Der Nervenarzt
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Practice Guideline
[Deep brain stimulation for dystonia. Consensus recommendations of the German Deep Brain Stimulation Association].
Medical treatment of dystonia, particularly generalised forms of the disorder, is often not satisfactory or causes intolerable side effects. In focal dystonia, a reasonable treatment option with botulinum toxin exists but some patients either do not respond well or develop neutralising antibodies with secondary therapy failure. ⋯ The inclusion criteria for DBS candidates as well as the peri- and postoperative patient management are addressed. These recommendations were developed in a consensus procedure in the German Deep Brain Stimulation Association.
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Neuropathic pain, caused by various central and peripheral nerve disorders, is especially problematic because of its severity, chronicity, and resistance to simple analgesics. Pathophysiologic changes responsible for generating pain following nerve lesions are usually independent of the etiology of the primary neuronal damage. ⋯ Classifying neuropathic pain by these basic mechanisms is considered appropriate for basing new treatment approaches. In coming years, several advances are expected in the basic and clinical sciences of neuropathic pain which will provide new and improved therapies for patients continuing to experience this sometimes very disabling condition.
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Orolingual angioedema (OA) is an unappreciated complication of acute stroke treatment with recombinant tissue plasminogen activator (rt-PA). It has been described in 2% of patients receiving thrombolysis, and it seems that patients taking angiotensin-converting enzyme inhibitors are especially at risk. Even though the presentation is generally unilateral and limited to lips and tongue, an extension of edema to the oropharynx may lead to life-threatening upper airway obstruction. ⋯ Besides prophylactic inspection of the oral cavity during and after thrombolysis, therapeutic options in case of OA include early intravenous antihistaminergic therapy and protective intubation.