European journal of neurology : the official journal of the European Federation of Neurological Societies
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Practice Guideline
AAN-EFNS guidelines on trigeminal neuralgia management.
Several issues regarding diagnosis, pharmacological treatment, and surgical treatment of trigeminal neuralgia (TN) are still unsettled. The American Academy of Neurology and the European Federation of Neurological Societies launched a joint Task Force to prepare general guidelines for the management of this condition. After systematic review of the literature the Task Force came to a series of evidence-based recommendations. ⋯ Gasserian ganglion percutaneous techniques, gamma knife and microvascular decompression may be considered. Microvascular decompression may be considered over other surgical techniques to provide the longest duration of pain freedom. The role of surgery versus pharmacotherapy in the management of TN in patients with multiple sclerosis remains uncertain.
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Comparative Study
Near-nerve needle sensory and medial plantar nerve conduction studies in patients with small-fiber sensory neuropathy.
The aim of this prospective study was to show and compare the rate of large-fiber involvement with near-nerve needle sensory (NNNS) nerve conduction study (NCS) and with medial plantar NCS recorded with surface electrodes in a group of patients who had clinically pure small-fiber sensory neuropathy (SFSN) with reduced intra-epidermal nerve fiber density in skin biopsy and with normal routine NCS. ⋯ This study showed that large-nerve fibers are also involved in some patients with pure SFSN and medial plantar NCS can accurately diagnose neuropathy without a need for NNNS NCS in patients with normal routine NCS.
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North American studies have indicated a high prevalence of impaired glucose tolerance (IGT) in patients with sensory polyneuropathy. We searched for the occurrence of IGT in a Norwegian patient material with polyneuropathy. ⋯ Patients with polyneuropathy and IGM had essentially the same degree of involvement of small and large nerve fibres as patients with CIAP. IGT seems less frequent in Norwegian patients with polyneuropathy than reported in North American populations.
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Information on headache-related disability helps clinicians create the optimal treatment plan for migraine sufferers. The estimation of disability must be determined by gathering the individual effects of multiple headache attacks within a given period of time. This study was aimed to examine migraine-related disability from diary-based assessment and to determine which elements of the headache characteristics are associated with disability. ⋯ These results demonstrated that a considerable amount of disability could occur during migraine attack and there are specified elements that act on the development of disability.
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Cervical spondylosis occurs universally, with cervical spondylotic myelopathy (CSM) as its most serious consequence. The electrical property of the spinal cord and its susceptibility to injury renders electrophysiology relevant to the management of CSM, as addressed in this review. Somatosensory-evoked potentials evaluate spinal cord integrity with regards to posterior column functions exclusively. ⋯ Electromyography may play a role in minimizing C5 root damage and spinal cord-evoked potentials can localize spinal conduction block during CSM surgery. Critically reviewing the available evidence, electrophysiology cannot be universally recommended as mandatory in the management of CSM at present. It may, however, play emergent, isolated roles in the diagnosis, follow-up and treatment of this common disorder.