Mayo Clinic proceedings
-
Mayo Clinic proceedings · Apr 2003
ReviewNew management strategies in the treatment of status epilepticus.
Status epilepticus is a neurologic emergency associated with high mortality and long-term disability. Recent advances in our understanding of the pathophysiological mechanisms involved in the initiation and perpetuation of seizure activity have revealed that status epilepticus is a dynamic and evolving process. Alterations at the cellular level parallel physiological, physical, and electrical changes at the bedside. ⋯ Two recent large clinical studies have shown the benefit of early administration of benzodiazepines to control status epilepticus. Pharmacological algorithms designed to focus medical management have trended toward earlier and more aggressive treatment. The hope is that continued exploration into the basic mechanisms involved in status epilepticus and future controlled clinical trials defining optimal medical management will produce further advances.
-
Mayo Clinic proceedings · Mar 2003
Primary and revision total hip arthroplasty for patients 90 years of age and older.
To assess the reliability, durability, and safety of primary and revision total hip arthroplasty (THA) in patients 90 years of age and older. ⋯ Total hip replacement was reliable, durable, and safe in this study group. Primary care physicians and surgeons should be aware that both primary and revision total hip replacement can be done safely and effectively in patients aged 90 years and older and can result in years of relief of pain and functional improvement.
-
Mayo Clinic proceedings · Feb 2003
ReviewNeurostimulation therapy for epilepsy: current modalities and future directions.
Neurostimulation is a recent development in the treatment of epilepsy. Vagus nerve stimulation (VNS), the only approved neurostimulation therapy for epilepsy to date, has proved to be a viable adjunctive treatment option. The exact mechanism of action of VNS is not fully understood. ⋯ Vagus nerve stimulation is best viewed as an option for patients who are not surgical candidates or who hesitate to take the risk of surgery yet continue to have seizures despite maximal medical therapy. Stimulation of other regions of the central nervous system for treating epilepsy, including the anterior and centromedian nuclei of the thalamus, the hippocampus, the subthalamic nucleus, and the cerebral neocortex, is currently under investigation. We review the history, proposed mechanisms of action, clinical trials, adverse effects, and future direction of VNS and other modalities of neurostimulation therapy for epilepsy.