Journal of neurology
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Migraine is a paroxysmal disorder characterized by attacks of headache, nausea, vomiting, photophobia, phonophobia, and malaise. This review summarizes new treatment options for therapy of the acute attack. ⋯ The new migraine drugs zolmitriptan, naratriptan, rizatriptan, and eletriptan differ slightly in their pharmacological profiles, which translates into minor differences in efficacy, headache recurrence, and side effects. New drugs in migraine prophylaxis include cyclandelate, valproic acid and magnesium.
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Journal of neurology · Jun 1999
ReviewEuropean brain death codes: a comparison of national guidelines.
The majority of European countries have published recommendations for the diagnosis of brain death as a necessary prerequisite for organ donation. The concept of brain death as defining the death of the individual is accepted in all European countries; however, the guidelines for determining the total and irreversible loss of all brain functions differ somewhat in the various countries. While the clinical examination and documentation of the clinical signs of brain death are very uniform, there are significant differences in the guidelines for using technical confirmatory tests to corroborate the clinical signs. ⋯ Brain scintigraphy can confirm the loss of isotope uptake into the brain. Doppler sonography also demonstrates cessation of brain perfusion. Cerebral panangiography may also be used to demonstrate the loss of brain perfusion but is less desirable since it might endanger the patient.
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This study attempted to corroborate findings on the association between butyrylcholinesterase K variant and Alzheimer's disease. This was performed on an autopsy-confirmed series of patients with Alzheimer's disease and controls. The butyrylcholinesterase K variant was found to be of increased allele frequency in patients with sporadic Alzheimer's disease. When related to APOE epsilon4 typing the association was specific but not sensitive for the diagnosis of Alzheimer's disease.
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Neuralgic amyotrophy consists of severe pain around the shoulder and arm followed by weakness in one or several muscles of the same area. We describe four patients with distal neuralgic amyotrophy in whom acute, severe, and transient pain around the shoulder or arm was followed by weakness of the forearm and hand muscles only. Minor sensory symptoms were present in only one patient. ⋯ Electrophysiological studies showed a motor axonopathy and minimal sensory axonopathy. A follow-up of 2 years or longer showed either spontaneous improvement or residual motor deficit. Unfamiliarity with a clinically distal localization of neuralgic amyotrophy may result in misdiagnosis of lower cervical (poly)radiculopathy in view of the distal localization of the motor deficit and the high prevalence of coincidental abnormalities of the lower cervical spine on plain radiography, computed tomography, or magnetic resonance imaging.
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Journal of neurology · Feb 1999
Comparative StudySerum soluble adhesion molecules in multiple sclerosis: raised sVCAM-1, sICAM-1 and sE-selectin in primary progressive disease.
Leucocyte invasion into the central nervous system in multiple sclerosis (MS) is complex, involving T-cell/endothelium interaction dependent upon initial adhesion mediated by molecules such as E-selectin, L-selectin, intracellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-(VCAM-1). Circulating levels of these can be measured by sensitive enzyme-linked immunoassay (ELISA) techniques. To assess whether serum concentrations of soluble adhesion molecules vary across the spectrum of patients with relapsing-remitting (RR), secondary progressive (SP) and primary progressive (PP) MS, we measured circulating levels of soluble (s)E-selectin, sL-selectin, sICAM-1 and sVCAM-1 in serum obtained from 78 PPMS patients, 71 patients with RRMS, 65 patients with SPMS and 66 patients with other neurological disease using commercially available ELISA systems. ⋯ In PPMS there was no correlation between levels of any adhesion molecule and disability or disease duration. These results provide evidence for significant immunological heterogeneity in MS and suggest that different leucocyte/endothelial cell interactions may be active in various MS subgroups. It also challenges the hypothesis that PPMS is a less inflammatory form of the disease.