Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
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Seizures and status epilepticus (SE) are serious complications in intensive care unit (ICU) patients. SE is often divided into convulsive and nonconvulsive types, based on clinical features. The EEG is helpful in further dividing SE into those that are generalized from onset, or have a partial onset, because this may be difficult to do clinically. ⋯ Furthermore, although an EEG is required to verify the diagnosis, there are not widely accepted criteria to diagnose this entity, particularly in obtunded/comatose patients. For example, it is controversial whether several EEG patterns, such as periodic lateralized and generalized periodic epileptiforms, are ictal or interictal. This article reviews EEG findings in different types of SE in adults and provides numerous examples.
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J Clin Neurophysiol · Jul 2004
Biography Historical ArticleMind, brain, body, and soul: a review of the electrophysiological undercurrents for Dr. Frankenstein.
Mary Shelley's Frankenstein is perhaps the most famous work of medical science fiction. She and her husband, the poet Percy Shelley, were aware of nascent neuroscience experimentation and the effects of electricity on neuromuscular function. ⋯ These demonstrations and theories find expression in Frankenstein and provide models for Dr. Frankenstein and his creation.
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J Clin Neurophysiol · Jan 2004
Comparative StudyDeep brain stimulation in the management of neuropathic pain and multiple sclerosis tremor.
Deep brain stimulation (DBS) of the central gray matter was an important component of the surgical management of chronic, drug-refractory, central neuropathic pain until only a decade ago. However, in the recent past, this technique has been increasingly neglected and has been largely replaced by motor cortex stimulation (MCS). The results of MCS, however, are far from uniform, and the best reports quote a range of 50% to 75% success in providing satisfactory pain relief. ⋯ As a result, DBS for MST has often been perceived as an unreliable and inconsistent therapeutic intervention. The authors present their experience with the application of DBS in these two relatively unpopular areas for neuromodulation in the current practice of functional stereotactic neurosurgery. The results demonstrate that with careful patient selection, DBS can offer significant functional benefit in both of these difficult clinical conditions.
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J Clin Neurophysiol · Jan 2004
ReviewDeep brain stimulation for the treatment of Parkinson's disease.
Deep brain stimulation (DBS) is increasingly accepted as an adjunct therapy for Parkinson's disease (PD). It is considered a surgical treatment alternative for patients with intractable tremor or for those patients who are affected by long-term complications of levodopa therapy such as motor fluctuations and severe dyskinesias. Thalamic stimulation in the ventral intermediate nucleus (Vim) leads to a marked reduction of contralateral tremor but has no beneficial effect on other symptoms of Parkinson's disease. ⋯ More recently, however, a number of reports on possible psychiatric and behavioral side effects of STN-DBS have been a matter of concern. Given the chronic nature of PD and the noncurative approach of DBS, both targets will need to be reevaluated on the basis of their long-term efficacy and their impact on quality of life. Despite the rapidly increasing numbers of DBS procedures, surprisingly few controlled clinical trials are available that address important clinical issues such as: When should DBS be applied during the course of disease? Which patients should be selected? Which target should be considered? Which guidelines should be followed during postoperative care? Here is summarized the available evidence on DBS as a therapeutic tool for the treatment of Parkinson's disease and the current state of debate on open issues.