Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Dec 2013
Development of gray matter atrophy in relapsing-remitting multiple sclerosis is not gender dependent: results of a 5-year follow-up study.
The aim of this study was to explore the evolution of MRI related gender differences in patients with relapsing-remitting (RR) multiple sclerosis (MS) who participated in a clinical trial over the 5 years. ⋯ No MRI lesion, global, tissue specific or regional brain volume gender change differences were found over the 5-year follow-up.
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Clin Neurol Neurosurg · Dec 2013
Whole brain CT perfusion combined with CT angiography in patients with subarachnoid hemorrhage and cerebral vasospasm.
To assess cerebral vasospasm (CVS) and monitor cerebral microcirculatory changes in patients with acute subarachnoid hemorrhage (SAH) via CT angiography (CTA) combined with whole-brain CT perfusion (CTP) techniques. ⋯ The study demonstrated that changes of microcirculation in patients with SAH could be assessed by whole-brain CTP. CTP combined with CTA could detect both macroscopic evident vasospasm on CTA and alterations of microcirculation on CTP. Mean CBF was significantly lower in patients with SAH.
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Clin Neurol Neurosurg · Dec 2013
ReviewCurrent management and surgical outcomes of medically intractable epilepsy.
Epilepsy is one of the most common neurologic disorders in the world. While anti-epileptic drugs (AEDs) are the mainstay of treatment in most cases, as many as one-third of patients will have a refractory form of disease indicating the need for a neurosurgical evaluation. Ever since the first half of the twentieth century, surgery has been a major treatment option for epilepsy, but the last 10-15 years in particular has seen several major advances. ⋯ Therefore, severe forms of hemispheric developmental epilepsy can now be surgically treated while substantially decreasing the amount of potential long-term complications resulting from cavitation of the brain following anatomical hemispherectomy. Despite the rapid pace at which we are gaining further knowledge about epilepsy and its surgical treatment, there remains a sizeable underutilization of such procedures. By reviewing the recent literature on resective treatment of MIE, we provide a recent up-date on epilepsy surgery while focusing on historical perspectives, techniques, prognostic indicators, outcomes, and complications associated with several different types of procedures.
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Teriflunomide is a new active drug which has recently been approved as a first-line treatment of relapsing forms of MS in the US, Australia, Argentina, and the European Union. It is characterized by a once-daily oral application and a well-established long-term safety profile. The main therapeutic effect is considered to be mediated via the inhibition of the de novo synthesis of pyrimidine in proliferating immune cells. ⋯ In patients treated with teriflunomide, the regular monitoring of blood cell counts and liver enzymes is required. Teriflunomide must not be used during pregnancy. In this article, we review recent phase II and phase III clinical trial data, and discuss the potential of teriflunomide for the treatment of relapsing forms of MS.
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"Asymptomatic multiple sclerosis (MS)" or "subclinical MS" describes "a clinically silent disease state of MS" discovered by chance either by imaging or at autopsy, or with incidental findings shown by other diagnostic tools that are consistent or suggestive of MS, and that cannot be explained by any other disease or condition. Since the early 1960s there have been a number of autopsy studies reporting cases, in which histopathological brain changes consistent with MS were found, despite that none had any clinical symptom or sign of the disease during their lifetime. Several reports have also shown that asymptomatic first-degree relatives of MS patients may have oligoclonal bands in their cerebrospinal fluids or may turn out to have abnormal evoked potential studies. ⋯ Currently this issue has gained a wide interest as there are no established protocols regarding how to study and follow these individuals or whether they should be treated or not. However, not all patients with RIS are predestined to develop clinical disease and it was recently shown that the rate of conversion to clinical MS is about one-third of RIS cases at five years. Although that there may be some risk factors suggestive of a higher or earlier conversion to clinical disease, none are definite and the current evidence is not supportive of initiating treatment in patients diagnosed as RIS.