Current neurology and neuroscience reports
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Curr Neurol Neurosci Rep · Jan 2010
ReviewPrevention of stroke in patients with high-risk atrial fibrillation.
Atrial fibrillation (AF) causes nearly 10% of all ischemic strokes. Long-term oral anticoagulation with warfarin currently is the best treatment for preventing stroke in patients with AF and other stroke risk factors. However, many eligible patients do not receive warfarin, and some patients with AF are unsuitable for this treatment. ⋯ Nonpharmacologic approaches to stroke prevention in atrial fibrillation also are under development. In addition, new diagnostic modalities may detect paroxysmal AF with more sensitivity, potentially expanding the population to be treated and the potential impact of stroke preventive strategies on the population. This review provides a practical guide to current treatment and diagnostic options.
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Status epilepticus (SE) still results in significant mortality and morbidity. Whereas mortality depends mainly on the age of the patient as well as etiology, morbidity often results from a myriad of complications that occur during prolonged admission to an intensive care environment. Although SE is a clinical diagnosis in most cases (convulsant), its treatment requires support by continuous electroencephalographic recording to ensure cessation of potential nonconvulsive elements of SE. ⋯ These initial interventions are followed by effective intravenous antiepileptic drugs. If the SE becomes refractory, more complex intensive care interventions, such as induction of barbiturate coma, need to be pursued. Data regarding the role of more recently available antiepileptic drugs in treating SE also are discussed in this review.
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Status epilepticus is a common, life-threatening medical emergency in pediatric patients. Recent medical literature has focused on identifying risks and treatment options. ⋯ It also reviews the recommended medications for first-line treatment of status epilepticus and refractory status epilepticus. Emphasis is placed on future pharmacotherapies and consideration of neurosurgical intervention when indicated.
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Curr Neurol Neurosci Rep · Mar 2009
ReviewMotor cortex and deep brain stimulation for the treatment of intractable neuropathic face pain.
Intractable neuropathic face pain is a syndrome of unremitting severe pain that stems from abnormal nociceptive processing at various levels of the trigeminal system. Treatment of this debilitating condition has long presented a challenge for physicians due to its refractoriness to standard pharmacologic therapies. With few viable treatments, surgical procedures such as motor cortex stimulation (MCS) and deep brain stimulation (DBS) provide additional options. This article reviews the current literature and practices regarding patient selection criteria, potential mechanisms of action, surgical technique, and outcome of patients with neuropathic face pain treated with MCS and DBS.
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The term medication overuse headache (MOH) was recently introduced by the International Headache Society to describe daily or nearly daily (chronic) headache that occurs after the regular intake (overuse) of any kind of antiheadache or antimigraine drug. Chronic headache is a growing problem throughout the world. ⋯ This article reviews the literature on the epidemiology, risk factors, and pathophysiology of MOH. It also summarizes current strategies for treating and preventing headache chronicity.