Funct Neurol
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Long-term oral therapy with levodopa is associated with the development of motor fluctuations and dyskinesia in a large percentage of patients with Parkinson's disease (PD). Motor complications are associated with a number of non-motor symptoms and have a negative impact on disability and quality of life. There are three therapeutic options available for the management of patients at this advanced stage: high frequency deep brain stimulation, continuous subcutaneous infusion of apomorphine, and continuous intestinal infusion of levodopa/carbidopa. On the basis of published data and in consideration of the risk-benefit profile of current therapeutic strategies, we here propose an algorithm to help clinicians select the most suitable treatment option for patients with advanced PD.
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Tourette syndrome (TS) is a childhood-onset neuropsychiatric condition characterised by multiple motor and phonic tics. Comorbid behavioural problems are common, especially attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Little is known about the long-term prognosis of TS, despite the need to inform patients about their possible clinical course and advise health care providers on clinical resource allocation strategies. ⋯ Predictors of increased tic severity in adulthood include higher childhood tic severity, smaller caudate volumes and poorer fine motor control. Furthermore, the presence of untreated comorbid psychopathology, such as ADHD and OCD, can adversely affect the long-term outcome of patients with TS. Future studies on the prognosis of TS should be conducted on larger samples, both in community and clinical settings.
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Prognostic determination of patients in coma after resuscitation from cardiac arrest is a common and difficult requirement with significant ethical, social and legal implications. We set out to seek markers that can be used for the early detection of patients with a poor prognosis, so as to reduce uncertainty over treatment and non-treatment decisions, and to improve relationships with families. ⋯ It seems unlikely that any single test will prove to have 100% predictive value for outcome; but the combination of various prognostic markers, as shown in some articles, could increase the reliability of outcome prediction. However, further research is needed.
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Non-invasive brain stimulation methods, such as repetitive transcranial magnetic stimulation (rTMS), are currently used to modulate the excitability of the cerebral cortex, providing important insights into mechanisms of cortical plasticity. Used to create long-lasting changes in the excitability of synapses, rTMS has been intensively investigated as a therapeutic tool in several neurological and psychiatric conditions and given some promising results. Recent studies have shown that rTMS of cerebellar structures is capable of inducing long-lasting changes in the excitability of cerebello-thalamo-cortical pathways. ⋯ Indeed, cerebellar rTMS has been shown to modulate motor control, cognitive functions, emotion and mood. Moreover, recent studies seem to indicate that long-lasting modifications of cerebellar pathways could be usefully exploited in the treatment of several pathological conditions characterized by altered cortical excitability, such as Parkinson's disease, stroke, depression and schizophrenia. The high potential of cerebellar rTMS as a therapeutic tool in neurology could depend on the possibility of modulating several interconnected remote areas, through the activation of different systems, such as the cerebello-thalamo-cortical and limbic-thalamo-cortical networks.
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Review
Sexual differentiation of the human brain in relation to gender identity and sexual orientation.
During the intrauterine period the fetal brain develops in the male direction through a direct action of testosterone on the developing nerve cells, or in the female direction through the absence of this hormone surge. In this way, our gender identity (the conviction of belonging to the male or female gender) and sexual orientation are programmed into our brain structures when we are still in the womb. ⋯ This also means that in the event of ambiguous sex at birth, the degree of masculinization of the genitals may not reflect the degree of masculinization of the brain. There is no proof that social environment after birth has an effect on gender identity or sexual orientation.