Neurologic clinics
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Pharmacologic therapy represents the first line of treatment of epilepsy and is effective in most patients. However, about 20% to 30% of cases develop intractable seizures that cannot be controlled by medication alone. In such cases, surgical intervention is considered for therapeutic, often curative purposes. ⋯ Many diagnostic modalities have been developed to identify different aspects of the epileptic focus. Older techniques are being increasingly supplemented by a variety of anatomic and functional imaging modalities that can help clarify discrepancies. Invasive electroencephalography remains the gold standard for identifying epileptic foci and guiding the surgeon to successful resections.
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Surgical approaches are an important consideration in the management of many movement disorders, particularly for patients refractory to medications. In this article, we review the history, pathophysiology, risks and indications for surgical treatment. Summaries of case studies, case series and clinical trials performed using deep brain stimulation are provided for Parkinson's disease, dystonia, essential tremor and other movement disorders.
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Neurologic symptoms are a prominent and often disturbing component of the migraine syndrome in many patients. Collectively termed "aura," migraine-related neurologic symptoms include visual, sensory, language, and motor disturbance. ⋯ Recently, motor symptoms previously included as a type of migraine aura have been reclassified as a component of hemiplegic migraine--a distinct migraine subtype. The tendency to aura is likely to be influenced by complex genetic and perhaps epigenetic factors.
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The trigeminal autonomic cephalalgias (TACs) are a group of primary headache syndromes all marked by headache and associated autonomic features. The TACs include cluster headache, paroxysmal hemicrania, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome. Diagnosis is made after looking at headache frequency, duration, and accompanying symptoms. Each TAC has its own unique treatment modality, which is discussed in depth.
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Of the nearly 32 million Americans with migraine, 24 million are women. It is a disorder affecting women throughout their lifetimes, from childhood and puberty through the postmenopausal years. ⋯ There are numerous times when hormonal influences have an impact on migraine and its pattern, including menarche, oral contraceptive use, pregnancy, perimenopause, and menopause. Hence practitioners treating women with migraine need to have a clear understanding of these special considerations.