Journal of neurology, neurosurgery, and psychiatry
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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.
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J. Neurol. Neurosurg. Psychiatr. · Feb 2014
The elbow flex-ex: a new sign to detect unilateral upper extremity non-organic paresis.
To examine a new neurological sign that uses synergistic oppositional movements of the arms to evaluate for non-organic upper extremity weakness. ⋯ The elbow flex-ex sign is useful in differentiating between functional and organic arm paresis.
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Déjà vu can occur as an aura of temporal lobe epilepsy and in some psychiatric conditions but is also common in the general population. It is unclear whether any clinical features distinguish pathological and physiological forms of déjà vu. ⋯ Déjà vu is common and qualitatively similar whether it occurs as an epileptic aura or normal phenomenon. However ictal déjà vu occurs more frequently and is accompanied by several distinctive features. It is distinguished primarily by 'the company it keeps'.
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J. Neurol. Neurosurg. Psychiatr. · Feb 2014
Review Meta AnalysisScreening for poststroke major depression: a meta-analysis of diagnostic validity studies.
Major depression is common in stroke patients and associated with increased rates of disability and mortality. Identifying depression may improve mental and physical health. The aim of this review was to determine the most accurate tool for detecting poststroke depression. ⋯ There are a number of possible instruments that may help in screening for poststroke depression but none are satisfactory for case-finding. Preliminary data suggests the CESD, HDRS or the PHQ-9 as the most promising options. Although it should be noted such scales should not be used in isolation but followed up with a more detailed clinical assessment. While there is promising data for the PHQ-2 in other populations, it performed less well than other measures.