Der Nervenarzt
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Gabapentin, which has been approved for add-on therapy of focal seizures, is increasingly used for treatment of neuropathic pain. Its analgesic effect is supposed to be due to reduction of glutamatergic transmission, improvement of GABAergic transmission and to binding to voltage-dependent calcium channels. Experimental studies demonstrated an ameliorating effect of gabapentin on neuropathic pain. ⋯ Case reports show an analgesic effect of gabapentin in trigeminus neuralgia and in reflex sympathetic dystrophy. The main adverse events are dizziness, ataxia and somnolence. Controlled studies, which compare the efficacy of gabapentin with that of the respective reference drug, are needed to evaluate its importance in treatment of pain.
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We describe a 25-year-old male who developed, in the course of an acute exacerbation of his multiple sclerosis, cluster headache-like attacks which responded to oxygen therapy. Magnetic resonance imaging revealed a lesion in the area of the ipsilateral pontomedullary trigeminal nuclei. This symptomatic case and other published cases are most probably explained by an activation of the trigeminovascular system as it is assumed for primary headache syndromes.
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Earlier design changes in hydrocephalus valves focusing on reducing overdrainage failed. Since the middle of the 1990s, hydrostatic valve constructions have been available which are claimed to solve this problem. The objective of this study was to evaluate the efficiency of these constructions. ⋯ Typically, the ventricular width was not or only marginally reduced in these 45 patients. In the patients treated for symptoms of overdrainage (group 3), complaints resolved within the first week after implantation of the shunt assistant. The study indicates that gravitational shunts may be very effective in preventing overdrainage in chronic hydrocephalus, and therefore these constructions could represent the gold standard in the treatment of chronic hydrocephalus.
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Intraoperative magnetic resonance imaging using a 0.2 Tesla, open-configured scanner was applied in a total of 243 patients. The aim of this study was to evaluate the feasibility, clinical application, and indications of this method. No adverse effects of the intraoperative imaging could be observed. ⋯ Especially when combined with functional neuronavigation, intraoperative magnetic resonance imaging allowed more radical resectioning with lower morbidity. Second looks to complete tumor removal during the same surgical procedure were possible to determine tumor remnants. Brain shift, which reduces the accuracy of neuronavigational systems, could be compensated for by intraoperative updates.
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Fifteen patients at our neurological intensive care unit were monitored with continuous EEG (cEEG: 10 channels EEG and ECG) for a total of 109 days. Primary indications for monitoring were nonconvulsive seizures in patients with altered consciousness (AC, n = 9) and control of therapy in generalized/partial status epilepticus (SE, n = 5). The cEEG findings influenced therapeutic management of patients in almost 50% of monitoring days (50/109), with decisive decisions (changes in medication) being made in 31/109 days. ⋯ Identification of repetitive, nonepileptic, involuntary movements was guided by cEEG in four patients. Aside from the established application of cEEG monitoring in SE, the usefulness of clarifying the differential diagnosis in patients with AC was demonstrated particularly by the finding of nonconvulsive seizures in three patients. In two of these, intermittent EEG recordings did not demonstrate the seizures.