Duodecim; lääketieteellinen aikakauskirja
-
Advanced Parkinson's disease, essential tremor and dystonia are the most common indications for deep brain stimulation (DBS). The patients having this disease should be referred to DBS assessment at a stage where a satisfactory response to motor symptoms is no longer obtained with conventional medication. DBS therapy is acceptable also in epilepsy, when standard epilepsy surgery is out of question. To date, about 500 patients have had a deep brain stimulator implanted in Finland.
-
Respiratory symptoms cause much of suffering in palliative care. Opioids are the first-line drugs in symptomatic treatment, and a therapeutic intervention with benzodiazepines may also be justified. ⋯ Physical therapy and methods of respiratory management are profitable in the treatment of respiratory symptoms. Radiation therapy relieves cancer-induced hemoptysis, cough, chest pain and dyspnea.
-
Palliative pain management is usually successful, if the medication is strengthened in a stepwise manner in accordance with pain intensity, and initiation of a strong opioid is not delayed. Finding of a sufficiently effective dose of the opioid drug with simultaneous management of adverse effects requires continuous pain assessment and patient monitoring. In many cases it is possible to enhance analgesia by supplementing the medication with an antidepressant or an antiepileptic along with the opioid and paracetamol or the analgesic. Palliative radiotherapy will relieve tissue injury pain caused by bone metastases and soft tissue tumors as well as pain due to the possible nerve entrapments caused by them.
-
New starting points are available for the diagnosis, classification and treatment of prolonged pain conditions in the foot and ankle region. Mechanisms maintaining the pain should be clarified, and a comprehensive patient interview must be conducted. ⋯ By careful examination and treatment of motor control and movement disorders it is possible to completely refrain from surgical treatment. If surgery has instead been decided upon, the loading defect underlying the problem must also be treated.
-
Natalizumab medication used in the treatment of active relapsing-remitting multiple sclerosis is associated with a risk of contracting progressive multifocal leukoencephalopathy (PML). Current risk of the PML disease in connection with natalizumab therapy in multiple sclerosis patients is 2.77/1,000. ⋯ There are 350 multiple sclerosis patients receiving natalizumab in Finland. We describe the first one of the two Finnish multiple sclerosis patients having so far been diagnosed with PML disease as a complication of natalizumab therapy.