Acta neurologica Belgica
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Acta neurologica Belgica · Sep 2002
Comparative StudyThe economic impact of dementia in Belgium: results of the National Dementia Economic Study (NADES).
To estimate costs associated with dementia and its severity and to identify main cost determinants. ⋯ A large fraction of the costs observed in dementia is explained by the association of dementia with physical dependence, co-morbidity and need for caregiving. From an economic point of view, the results support the caring for patients at home.
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Acta neurologica Belgica · Mar 2001
Review Clinical TrialNew generation anti-epileptics for facial pain and headache.
The prophylactic management of recurrent head and facial pains may be challenging because of lack of efficacy and/or bothersome adverse effects of available drug therapies. New generation antiepileptic drugs offer new perspectives in difficult cases. ⋯ The dose was gradually increased in steps of 25 mg up to the effective dose (mean 250 mg/d). Lamotrigine was most effective in trigeminal neuralgia and dysesthesia, but was of little utility in the other head or facial pains.
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Neuropathic pains associated with an injury of the peripheral or central nervous system are among the most difficult to treat. One of the reasons for the therapeutic difficulties in these patients is that the pharmacological treatments are used in a uniform fashion whatever the clinical picture, while these syndromes are in fact highly heterogenous. The patients can express various combinations of painful symptoms--spontaneous (continuous and/or paroxysmal) and evoked (allodynia and/or hyperalgesia). ⋯ Such data emphasize the necessity of a thorough evaluation of patients presenting with neuropathic pains, notably by using quantitative sensory testing. Following recent advances in the understanding of the pathophysiological mechanisms underlying these painful syndromes, through experimental studies in animals, a "mechanism-based" classification and treatment of neuropathic pains can be envisaged. The main goal for clinicians is to propose new methods and strategies for identifying pathophysiological mechanisms in patients in order to validate such an approach in the clinical context.
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There is currently no consensus concerning the optimal therapeutic strategy for neuropathic pain, despite an increasing number of clinical trials demonstrating successful pain relief with several drugs. Treatments have generally been selected on the basis of evidence for efficacy in randomized placebo-controlled trials conducted in disease-based groups of patients, notably in postherpetic neuralgia and diabetic polyneuropathy. ⋯ Pharmacological tests, notably therapeutic infusions, have been proposed for predicting the effectiveness of long-term treatments, but are not routinely performed. An analysis of the various neuropathic symptoms, aimed at selecting treatments targeted at mechanisms, may ultimately help the choice of different pharmacologic agents.
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Acta neurologica Belgica · Mar 2001
ReviewThalamic stimulation in neuropathic pain: 27 years later.
An overview is given of CNS mechanisms which are behind the beneficial effects of VPL-VPM thalamic stimulation in the treatment of neuropathic pain. Further research in this field is urgently needed and the recent possibility to combine Deep Brain Stimulation with positron emission tomography (PET) will certainly help to unravel the brain circuitry implicated in stimulation-produced analgesia. Brain stimulation is an artificial way to activate nervous tissue that is reversible and, when correctly applied, has few complications. The clinical results warrant a continued dissemination of brain stimulation as a treatment in well selected cases of neuropathic pain.