Neurology
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To investigate the association between migraine and cognitive ability among members of a longitudinal birth cohort study. ⋯ Findings suggest that the poorer verbal performance was unlikely to have resulted from cumulative attacks and may be due to developmental factors beginning in utero.
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Nonpharmacologic treatment options are effective in reducing seizures and improving quality of life without the negative side effects associated with antiepileptic drug (AED) therapy among pediatric epilepsy patients. One such treatment, vagus nerve stimulation (VNS) therapy, appears to be particularly effective among pediatric patients with refractory seizures. Seizure severity and frequency, as well as quality of life, are improved with VNS therapy.
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With more than 16,000 patients implanted with the vagus nerve stimulation (VNS) therapy system (Cyberonics, Inc., Houston, Texas), VNS therapy has assumed an increasingly important role in the treatment of medically refractory seizures since its approval 5 years ago by the United States FDA. This review discusses the clinical trials that provided evidence for the approval, long-term efficacy, efficacy in special populations and co-morbid conditions, and safety and tolerability. Additional studies are suggested to further explore the capabilities of VNS therapy.
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Comparative Study
Arterial reocclusion in stroke patients treated with intravenous tissue plasminogen activator.
Arterial reocclusion has not been systematically studied despite the fact that 13% of patients in the National Institute of Neurological Diseases and Stroke rt-PA Trial deteriorated following initial improvement, suggesting that reocclusion might be responsible for poor clinical outcome in some of these patients. ⋯ Early reocclusion occurs in 34% of TPA-treated patients with any initial recanalization, accounting for two-thirds of deteriorations following improvement. Reocclusion occurs more often in patients with earlier and partial recanalization, leading to neurologic deterioration and higher in-hospital mortality. However, patients with reocclusion have better long-term outcomes than patients without any early recanalization.
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Recent studies suggest that epilepsy that is unresponsive to medical therapy is likely to be refractory from the onset. Identifying such patients early and treating them with nonpharmacologic therapies may improve their outcome. We hypothesized that patients who had adjunctive therapy with vagus nerve stimulation (VNS) earlier in the course of their epilepsy would have a better response compared with patients who had VNS therapy instituted later in the course. ⋯ Patients reported even higher rates of no seizures when simple partial seizures were excluded from the analysis or when only complex partial seizures were considered. Although these results are preliminary, they offer promise of success in achieving seizure control among patients with refractory seizures who have been diagnosed with epilepsy for less than 5 years or who have tried four or fewer AEDs. We suggest future prospective studies evaluating VNS therapy versus best medical therapy after the first two to three AEDs have failed, which typically occurs within 2 years of seizure onset.