Neurology
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Randomized Controlled Trial Clinical Trial
Treatment of restless legs syndrome with gabapentin: a double-blind, cross-over study.
To assess the effects of gabapentin on sensory and motor symptoms in patients with restless legs syndrome (RLS). ⋯ Gabapentin improves sensory and motor symptoms in RLS and also improves sleep architecture and PLMS.
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Noninvasive mechanical ventilation using bilevel positive pressure ventilation (BiPAP) has not been studied in acute respiratory failure caused by MG. Eleven episodes in nine patients were initially managed with BiPAP, and endotracheal intubation was avoided in seven of these trials. Presence of hypercapnia (PaCO2 greater than 50 mm Hg) at onset predicted BiPAP failure and subsequent intubation. Results of this preliminary study suggest that a trial of BiPAP may prevent intubation in patients with myasthenic crisis without overt hypercapnia.
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Seizures have a partial onset in approximately two-thirds of epilepsy patients. In most of these cases epilepsy is a consequence of a brain-damaging insult such as head trauma, stroke, brain infection, brain surgery, or status epilepticus. The epileptic process consists of three phases: initial insult U27AA; latency period (epileptogenesis) U27AA; recurrent seizures (symptomatic epilepsy). ⋯ Analysis of these data suggests that by using compounds currently available, beneficial effects on the outcome can be achieved by modification of the epileptogenic insult at the acute phase and by modification of circuitry reorganization that is induced/maintained by brief seizures after the diagnosis of epilepsy. Discontinuation or modification of epileptogenesis in patients who experienced an epileptogenic insult months or years before is more complicated. However, molecular screening of candidate epileptogenesis-related genes has revealed novel mechanisms underlying network reorganization and will undoubtedly provide exciting avenues for the development of true antiepileptogenic and disease-modifying agents.
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The authors report a patient with cervical dystonia, previously treated with botulinum toxin A (BTX-A), who developed bilateral ptosis and difficulty with accommodation only after botulinum toxin B (BTX-B). High-frequency repetitive nerve stimulation of the abductor digiti minimi demonstrated a 34% increment in compound muscle action potential. No increment in 20 people injected with BTX-A and no cases of ptosis in a chart review of 1,606 BTX-A injections for cervical dystonia were found. The authors conclude that systemic spread of BTX-B can cause symptomatic involvement of autonomic neurons.
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Three of 282 consecutive patients who had temporal resections for intractable epilepsy developed postoperative postictal psychosis. These three patients had seizure recurrence contralateral to the resection, whereas none of the patients with ipsilateral seizure recurrence developed any psychiatric symptoms after surgery. Two had left amygdalo-hippocampectomy and one right temporal lobectomy. The de novo occurrence of postoperative postictal psychosis is a well-defined complication of surgery for temporal lobe epilepsy, and may relate to contralateral epileptogenesis.