European journal of neurology : the official journal of the European Federation of Neurological Societies
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Randomized Controlled Trial Multicenter Study
A double-blind, randomized trial of duloxetine versus placebo in the management of chronic low back pain.
Duloxetine has demonstrated analgesic effect in chronic pain states. This study assesses the efficacy of duloxetine in chronic low back pain (CLBP). ⋯ Duloxetine was superior to placebo on the primary objective from weeks 3-11, but superiority was not maintained at end-point. Duloxetine was superior to placebo on many secondary measures, and was well-tolerated.
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Meta Analysis
Adjunctive dexamethasone therapy for bacterial meningitis in adults: a meta-analysis of randomized controlled trials.
The objective of this review was to study the effectiveness of dexamethasone for the treatment of adult patients with bacterial meningitis. Data was extracted from randomized controlled trials (RCTs) comparing dexamethasone with placebo or no treatment and pooled using meta-analysis techniques. Treatment with dexamethasone was associated with a non-significant lower mortality than placebo or no treatment [odds ratio (OR) = 0.68, 95% confidence interval (CI) 0.45-1.04]. ⋯ Dexamethasone was associated with fewer episodes of hearing impairment in high quality RCTs (OR = 0.64, 95% CI 0.43-0.94). The currently available evidence suggests that dexamethasone should be administered to all adult patients with bacterial meningitis. Large studies are needed to clarify the role of the duration of symptoms, disease severity, and antibiotic administration before the initiation of treatment with dexamethasone on modifying the outcomes.
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Amyotrophic lateral sclerosis (ALS) is classically assumed to be a neurodegenerative disorder. Inflammation has been observed in CNS tissue in ALS patients. We investigated the expression and prognostic relevance of proinflammatory chemokines in ALS. ⋯ We confirmed previous findings of increased MCP-1 levels in CSF of ALS patients. Furthermore, increased levels of IL-8 in CSF suggest a stimulation of a proinflammatory cytokine cascade after microglia activation. We found a tendency for higher MCP-1 values in patients with a shorter diagnostic delay, who are known to have also a shorter survival. This may suggest an association of higher MCP-1 levels with rapidly progressing disease.
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Letter Case Reports
Hemiballismus in subthalamic haemorrhage: efficacy of levetiracetam.