Journal of neurology, neurosurgery, and psychiatry
-
J. Neurol. Neurosurg. Psychiatr. · Feb 2014
ReviewA systematic review of transcranial magnetic stimulation in the treatment of functional (conversion) neurological symptoms.
Functional (conversion) neurological symptoms (FNS) are commonly encountered in neurological and psychiatric clinical settings and represent a considerable burden on healthcare systems. There is a conspicuous paucity of evidence-based treatments for FNS. Transcranial magnetic stimulation (TMS) offers a safe, non-invasive method of probing changes in cortical excitability and/or connectivity. ⋯ No studies were placebo controlled. Despite the majority of studies claiming success for the technique, there is insufficient good quality evidence to establish TMS as an effective treatment modality for FNS. We outline the methodological considerations that should be taken into account in future studies of the efficacy of TMS in treating FNS and discuss mechanisms by which TMS, if efficacious, may exert a therapeutic effect, including: (a) via genuine neuromodulation, (b) via non-specific placebo effects and (c) by demonstrating, through its immediate effects on the motor system (eg, movement in a 'paretic' limb), that symptom improvement is possible, thus directly changing higher level beliefs that may be responsible for the maintenance of the disorder.
-
J. Neurol. Neurosurg. Psychiatr. · Feb 2014
ReviewDepression in glioma: a primer for clinicians and researchers.
Depression is one of the leading causes of global disability, and a considerable hidden morbidity among patients with glioma. In this narrative review, we summarise what is currently known about depression in glioma, the main unanswered questions and the types of studies that should be prioritised in order to find out. We conclude by calling for a prospective Phase II study of antidepressants in depressed glioma patients, to test methodologies for a multicentre randomised controlled trial.
-
J. Neurol. Neurosurg. Psychiatr. · Feb 2014
Clinical TrialDeep brain stimulation for obsessive-compulsive disorders: long-term analysis of quality of life.
To evaluate the long-term effects of deep brain stimulation (DBS) on quality of life (QOL) in therapy-refractory obsessive-compulsive disorder (OCD) patients. ⋯ http://isrctn.org identifier: ISRCTN23255677.
-
J. Neurol. Neurosurg. Psychiatr. · Feb 2014
Impulse control disorders in Parkinson's disease: decreased striatal dopamine transporter levels.
Impulse control disorders are commonly associated with dopaminergic therapy in Parkinson's disease (PD). PD patients with impulse control disorders demonstrate enhanced dopamine release to conditioned cues and a gambling task on [(11)C]raclopride positron emission tomography (PET) imaging and enhanced ventral striatal activity to reward on functional MRI. We compared PD patients with impulse control disorders and age-matched and gender-matched controls without impulse control disorders using [(123)I]FP-CIT (2β-carbomethoxy-3β-(4-iodophenyl)tropane) single photon emission computed tomography (SPECT), to assess striatal dopamine transporter (DAT) density. ⋯ Our findings suggest that greater dopaminergic striatal activity in PD patients with impulse control disorders may be partly related to decreased uptake and clearance of dopamine from the synaptic cleft. Whether these findings are related to state or trait effects is not known. These findings dovetail with reports of lower DAT levels secondary to the effects of methamphetamine and alcohol. Although any regulation of DAT by antiparkinsonian medication appears to be modest, PD patients with impulse control disorders may be differentially sensitive to regulatory mechanisms of DAT expression by dopaminergic medications.
-
J. Neurol. Neurosurg. Psychiatr. · Feb 2014
Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL).
Known risk factors for Alzheimer's disease and other dementias include medical conditions, genetic vulnerability, depression, demographic factors and mild cognitive impairment. The role of feelings of loneliness and social isolation in dementia is less well understood, and prospective studies including these risk factors are scarce. ⋯ Feeling lonely rather than being alone is associated with an increased risk of clinical dementia in later life and can be considered a major risk factor that, independently of vascular disease, depression and other confounding factors, deserves clinical attention. Feelings of loneliness may signal a prodromal stage of dementia. A better understanding of the background of feeling lonely may help us to identify vulnerable persons and develop interventions to improve outcome in older persons at risk of dementia.