Current neurology and neuroscience reports
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Dementia with Lewy bodies (DLB) presents to a range of specialists and involves a number of management challenges. The nosologic status of the disorder is controversial, especially its clinical overlap with Parkinson's disease-related dementia and its pathologic distinction from Alzheimer's disease. This article considers some of the controversies surrounding DLB with reference to recent literature. Emphasis is given to clinical topics, including the clinical phenomenology, differential diagnosis, and the treatment of core features of the disease.
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Curr Neurol Neurosci Rep · Jul 2005
ReviewContinuous electroencephalogram monitoring in critically ill patients.
The past few years have witnessed remarkable advances in continuous EEG monitoring (cEEG). The indications and applications for cEEG are broadening, including detection of nonconvulsive seizures, spell characterization, and prognostication. Seizures are common in the critically ill, are usually nonconvulsive, and can easily be missed without cEEG. ⋯ With the use of quantitative analysis techniques, cEEG can detect cerebral ischemia very early, before permanent neuronal injury occurs. This article reviews the indications and recent advances in cEEG in critically ill patients. Continuous brain monitoring with cEEG is rapidly becoming the standard of care in critically ill patients with neurologic impairment.
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Curr Neurol Neurosci Rep · May 2005
ReviewOptimal role of temozolomide in the treatment of malignant gliomas.
Temozolomide (TMZ) is an alkylating agent that was approved for anaplastic astrocytoma and glioblastoma. Its role in the treatment of recurrent disease has been confirmed, and more importantly, alternative treatment schedules and combination regimens have been developed. ⋯ Molecular studies suggest a strong predictive role of the DNA repair enzyme O6-methyl-guanine-DNA-methyl-transferase (MGMT) and outcome of TMZ-based chemotherapy. This review summarizes the current knowledge, highlights approved and nonapproved indications, and describes molecular studies that may allow us to identify the patients most likely to benefit from this treatment.
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The mechanism of epilepsy in brain tumor patients is probably multifactorial, and its incidence depends on tumor type and location. Refractory epilepsy is common in patients with a structural brain lesion, and a role for multidrug resistance proteins has been suggested. Until now, the medical treatment of epilepsy in brain tumor patients has only been studied retrospectively. ⋯ Choices depend on the outcome of retrospective studies, a few nonrandomized series, extrapolation from other studies in symptomatic epilepsy, and anticipated interactions, most notably between AEDs and anticancer agents. The newly developed AEDs levetiracetam and gabapentin are recommended because of good results in preliminary studies and because they do not show interactions with anticancer agents. The use of prophylactic AEDs in brain tumor patients is disputable and generally not advised.