Neurologist
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Essential tremor (ET) is the most common adult tremor disorder and is characterized by postural and kinetic tremor. Symptoms are typically progressive and potentially disabling, often forcing patients to change jobs or seek early retirement. Proper treatment is contingent on a correct diagnosis, and other possible causes of tremor must be excluded. ⋯ Despite a range of treatment options currently available, further research is necessary to manage this syndrome most effectively. Double-blind, controlled trials are needed to determine whether primidone, propranolol, or a combination of these medications is superior in the initial management of ET. Other pharmacologic agents have shown potential to reduce tremor and should be investigated further. Additional studies are also needed to determine the best treatment of head and voice tremor with pharmacologic and surgical interventions. With proper treatment, tremor is sufficiently reduced in the majority of patients.
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Over the past decade, the treatment of Parkinson disease (PD) has undergone tremendous changes. New drugs have been introduced to manage the cardinal motor symptoms of PD, and other agents have been borrowed to treat the nonmotor manifestations of the illness. For neurologists faced with the task of treating PD patients, the available array of medications may be confusing and intimidating. ⋯ Neurologists have a vast armamentarium to treat both motor and nonmotor manifestations of PD. Understanding this array allows the astute clinician to improve the lives of their patients with PD.
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Stiff-person syndrome (SPS) is a rare neurologic disorder with autoimmune features. It is characterized by progressive, severe muscle rigidity or stiffness most prominently affecting the spine and lower extremities. ⋯ This article summarizes the history of SPS, describes important clinical features, discusses management, touches upon areas of uncertainty, and postulates some avenues for research.
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The Accreditation Council for Graduate Medical Education (ACGME) Core Competency project for graduate medical education was developed in the late 1990s and is now being implemented in residency programs across all specialties. Program directors and residents in neurology are seeking national guidance in how to adjust educational curricula and establish new evaluation tools that meet ACGME standards. ⋯ All neurology programs must comply with new requirements generated by the competencies that will require significant time and energy for program directors. An effective approach to implementation involves careful review of existing evaluation tools established by other subspecialties and expansion of reliable tools used already in place in most programs such as the mock oral board and RITE In-Training Examination. The individual program director is encouraged to monitor resources nationally through the AAN Program Director's Consortium and locally through institutional projects which can incorporate neurology residents.
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Persistent and intractable hiccups indicate multiple neurologic and extraneurologic disorders. Chronic hiccup is not so rare in patients suffering from stroke: its impact on quality of life and on rehabilitation management is substantial, and it may be closely related to aspiration pneumonia, respiratory arrest and nutritional depletion. ⋯ The results were promising, with the immediate disappearance of the hiccups, and the complete absence of side effects. The 36-months follow up was favorable to all the patients, who, after 6 days of treatment remain asymptomatic.