Journal of neurology
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Subarachnoid haemorrhage (SAH) is less frequent than ischaemic stroke or intracerebral haemorrhage, but has a high public health relevance because it can affect young and middle-age adults, has considerable mortality and morbidity, it is treatable and preventable. SAH is traditionally a topic for neurosurgeons. ⋯ We review the recent advances in the clinical and diagnostic aspects of SAH and in the genetics of intracranial aneurysms. A systematic review of the treatment of SAH and grading of the available evidence is included.
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Journal of neurology · Mar 2008
Ideomotor limb apraxia in Huntington's disease: a case-control study.
Ideomotor limb apraxia is the disturbance of planning and of execution of motor activity,which is not caused by a dysfunction of the motor or sensory nervous system. Apraxia is a diagnostic criterion in dementialike Alzheimer's disease. However, this symptom may also occur in dementia with subcortical lesions like Huntington's disease (HD), a hereditary, devastating neurodegenerative disease leading to neurological and psychiatric dysfunction. The aim of our study is to determine the correlation between the occurrence of ideomotor limb apraxia and neuropsychological deficits in HD. ⋯ This is the largest study on apraxia in HD. Ideomotor limb apraxia is a common sign in HD patients, occurring in a high percentage. In contrast to the opinion of several authors, occurrence of apraxia in HD is independent from neuropsychological decline and the severity of most neurological symptoms.
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Journal of neurology · Mar 2008
ReviewThe search for a balance between short and long-term treatment outcomes in multiple sclerosis.
Multiple sclerosis is a lifelong, immune-mediated progressive disorder. The early age of onset and the chronic nature of the disease with accumulation of physical disability, demand a long-term ("lifelong") management, including disease-modifying immunomodulatory therapies and symptomatic treatments. The ultimate goal in the long-term management of multiple sclerosis is to prevent or delay the appearance of permanent neurological disability. ⋯ Such long-term data, which demonstrate safety, tolerability and sustained clinical benefit, help improve patient care and may contribute to patients taking a more positive view of treatment. Effective immunomodulatory treatment needs comprehensive information and education of the patient to establish long-term adherence, a critical determinant of long-term outcome. A multidisciplinary approach through a health care team is the optimal strategy, with encouragement to continue the therapy.
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A high degree of psychiatric disorders has repeatedly been described among patients with organic vertigo syndromes and attributed to vestibular dysfunction. Yet almost no investigations exist which differentiate between various organic vertigo syndromes with regard to psychiatric comorbidity. The following prospective, interdisciplinary study was carried out to explore whether patients with different organic vertigo syndromes exhibit different psychological comorbidities. ⋯ As a consequence, a structured psychological and psychometric testing and an interdisciplinary therapy should be proceeded in cases with complex and prolonged vertigo courses, especially in patients with VM and MD. Possible reasons of these unexpected results in VM and MD are discussed.
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Journal of neurology · Mar 2008
The impact of subthalamic deep brain stimulation on bradykinesia of proximal and distal upper limb muscles in Parkinson's disease.
To assess the differential effects of bilateral deep brain stimulation of the subthalamic nucleus on proximal and distal muscle groups of the upper limb in Parkinson's disease. ⋯ The data suggest that bilateral stimulation of the subthalamic nucleus improves bradykinesia of both distal and proximal muscles of the arm and hand in Parkinson's disease; however, dependent upon task complexity proximal and distal movement components may be affected differentially. Kinematic motion analysis is an efficient tool to objectively evaluate the beneficial effects of subthalamic nucleus stimulation on dexterity in Parkinson's disease.