Neurology
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Atherosclerosis may be linked to cognitive decline and depression in old age. ⋯ In the population at large, generalized atherosclerosis contributes to cognitive decline in old age but not to depression.
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Hypocretin-1 is involved in the regulation of the sleep-wake cycle. The authors prospectively assessed CSF hypocretin-1 levels in 44 consecutive patients with acute traumatic brain injury (TBI). Compared with controls, hypocretin-1 levels were abnormally lower in 95% of patients with moderate to severe TBI and in 97% of patients with posttraumatic brain CT changes. Hypocretin-1 deficiency after TBI may reflect hypothalamic damage and be linked with the frequent development of posttraumatic sleep-wake disorders.
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Medical therapy is the mainstay for epilepsy, with most patients well controlled on a single antiepileptic drug (AED). In this non-refractory group, many patients have medication side effects and occasional seizures. Approximately 30% of patients with partial epilepsy and 25% of patients with generalized epilepsy are not well controlled on medications. ⋯ A meta-analysis of the second-generation AEDs used as adjunctive therapies shows that 12% to 29% of patients had a 50% or greater reduction in seizure frequency. Surgery and the vagus nerve stimulator provide important therapeutic options in patients whose seizures are not controlled by AEDs. Special considerations about epilepsy care must be made in pediatric populations, those with developmental delays, women, and the elderly.
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Preclinical studies have increased our understanding of the pathophysiology of neuropathic pain at the anatomic, cellular, and molecular levels. These lines of investigation have enabled more logical uses of older therapies for neuropathic pain and have contributed to our understanding of the potential mechanisms underlying the efficacy of newer remedies. ⋯ This review focuses on the central and peripheral nervous system changes believed to be important in the initiation and perpetuation of neuropathic pain. Currently used medications, as well as medications that are on the horizon, are highlighted.