual deficits that cannot be accounted for by general cognitive impairment. These novel findings provide insights into the neural mechanisms underling delirium and might help to improve clinical detection and management of the disorder. The results also support previous suggestions that cognitive perceptual deficits play a causal role in eliciting psychiatric symptoms of perceptual disturbance.
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J. Neurol. Neurosurg. Psychiatr. · Jun 2009
Intravenous levetiracetam: a new treatment alternative for refractory status epilepticus.
The purpose of this study was to investigate the safety and efficacy of intravenous levetiracetam (LEV-iv) in refractory status epilepticus (SE). A retrospective chart review was performed on patients who received LEV-iv for treatment of SE (n = 36) and had failed at least one other antiepileptic drug. LEV-iv (median 3000 mg/day; range 1000-9000) was administered as a bolus loading (500-2000 mg per 30-60 min, n = 30) or as a continuous pump infusion (n = 6). ⋯ Two patients experienced nausea and vomiting during LEV-iv loading, leading to aspiration pneumonia in one. This study suggests that LEV-iv may be a safe and efficacious treatment of SE. Prospective and controlled trials are imperative to confirm these preliminary findings.