Current neurology and neuroscience reports
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Curr Neurol Neurosci Rep · Nov 2002
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialHypothermia for neuroprotection after cardiac arrest.
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There have been many important developments in the diagnosis and treatment of status epilepticus in the recent past. Earlier treatment, including at home by caregivers and in the field by paramedics, has been shown to be safe and effective. Rapid-acting anesthetic agents, such as midazolam and propofol, are being used more often for refractory status epilepticus, though clinical trials are lacking. ⋯ Modern technology and continuous digital electroencephalogram (EEG) recordings have taught us many things, but have raised at least as many questions. Much work needs to be done regarding the significance of certain EEG patterns (particularly periodic discharges) and when and how to treat them. This article reviews these issues, concentrating on recent advances and practical issues related to the clinical care of patients with status epilepticus.
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Essential tremor (ET) is the most prevalent tremor syndrome. It commonly affects the hands, head, voice, and other body parts. ⋯ Primidone and propranolol are the first-line medications for the treatment for ET, but several other medications may also provide benefit. In patients with medically refractory tremor, alternative therapies, including surgery or injections of botulinum toxin, may be considered.
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Neurostimulation therapy for epilepsy is growing in popularity. By appropriate targeting of applied electrical activation at selected nervous system sites, antiseizure effects may be achieved without the common sedative side effects of antiepileptic medications. Risks of neurostimulation therapy are those associated with the device implantation surgical procedures. ⋯ New reports suggest VNS is particularly beneficial for patients with Lennox-Gastuat syndome. VNS also reduces sudden unexpected death in epilepsy. New publications describing small, uncontrolled case series also suggest deep brain stimulation and transcranial magnetic stimulation may develop into effective antiepileptic therapies in the future.
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Sleep disorders are very common among older patients. Our population as a whole is experiencing substantial growth in the geriatric population. ⋯ Special attention is paid to sleep-disordered breathing, periodic limb-movement disorder of sleep, insomnia, and circadian rhythm anthology, as well as parasomnias that are unique to the older patient. The final section of the paper deals with specific neurologic disorders and their impact on sleep patterns.