Neurologic clinics
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Although uncommon in the general population, cerebral arteriovenous malformations (AVMs) can pose a significant health risk if a rupture occurs. Advances in noninvasive imaging have led to an increase in the identification of unruptured AVMs, presenting new challenges in management, given their poorly understood natural history. Over the past decade, there have been significant developments in the management and treatment of intracranial AVMs. This article discusses the pathophysiology, natural history, clinical presentations, and current treatment options, including multimodal approaches, for these vascular malformations.
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Review Case Reports
Deep brain stimulation in nonparkinsonian movement disorders and emerging technologies, targets, and therapeutic promises in deep brain stimulation.
This article focuses on the evolution of deep brain stimulation (DBS) targets within the brain, beginning with the discovery of DBS's potential in non-Parkinson disease movement disorders. DBS has gained in popularity and applicability for a growing number of neuropathologic conditions with neural network disorders and dysfunction. Targets within the brain have been based frequently on historical sites used for ablative surgeries in years past, derived from experiment and experience but also have arisen via elucidation of neural networks, transmitter function and location, disease neuropathology, and also, fortuitous discovery.
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Although intravenous thrombolysis with recombinant tissue plasminogen activator is a proven effective therapy for acute ischemic stroke, it is often insufficient to achieve recanalization in patients with large intracranial artery occlusions. In these cases, intra-arterial reperfusion techniques may be useful. ⋯ Rapid technological advances have led to the development and refinement of various neurothrombectomy devices. This article reviews the evolution of neuroendovascular approaches for the management of severe acute ischemic stroke, including evidence from the main trials evaluating clinical and angiographic outcomes after neurothrombectomy.
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Nonmotor symptoms (NMS) of Parkinson's disease (PD) are critical to identify and treat because of their impact on quality of life. Despite growing evidence of the importance of NMS on patients' quality of life, gaps remain in their recognition and treatment. The result is a need for increased information and understanding of specific NMS and the clinical approaches for their assessment and management in the context of PD as a whole. This article discusses the NMS of PD, their relationship to the pathologic basis of PD, and how NMS can be best managed.
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Despite advances in the medical and surgical therapy for epilepsy, about 30% of patients do not achieve full seizure control. In the past 5 years new antiepileptic drugs have been approved for clinical use. Some of these drugs have unique, novel mechanisms of action. ⋯ Vagus nerve stimulation is a well-established palliative therapy for medically resistant epilepsy. Neurostimulation, with newer devices and targets becoming available, is a rapidly expanding field in epileptology. Considerable development and research are still necessary before these newer techniques become the standard of care for the treatment of epilepsy.