Archives of neurology
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Archives of neurology · Jul 2008
Randomized Controlled Trial Comparative StudyInternal pallidal and thalamic stimulation in patients with Tourette syndrome.
Tourette syndrome (TS) is thought to result from dysfunction of the associative-limbic territories of the basal ganglia, and patients with severe symptoms of TS respond poorly to medication. High-frequency stimulation has recently been applied to patients with TS in open studies using the centromedian-parafascicular complex (CM-Pf) of the thalamus, the internal globus pallidus (GPi), or the anterior limb of the internal capsule as the principal target. ⋯ High-frequency stimulation of the associative-limbic relay within the basal ganglia circuitry may be an effective treatment of patients with TS, thus heightening the hypothesis of a dysfunction in these structures in the pathophysiologic mechanism of the disorder.
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Archives of neurology · Jul 2008
Multicenter Study Comparative StudyRetinal imaging by laser polarimetry and optical coherence tomography evidence of axonal degeneration in multiple sclerosis.
Optical coherence tomography (OCT) and scanning laser polarimetry with variable corneal compensation (GDx) are similar yet provide information on different aspects of retinal nerve fiber layer (RNFL) structure (thickness values similar to histology for OCT vs birefringence of microtubules for GDx). ⋯ Scanning laser polarimetry with variable corneal compensation measurements of RNFL thickness corroborates OCT evidence of visual pathway axonal loss in MS and provides new insight into structural aspects of axonal loss that relate to RNFL birefringence (microtubule integrity). These results support validity for RNFL thickness as a marker for axonal degeneration and support use of these techniques in clinical trials that examine neuroprotective and other disease-modifying therapies.
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Archives of neurology · Jul 2008
Comparative StudyOptical coherence tomography in neuromyelitis optica.
Neuromyelitis optica (NMO) is an inflammatory disease with combined features of optic neuritis and myelitis. This pathologic entity may induce severe disability, including visual loss and paraplegia. Other than clinical follow-up, there is no marker for severity of the disease. ⋯ Optical coherence tomography results are significantly altered in patients with NMO. Optical coherence tomography is easy to perform, and the results are well correlated with visual acuity and visual field findings. It could be considered a marker of axonal loss because we found good correlation between OCT and the Expanded Disability Status Scale score. These preliminary results will need to be confirmed in a longitudinal prospective study.
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Archives of neurology · Jul 2008
Comparative StudyPredictors of extubation failure in myasthenic crisis.
The ideal timing for extubation of patients with myasthenic crisis (MC) and the factors that influence extubation outcome are not well established. ⋯ Extubation failure is relatively common in patients with MC. Atelectasis is the strongest predictor of this complication.
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Archives of neurology · Jul 2008
Comparative StudyAquaporin-4 antibodies in neuromyelitis optica and longitudinally extensive transverse myelitis.
There is increasing recognition of antibody-mediated immunotherapy-responsive neurologic diseases and a need for appropriate immunoassays. ⋯ Aquaporin-4 is a major antigen in neuromyelitis optica, and antibodies can be detected in more than 75% of patients. Further studies on larger samples will show whether this novel FIPA is suitable for clinical use. The IgG1 antibodies bind to AQP4 on the cell surface and can initiate complement deposition. These approaches will be useful for investigation of other antibody-mediated diseases.