Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Sep 2001
Randomized Controlled Trial Clinical TrialOutcome of unilateral pallidotomy in advanced Parkinson's disease: cohort study of 32 patients.
In a randomised trial to study the efficacy of unilateral pallidotomy in patients with advanced Parkinson's disease, patients having pallidotomy within 1 month after randomisation were compared with patients having pallidotomy 6 months after the primary outcome assessment. Of the 37 patients enrolled 32 had a unilateral pallidotomy. The follow up study of these patients is presented to report (1) clinical outcome; (2) adverse effects; (3) cognitive and behavioural effects; (4) relation between lesion location and outcome; and (5) preoperative patient characteristics predictive for good outcome. ⋯ The positive effects of unilateral pallidotomy are stable up to 1 year after surgery. Patients taking less than 1000 LEU per day were most likely to improve.
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J. Neurol. Neurosurg. Psychiatr. · Sep 2001
Clinical TrialCombination of cyclophosphamide and interferon-beta halts progression in patients with rapidly transitional multiple sclerosis.
The effects of combined treatment with cyclophosphamide (CTX) and interferon-beta (IFN-beta) are described in selected patients with "rapidly transitional" multiple sclerosis. This form of multiple sclerosis is extremely active with very frequent and severe attacks which produce a dramatic increase on the expanded disability status scale (EDSS). ⋯ This particular group of patients benefited by combining cyclophosphamide and IFN-beta. The possibility is considered of carrying out further studies to test the efficacy of the association between the two drugs for patients who are not responsive to IFN-beta or other active disease modifying therapies.
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J. Neurol. Neurosurg. Psychiatr. · Sep 2001
The SF-36 in multiple sclerosis: why basic assumptions must be tested.
To evaluate, in people with multiple sclerosis, two psychometric assumptions that must be satisfied for valid use of the medical outcomes study 36-item short form health survey (SF-36): the data are of high quality and, it is legitimate to generate scores for eight scales and two summary measures using the standard algorithms. ⋯ When using the SF-36 as a health measure in multiple sclerosis summary scores should be reported with caution.
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The strict definition of the Ramsay Hunt syndrome is peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear (zoster oticus) or in the mouth. J Ramsay Hunt, who described various clinical presentations of facial paralysis and rash, also recognised other frequent symptoms and signs such as tinnitus, hearing loss, nausea, vomiting, vertigo, and nystagmus. He explained these eighth nerve features by the close proximity of the geniculate ganglion to the vestibulocochlear nerve within the bony facial canal. ⋯ Finally, some patients develop peripheral facial paralysis without ear or mouth rash, associated with either a fourfold rise in antibody to VZV or the presence of VZV DNA in auricular skin, blood mononuclear cells, middle ear fluid, or saliva. This indicates that a proportion of patients with "Bell's palsy" have Ramsay Hunt syndrome zoster sine herpete. Treatment of these patients with acyclovir and prednisone within 7 days of onset has been shown to improve the outcome of recovery from facial palsy.
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J. Neurol. Neurosurg. Psychiatr. · Aug 2001
Acute care in neurosurgery: quantity, quality, and challenges.
Part of the daily routine in neurosurgery is the treatment of emergency room admissions, and acute cases from other departments or from outside hospitals. This acute care is not normally included in performance figures or budget management, nor analysed scientifically in respect of quantity and quality of care provided by neurosurgeons. ⋯ The current policy in public health, which includes cuts in resources, transport facilities, and manpower, is not compatible with the demonstrated extent of acute neurosurgical care. In addition to routine elective work, many extra admissions, evening or night time surgery, and imaging procedures have to be accomplished. An education programme for generalists is required to improve overall patient outcome. These conclusions hold special importance if health authorities wish to not only maintain present standards but aim to improve existing deficits.