Der Nervenarzt
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Randomized Controlled Trial
[EuroHYP-1 trial: EU-funded therapy study on the effectiveness of mild therapeutic hypothermia for acute ischemic stroke].
Therapeutic hypothermia (TH) improves the neurological outcome in experimental brain trauma models as well as in patients suffering from cardiac arrest and perinatal asphyxia. So far the efficacy of TH has not been proven in acute ischemic stroke due to lack of clinical data. The EuroHYP-1 study will investigate whether TH with an individual target range temperature between 34 and 35 °C administered for 24 h will improve the neurological outcome in ischemic stroke patients treated within 6 h from symptom onset. The target patient number of 1,500 to be included in EuroHYP-1 is sufficiently powered to detect the efficacy of TH.
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In view of the forthcoming revisions of DSM-5 and ICD-11, conceptual and diagnostic issues of somatoform disorders are being discussed. Current diagnostic categories as well as criteria have been shown to have limited validity and practicability. ⋯ New classificatory approaches will probably drop the demand for the complaints to be insufficiently explained by somatic disease and thus emphasize the similarities of somatoform and somatopsychic disorders. For DSM-5, the implementation of psychobehavioral positive criteria has been suggested as contributing to both illness severity and clinical need for action.
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Historical Article
[Deep brain stimulation for psychiatric disorders: historical basis].
Deep brain stimulation (DBS), which is already established as an effective treatment for movement disorders, such as Parkinson's disease, is increasingly being considered as a therapy option for mental diseases. Due to the increasing number of successful applications of DBS for otherwise therapy-resistant psychiatric diseases, DBS is becoming more and more of interest in fields of fundamental research as well as clinical care. However, the stimulation system is a medical product which has to be neurosurgically implanted and this fact is often used to draw certain analogies to earlier psychosurgical approaches in the era of Freeman. ⋯ In fact, two partly in parallel evolving lines of medical progress have contributed to the development of DBS as it is applied today. One of these lines is the use of lesional neurosurgical procedures, such as incision of capsules and cingulotomy, which in contrast to psychosurgical interventions in the era of Freeman, is aimed at subcortical structures and provides important basic knowledge for the choice of target points. In addition DBS is rooted in the application of an electrical charge with the goal to stimulate neuronal networks.
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Induced therapeutic hypothermia (TH) is defined as a controlled reduction of the core body temperature below the physiological range. While TH is neuroprotective in many different models of brain injury, it is only recommended for patients after cardiopulmonary resuscitation and newborns suffering from perinatal hypoxic-ischemic encephalopathy (HIE). Although a strong association exists between elevated body core temperature (fever) and worsening of outcome, TH has so far not been proven to influence outcome after ischemic stroke, intracerebral hemorrhage or subarachnoidal hemorrhage because of insufficient clinical data. This review summarizes the data on TH for different clinical indications and discusses relevant aspects of its use in neurological intensive care units.