Current opinion in neurology
-
Curr. Opin. Neurol. · Feb 2008
ReviewInterventional treatments for stroke prevention in atrial fibrillation with emphasis upon the WATCHMAN device.
Stroke is a leading cause of death and disability worldwide. Many strokes occur in patients with atrial fibrillation. Current guidelines recommend an antithrombotic regimen with warfarin to prevent thromboembolism in atrial fibrillation; however, a substantial number of patients are not eligible for this therapy. The exclusion of the left atrial appendage from circulation seems to be an alternative strategy for stroke prevention in atrial fibrillation. The review focuses on the different devices for stroke prevention in patients with atrial fibrillation. ⋯ For both devices, a reduction in the risk of stroke was documented, and device implantation was shown to be safe and feasible. Provided the ongoing trials show noninferiority to oral anticoagulation, another therapeutic option will become available to prevent ischemic strokes.
-
Curr. Opin. Neurol. · Dec 2007
ReviewRecovery and treatment of aphasia after stroke: functional imaging studies.
In this review of papers published between May 2006 and May 2007, we discuss functional neuroimaging studies of recovery and treatment of patients with aphasia after stroke. ⋯ Recent studies of aphasia recovery allow a deeper appreciation of the changing neuronal activation patterns associated with time after stroke. The distinction between neuronal reorganization that does and does not sustain recovery in the chronic phase after stroke, either spontaneous or in response to treatment, remains controversial and further studies are necessary. Clinical diagnosis and treatment of aphasia requires many more longitudinal studies with larger patient numbers and more detailed behavioural and lesion characterization of stroke patients.
-
Patients in a vegetative or minimally conscious state continue to pose problems in terms of diagnosis, prognosis and treatment. Despite recent waves of international media attention following Terri Schiavo's death and the 'miracle recovery' of Terry Wallis, research efforts aimed at increasing our knowledge about brain function in these conditions remain scarce and must address a series of difficulties, including financial and ethical barriers. Here we review current possibilities and limitations of clinical and para-clinical assessment of chronic disorders of consciousness. ⋯ Consciousness is a subjective experience whose study has remained within the purview of philosophy for millennia. That has finally changed, and empirical evidence from functional neuroimaging offers a genuine glimpse at a solution to the infamous mind-body conundrum. New technological and scientific advances offer the neurological community unique ways to improve our understanding and management of vegetative and minimally conscious patients.
-
Curr. Opin. Neurol. · Dec 2007
ReviewDeep brain stimulation and cognition: moving from animal to patient.
Brain electrical stimulation has been proposed as a strategy to improve chronically impaired cognitive function. This brief review places a small number of recent studies into a broader historical context and identifies important challenges for further development of this area of research. ⋯ This area of research offers the promise of new avenues to engage patients with nonprogressive brain injuries who, at present, have rather limited therapeutic options. These efforts, however, will require careful attention to issues of research and clinical ethics and study design.