Neurology
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To evaluate the frequency and identify risk factors of unruptured aneurysms in first-degree relatives of patients with sporadic subarachnoid hemorrhage (SAH). ⋯ First-degree relatives of index patients with sporadic subarachnoid hemorrhage have a 4.0% chance of intracranial aneurysms. Being a sibling of the index patient is the most important risk factor. Risk factors for general atherosclerosis (hypertension, smoking, hypercholesterolemia, high levels of blood triglycerides, lipoprotein a, and apoprotein A1) and use of alcohol do not increase the risk of intracranial aneurysms significantly in these relatives.
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Outcome studies have generally not indicated significant cognitive disturbances after cingulotomy. There is now considerable evidence that the cingulate may play an important role in emotional behavior and attention. ⋯ The anterior cingulate cortex modulates response intention and focused attention.
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Clinical Trial
Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation.
To compare the effects of unilateral subthalamic nucleus (STN) deep brain stimulation (DBS) with bilateral STN DBS in advanced PD. ⋯ Bilateral STN DBS improves parkinsonism considerably more than unilateral STN DBS; bilateral simultaneous electrode implantation may be the most appropriate surgical option for patients with significant bilateral disability. Unilateral STN DBS results in moderate improvement in all aspects of off-period parkinsonism and improves tremor as much as is typically reported with DBS of the ventral intermedius nucleus of the thalamus (Vim). For this reason, STN DBS may be a more appropriate choice than Vim DBS or thalamotomy for parkinsonian tremor. Some patients with highly asymmetric tremor-dominant PD might be appropriately treated with unilateral instead of bilateral STN DBS.
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Nucleoside analogue reverse transcriptase inhibitors are a critical component of antiretroviral therapy in HIV-infected persons. Several of these medications cause painful, dose-limiting peripheral neuropathy (PN), which may develop earlier and more intensely in persons with preexisting neuropathy. The prevalence of baseline peripheral neuropathy in injection drug users (IDUs), one of the largest populations of HIV-infected persons, has not been described, yet has important implications for the selection of antiretroviral therapy. ⋯ There is a high prevalence of PN in HIV-seronegative IDUs. Although these PNs do not seem to predispose HIV-seropositive IDUs to HIV-related PN, they may increase the likelihood of iatrogenic neuropathy. Intravenous drug users may need more diligent monitoring when administered nucleoside analogues than patients in risk groups with lower endemic rates of PN.
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Randomized Controlled Trial Clinical Trial
TNF neutralization in MS: results of a randomized, placebo-controlled multicenter study. The Lenercept Multiple Sclerosis Study Group and The University of British Columbia MS/MRI Analysis Group.
A double-blind, placebo-controlled phase II study was conducted in 168 patients, most with relapsing-remitting MS, to evaluate whether lenercept would reduce new lesions on MRI. ⋯ Lenercept failed to be beneficial, but insight into the role of TNF in MS exacerbations was gained.