Journal of the neurological sciences
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Clinical Trial
Evaluation of early dynamic changes of intracranial arterial occlusion is useful for stroke etiology diagnosis.
The etiologic diagnosis of intracranial arterial occlusion is sometimes challenging because of the dynamic nature of acute stroke. We investigated whether short-term follow-up vascular imaging adds additional information to the differential diagnosis between intracranial atherosclerotic and embolic occlusion. ⋯ In the absence of follow-up vascular imaging, a substantial proportion of patients with intracranial middle cerebral arterial occlusion may be misdiagnosed as ICLAA. Evaluation of early dynamic changes in intracranial middle cerebral arterial occlusion may provide useful information for the differential diagnosis of intrinsic atherosclerosis and embolic occlusion.
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Vitamin D has been studied for over a century and its functions related to calcium homeostasis are well established. Over the last 30 years or so it has become increasingly clear that it has a wider role in physiology and, importantly, also in disease. ⋯ Recent technological advances have provided major insights as to how vitamin D may exert its role, particularly through the actions of the vitamin D receptor (VDR). In this review we aim to highlight the importance of the interaction between vitamin D and MS associated genes which provide a biological basis for the association between vitamin D and MS risk.
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Magnetic resonance imaging (MRI) has had an enormous impact on multiple sclerosis, enabling early diagnosis and providing surrogate markers for monitoring treatment response in clinical trials. Despite these advantages, conventional MRI is limited by lack of pathological specificity and lack of sensitivity to grey matter lesions and to microscopic damage in normal appearing tissue. Quantitative MRI techniques such as measures of parenchymal volume loss, magnetisation transfer imaging, diffusion tensor imaging, and proton magnetic resonance spectroscopy have enhanced our understanding of the nature and mechanism of tissue injury and repair in multiple sclerosis, and provided more specific correlates of neurological deficits and disability accrual. ⋯ In the proceedings of the meeting, published in 2009 [1], brain volume changes, T1 hypointensity, magnetisation transfer ratio and optical coherence tomography were deemed the most promising measures for screening the neuroprotective capacity of new agents. Other MRI techniques, such as DTI, (1)H-MRS and functional MRI, although potentially useful, require more observational data to help determine the optimal trial design. This article will review some of the issues that were discussed at this meeting, and present some of the imaging techniques that were considered to be the most promising.
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Pain is a well-recognized feature of Parkinson disease (PD), and for some patients it is the most disabling symptom. Patients with PD may experience various types of pain, and the treatment of their pain depends on its presumed cause. However, in many patients, both pain that appears to be unrelated to PD and PD-related pain can be alleviated by medical and surgical interventions that target the motor symptoms of PD. In this article we review reports on the improvement of pain in PD by surgical interventions such as subthalamic deep brain stimulation (STN DBS), and discuss the possible mechanisms by which STN DBS improves pain in PD.
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Deep brain stimulation (DBS) is a neurosurgical technique that has now been available for some 25 years. It is used in the treatment of various motor disorders, e.g. Parkinson's disease (PD), essential tremor and dystonia, and neuropsychiatric illnesses, e.g. obsessive-compulsive disorder and Tourette syndrome. ⋯ The physiopathological mechanisms responsible for the weight gain are multifactorial (changes in energy metabolism and eating behaviour, reduction of motor complications, etc.). This review reports current knowledge concerning weight changes in patients treated by DBS with different surgical targets. It also describes the mechanisms responsible for weight gain and the health outcome for the patients.