Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Mar 1998
Cerebrospinal fluid tau protein as a biochemical marker for Alzheimer's disease: a community based follow up study.
Biochemical markers for Alzheimer's disease would be of great value, especially to help in diagnosis early in the course of the disease. A pronounced increase in CSF tau protein (CSF-tau) is found in most patients with Alzheimer's disease. However, the specificity has to be further studied, as an increase in CSF-tau has also been found in other dementias, especially in vascular dementia. As most previous CSF studies have been based on selected inpatients, it was considered of special interest to examine the diagnostic potential of CSF-tau in a community population based sample of consecutive patients with dementia. Such patient material has been examined at the Piteå River Valley Hospital in Northern Sweden since 1986, and includes all those with memory disturbances in the community. The aim was also to study if an increase in CSF-tau is found early in the disease process, and whether CSF-tau changes during the progression of disease. ⋯ The findings confirm the high sensitivity of CSF-tau for the diagnosis of Alzheimer's disease, but high CSF-tau was also found in vascular dementia, resulting in a lower specificity. However, high CSF-tau is preferentially found in patients with vascular dementia without progressive leukoaraiosis, which may constitute a group with concomitant Alzheimer's disease pathology. High CSF-tau may be present during the whole course of the disease in Alzheimer's disease. Possibly, therefore, the same high CSF-tau concentrations may be present before the onset of clinical dementia. Follow up studies on such patients will tell whether analysis of CSF-tau is useful as a biochemical marker for early Alzheimer's disease.
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J. Neurol. Neurosurg. Psychiatr. · Mar 1998
Circumstances of death in sudden death in epilepsy: interviews of bereaved relatives.
To study the circumstances of death in sudden death in epilepsy. ⋯ Although the deaths in question were largely unwitnessed, the available evidence suggested that most cases of SUDEP represented ictal or postictal seizure deaths, occurring in people with a history of generalised tonic clonic seizures, and in both primary generalised and localisation related epilepsy. These interviews highlight the needs of bereaved relatives and their sense of isolation in the face of an entirely unexpected and apparently unexplained loss.
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J. Neurol. Neurosurg. Psychiatr. · Mar 1998
Neurofilament protein in cerebrospinal fluid: a potential marker of activity in multiple sclerosis.
The neurofilament protein is a major structural protein of neurons and a marker for axonal damage. The concentrations of the light subunit of the neurofilament triplet protein (NFL) in CSF were significantly increased in patients with relapsing-remitting multiple sclerosis compared with healthy controls (p<0.001). ⋯ The results suggest that axonal damage occurs during relapsing-remitting multiple sclerosis and that the damage contributes to disability and the appearance of clinical exacerbations. The concentration of NFL in CSF is a potential marker of disease activity in multiple sclerosis and might be useful in future clinical trials of multiple sclerosis.
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J. Neurol. Neurosurg. Psychiatr. · Jan 1998
Meta AnalysisProphylactic antiepileptic agents after head injury: a systematic review.
To determine the effectiveness and safety of prophylactic antiepileptic agents in the management of acute traumatic head injury. ⋯ Prophylactic antiepileptic drugs are effective in reducing early seizures, but there is no evidence that treatment with such drugs reduces the occurrence of late seizures, or has any effect on death and neurological disability. Insufficient evidence is available to establish the net benefit of prophylactic treatment at any time after injury.
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J. Neurol. Neurosurg. Psychiatr. · Jan 1998
Comparative StudyMeasurement of impaired consciousness in the neurological intensive care unit: a new test.
Neurological deterioration in alert patients with an acute CNS disorder can be subtle, but current coma scales may not clearly capture changes in level of alertness. Many coma scales include components such as eye opening and content of speech, features that are difficult to assess in intubated patients and patients with facial trauma. Two new tools have been devised by the authors. ⋯ On the first visit 49% of all tests with a maximum Glasgow coma score had a negative continuous performance test as opposed to 13% of tests with a less than maximum Glasgow coma score. For the consecutive hand position test, these numbers were respectively 25% and 2%. These tests may be a reasonable alternative to the Glasgow coma score to monitor patients, in particular when the verbal and eye response cannot be reliably tested.