Neurology
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Randomized Controlled Trial
A randomized controlled trial of duloxetine in diabetic peripheral neuropathic pain.
Serotonin (5-HT) and norepinephrine (NE) are involved in pain modulation via descending inhibitory pathways in the brain and spinal cord. ⋯ This study confirms previous findings that duloxetine at 60 mg QD and 60 mg BID is effective and safe in the management of diabetic peripheral neuropathic pain.
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To prospectively evaluate the effect of pump-infused intrathecal baclofen infusion (ITB) in therapeutic doses on sleep quality and on daytime and nighttime respiratory function in patients with severe spasticity. ⋯ Compared with oral baclofen, intrathecal baclofen infusion did not affect respiratory function and improved sleep continuity. Intrathecal baclofen infusion in therapeutic doses may act at the spinal level rather than at the supraspinal level.
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To characterize the prevalence, time of onset, and cause of neuromuscular dysfunction in patients with severe sepsis. ⋯ Changes in nerve conduction studies occur in the majority of patients early in the course of severe sepsis and predict the development of acquired neuromuscular dysfunction and mortality in intensive care unit patients. Most patients with acquired neuromuscular dysfunction after sepsis have both critical illness myopathy and critical illness neuropathy.
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We performed sonographic examination of the common peroneal nerve in 41 consecutive patients with a footdrop to determine whether there was a structural lesion of the peroneal nerve. Five of the 28 patients (18%) with an isolated peroneal mononeuropathy had an intraneural ganglion of the peroneal nerve confirmed by histology. High-resolution sonography should be considered in patients with nontraumatic peroneal palsy.
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Dose stabilization of intrathecal baclofen (ITB) is usually achieved within 6 to 18 months. In some patients, an increase in ITB dose may result in paradoxical unresponsiveness to baclofen. We present two cases demonstrating increased tone and functional decline with increasing ITB doses after a period of clinical stability. In both cases, reduction of ITB dose was associated with marked clinical improvement.