Funct Neurol
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Comparative Study
The effect of chronic carbamazepine, valproic acid and phenytoin medication on the periodontal condition of epileptic children and adolescents.
Periodontal condition was studied in 84 epileptic 8-18 year-old patients who had been undergoing antiepileptic drug (AEP) treatment for a period of at least 3 years. They were diagnosed as suffering from partial seizures (simplex or complex) or general tonic-clonic fits and were treated with therapeutic oral doses of phenytoin (PHT) and carbamazepine (CBZ) or valproic acid (VPA) in mono- or polytherapy. All patients received a drug dosage to ensure adequate plasma concentration and satisfactory seizure control. ⋯ Only the Pl-I was similar in both groups. Gingival enlargement was found in 30% of the epileptic patients. There was no definite plasma concentration-dependent increase in the incidence of gingival overgrowth.
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Comparative Study
Bilateral sympathetic skin response following nociceptive stimulation: study in healthy individuals.
Bilateral sympathetic skin response (SSR) was evaluated in 25 normal subjects aged (29 +/- 5 years). The stimulation (an electrical pulse train randomly applied to the sural nerve) was equal to 0.5-1.0-1.5 times the nociceptive flexion reflex (RIII) thresholds. This method allowed us to quantify the pain threshold, since a close relationship between the RIII threshold and subjective pain threshold has been described. ⋯ A positive correlation was recognized between RIII threshold and amplitude and duration of SSR. Test-retest evaluation in 12 individuals revealed good reproducibility of SSR in terms of latency and duration, while amplitudes showed large variability. The accuracy of SSR response concerning latency and duration was better (range 0.88-0.92) when 1.5 RIII threshold was used, showing that painful stimulation should be used to obtain reliable SSR in clinical practice.
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SUNCT is a recently described unilateral headache with frequently occurring, shortlasting pain attacks in the ocular area accompanied by ipsilateral conjunctival injection, lacrimation, and (subclinical) forehead sweating. In some patients, attacks may be triggered by cutaneous stimuli. In this communication, SUNCT patients (n = 5) are compared with the considerable clinical series of trigeminal neuralgia in the literature (e.g. ⋯ In several respects (unilaterality, triggering, brevity and frequency of paroxysms), SUNCT shows similarity to trigeminal neuralgia. SUNCT seems to differ clearly from trigeminal neuralgia in other respects: sex distribution (SUNCT patients are often males), pain localization (SUNCT patients have the pain in the ocular area), the carbamazepine effect, presence of conjunctival injection, lacrimation, etc. SUNCT may accordingly altogether seem to be distinct from trigeminal neuralgia.
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The aim of this paper is to discuss whether in the realm of diseases of the nervous system the concept of "dysfunctional" versus "organic" disorders is still useful. The knowledge on the Common Brain Stem System (CBSS) described by Hess is reviewed in order to underline its role as a control centre integrating all the homeostatic and adaptive nervous activities, and in this context, the nervous control of the cardiovascular system is examined, particularly in relation to higher nervous activities. The neurogenic syncopes are chosen as examples of the either "organic" or "dysfunctional" conditions whose semeiotic and pathophysiological distinctive features are analysed. In conclusion the distinction between "organic" diseases and "dysfunctional" disorders seems to be still justified, mainly for the nervous affections involving the homeostatic-adaptive properties of the CBSS.