Rev Neurol France
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Neuropathic pain, i.e., pain resulting from functional changes in peripheral and central pathways subsequent to injury to the peripheral nervous system, offers a most difficult challenge to therapy. To date, only the antidepressants and the anticonvulsants have shown any effectiveness, albeit incomplete and inconsistent, and many questions remain unanswered: What are the exact indications for the antidepressants? What component of neuropathic pain do they relieve, and through which mechanisms? Which type of antidepressants should be prescribed? A first-generation tricyclic? Or a new compound with a selective action on serotonin reuptake? What are the effective dosage and duration of the treatment? What is it mechanism of action? What other antalgic effects do carbamazepine and baclofen possess apart from their action on trigeminal neuralgia? The opiates are generally considered to be without effect, but recent clinical and experimental findings seem to point otherwise. In the meantime, following a few simple rules will optimize the benefit of drug treatment in neuropathic pain: treatment tailored to individual cases; adequate dosage and duration of treatment. However, it is from the near future that breakthroughs are being expected, dues to the multiplication of animal models and more accurate analysis; new clinical evaluation tools which help in distinguishing the different mechanisms underlying the various aspects of pain; the development of new substances, such as capsaicin, local anesthetics, anti-inflammatory agents (NSAIDs for example); and better defined methodological conditions for therapeutic trials.
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The progress that has been made in the treatment of the patient with medulloblastoma is gratifying. Survival for those who fall into the lower risk category probably exceeds 75%. ⋯ Radiation therapy and chemotherapy regimens have been increasingly successful, and further refinements of treatment are to be expected with the completion of randomized cooperative group trials. It is time to focus on means of achieving similar, or even better results, with reduced doses of neuraxis radiation, whenever possible, especially in the younger patient.
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Review Case Reports
[Recurrent Neisseria meningitidis meningitis associated with homozygote complement C7 fraction deficiency].
A 20-year old man had three episodes of meningococcal meningitis. Complement assays showed a complete deficiency of the seventh component of the complement system. This case emphasizes the need to perform complement assays in young patients with recurrent bacterial meningitis.
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Review Case Reports
[Bilateral thalamic glioma. A clinicopathological study of 2 cases].
Two cases of bilateral thalamic glioma in a 70 year-old man and a 8 year-old boy, documented by MRI and pathological data are reported. Such tumors are rare. Early symptoms may be misleading, with intellectual impairment or psychiatric disorders together with a normal CT scan. MRI and pathological findings support the view that bilateral thalamic gliomas represent a particular clinico-pathological entity among thalamic tumors.
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Review Case Reports
[Neurosarcoidosis with meningoencephalitis and tumoral granuloma].
A 24-year old woman had neurosarcoidosis with meningoencephalitis and frontal granuloma. After corticosteroid therapy for two years, CT showed that the granuloma had nearly disappeared and that there was a hydrocephalus.