Expert review of neurotherapeutics
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Intracerebral hemorrhages (ICH) cause high levels of morbidity and mortality. Secondary neuronal injury from perihematomal edema is thought to contribute to poor outcomes. ⋯ Recent exploration of minimally invasive techniques for ICH removal includes stereotactic surgery combined with intra-clot thrombolysis, as well as endoscopic hematoma evacuation. Ongoing trials have demonstrated the safety of such minimally invasive approaches, and pending efficacy data from these studies is likely to change the standard management of ICH.
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Expert Rev Neurother · Jan 2015
ReviewEffect of Sativex on spasticity-associated symptoms in patients with multiple sclerosis.
Individuals with multiple sclerosis (MS) spasticity may experience a range of symptoms, such as bladder dysfunction, pain, impaired sleep quality and mobility restrictions that worsen as spasticity severity increases. In this review, the effects of Sativex(®) oromucosal spray on symptoms and functional impairment associated with MS-related spasticity were examined. ⋯ Meaningful symptomatic improvement was achieved within the recommended dosage limit of ≤12 sprays per day. In appropriate patients, Sativex has the potential to minimize the consequences of spasticity-related symptoms on quality of life and reduce the economic burden on healthcare systems.
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Expert Rev Neurother · Jan 2015
ReviewNew understanding of nonconvulsive status epilepticus in adults: treatments and challenges.
Nonconvulsive status epilepticus (NCSE) in adults represents a constellation of conditions producing ongoing ictal impairment with myriad clinical presentations. These may vary from minimal obtundation, to psychosis to coma for which electroencephalography is essential to diagnosis. ⋯ There is a new and emerging understanding of the nature of NCSE, its classification and the challenges in treatment. The aim of this article is to review the classic and most recent literature on NCSE in adults focusing attention on the clinical settings in which NCSE frequently occurs, in order to improve awareness of the issues involved in electroclinical diagnosis, treatment and prognostication.
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Expert Rev Neurother · Jan 2015
ReviewPrehospital stroke care: telemedicine, thrombolysis and neuroprotection.
Over the last 15 years, new approaches regarding neuroprotective and thrombolytic strategies in stroke management have been evaluated in the prehospital setting. These efforts have provided exciting new potentials of hyperacute stroke care. Trials have shown that the use of specialized stroke ambulances increases the proportion of patients receiving intravenous thrombolysis and shortens alarm-to-treatment time by approximately half an hour compared to standard care. ⋯ However, direct effects of prehospital stroke care on functional outcome have yet to be shown and other approaches such as neuroprotective treatments could not demonstrate clinical benefit so far. There is a clear need for systematic research in the prehospital field to test the clinical effectiveness and cost-effectiveness of new therapeutic strategies. It will be necessary to test various components of prehospital stroke care alone and in combination.
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Expert Rev Neurother · Jan 2015
ReviewTopical amitriptyline and ketamine for the treatment of neuropathic pain.
A neuropathy is a disturbance of function or pathological change in nerves. In some cases, peripheral neuropathic pain may occur due to a lesion or disease of the peripheral somatosensory nervous system. Efficacy of different agents for peripheral neuropathic pain conditions is less than optimal. ⋯ However, this data was not uniformely obtained and its role remains still controversial. Efficacy may depend on many factors, including the choice of the vehicle, the concentration, the pain site, and specific diseases. More studies are necessary to support the use of AK in clinical practice.