Current neurology and neuroscience reports
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Curr Neurol Neurosci Rep · Sep 2007
ReviewType 2 diabetes and risk of cognitive impairment and dementia.
Diabetes is a major public health burden. Even a modest effect of diabetes on cognitive function has significant public health implications. ⋯ There are many mechanisms through which diabetes could increase risk of dementia, including glycemia, insulin resistance, oxidative stress, advanced glycation endproducts, inflammatory cytokines, and microvascular and macrovascular disease. This paper presents a review of the evidence on diabetes and increased risk of dementia and cognitive impairment, a discussion of different possible mechanisms, and remaining gaps in our knowledge.
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A review of electrical stimulation in patients with refractory epilepsy, including animal and human data, shows that there is anatomic and physiologic evidence supporting the role of the thalamus in epilepsy. The most recent reports in patients with refractory epilepsy suggest that deep brain stimulation and cortical electrical stimulation of the anterior thalamic nucleus and hippocampus may reduce seizure frequency in patients with refractory partial and secondarily generalized seizures. This has led to a multicenter, prospective randomized trial called the Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy (SANTE trial) that is currently being conducted at several centers in the United States. ⋯ Preliminary reports from the RNS system feasibility trial (the NeuroPace trial) suggest that electrographic seizures can be detected before they evolve into clinical seizures, and that electrical stimulation of the epileptogenic zone can then terminate the electrographic seizures. The preliminary data in patients using deep brain stimulation of the anterior thalamic nucleus and hippocampus, and cortical stimulation studies of the epileptogenic zone are promising and suggest a reduction in seizure frequency in some patients with refractory partial and secondarily generalized seizures. The exact mechanism of action and the best parameters used during electrical stimulation remain unknown and are the subject of ongoing research.
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Curr Neurol Neurosci Rep · Jul 2007
Editorial Review Historical ArticleRethinking Alzheimer's disease: the role of age-related changes.
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Curr Neurol Neurosci Rep · Mar 2007
ReviewThunderclap headache: an approach to a neurologic emergency.
Thunderclap headache (TCH) refers to an excruciating headache of instantaneous onset. Recognition and accurate diagnosis of this headache are important because it can be caused by various serious underlying brain disorders such as subarachnoid hemorrhage, intracranial hematoma, cerebral venous sinus thrombosis, cervical artery dissection, ischemic stroke, pituitary apoplexy, acute arterial hypertension, spontaneous intracranial hypotension, third ventricle colloid cyst, and intracranial infections. ⋯ Primary TCH is diagnosed when no underlying etiology is identified. In this review, we discuss the differential diagnosis of TCH, outline the characteristics and diagnostic criteria for primary TCH, offer a pathophysiologic hypothesis for primary TCH, and detail the diagnostic evaluation of the patient presenting with TCH.
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Curr Neurol Neurosci Rep · Mar 2007
ReviewTrigeminal autonomic cephalalgias: diagnosis and treatment.
The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders characterized by unilateral head pain that occurs in association with ipsilateral cranial autonomic features. The TACs include cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and its close relative short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). ⋯ They are distinguished by the frequency of attacks of pain, the length of the attacks, and very characteristic responses to medical therapy, such that the diagnosis can usually be made clinically, which is important because it completely dictates therapy. The management of TACs can be very rewarding for physicians and highly beneficial to patients.