Current neurology and neuroscience reports
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A prerequisite for the efficacy of any cancer drug is that it reaches the tumor in therapeutic concentrations. This is difficult to accomplish in most systemic solid tumors because of factors such as variable hypoxia, intratumoral pressure gradients, and abnormal vasculature within the tumors. ⋯ Many approaches to overcome, circumvent, disrupt, or manipulate the BBB to enhance delivery of drugs to brain tumors have been devised and are in active investigation. These approaches include high-dose intravenous chemotherapy, intra-arterial drug delivery, local drug delivery via implanted polymers or catheters, BBB disruption, and biochemical modulation of drugs.
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Curr Neurol Neurosci Rep · Mar 2008
ReviewPresent status of surgical intervention for children with intractable seizures.
We present a discussion of recent relevant publications in pediatric epilepsy surgery. In 1998, the Commission on Neurosurgery of the International League Against Epilepsy formed the Subcommission for Pediatric Epilepsy Surgery. Their proposed recommendations are included here. ⋯ Routine positron emission tomography, positron emission tomography with special tracers, and single photon emission computed tomography have proven to be beneficial. Other newer investigative techniques await validation. A number of studies on postoperative outcomes over the past few years have demonstrated the benefits of early surgical treatment for selected children.
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Curr Neurol Neurosci Rep · Mar 2008
ReviewChronic daily headache: transformational migraine, chronic migraine, and related disorders.
Chronic daily headache is an important category of headache illness that affects 4% of the general population. Within this classification are four chronic headache entities: chronic migraine/transformational migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. ⋯ Current research is directed at identifying factors that might promote the progression of this disorder from episodic migraine to daily or almost daily headache, and at identifying the best approaches to treatment, which include both pharmacotherapeutic and non-medicinal interventions. Patients with intractable cases are often hospitalized as a consequence of the convergence of several factors that make outpatient management unlikely to succeed.
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Curr Neurol Neurosci Rep · Mar 2008
ReviewIdiopathic intracranial hypertension (pseudotumor cerebri).
Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a disorder of elevated intracranial pressure of unknown cause. Patients present with daily headache, pulse-synchronous tinnitus, transient visual obscurations, papilledema with its associated visual loss, and diplopia from sixth nerve paresis. Many disease associations have been alleged, but few besides obesity, hypervitaminosis A and related compounds, steroid withdrawal, and female gender have been proven. ⋯ If patients fail medical therapy, surgical procedures, most commonly optic nerve sheath fenestration and CSF shunting, are employed. The main morbidity of IIH is visual loss. This is present in most patients and can usually be reversed if recognized early in the course of the disease and treated.