Expert review of neurotherapeutics
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Expert Rev Neurother · Sep 2011
ReviewAntiganglioside antibodies in Guillain-Barré syndrome and its related conditions.
Guillain-Barré syndrome (GBS) is typically classified into two major subtypes: acute inflammatory demyelinating neuropathy and acute motor axonal neuropathy. Its most recognizable variant is Fisher syndrome. ⋯ In this article, we discuss the different clinical presentations in GBS and the role of antiganglioside antibodies in their underlying pathogenesis. We also discuss the impact that antiganglioside antibodies have had in the development of experimental models and treatment modalities in GBS.
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The purpose of this article is to systematically review the use of fentanyl as an analgesic for breakthrough pain. This article found that the oral transmucosal fentanyl (OTFC) had a quicker onset to analgesia than oral immediate-release opioids. ⋯ OTFC and INFS have been used effectively to reduce acute pain in children who are opioid-naive. Abuse and addiction to OTFC, fentanyl buccal tablets and INFS was low, owing to patient selection.
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Expert Rev Neurother · Aug 2011
ReviewAdvances in revascularization for acute ischemic stroke treatment: an update.
Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the established treatment for acute ischemic stroke patients presenting within 4.5 h of stroke onset based on the results of the National Institute of Neurological Disorders and Stroke Study Group trial and European Cooperative Acute Stroke Study III. In a significant number of patients, however, intravenous thrombolysis with rt-PA remains ineffective, with lower rates of recanalization, especially for proximal occlusions and a large thrombus burden. Newer thrombolytic agents, such as reteplase, tenecteplase or desmoteplase, offer pharmacokinetic and hemodynamic advantages over rt-PA and have been, or are currently being, tested for safety and efficacy in clinical trials. ⋯ Endovascular revascularization is an evolving treatment option enabling mechanical clot disruption or extraction in combination with local directed pharmacological thrombolysis. Several new endovascular devices have been successfully tested for safety in acute ischemic stroke patients and are now being tested for efficacy in larger clinical trials. Continued innovation and refinement of endovascular technology and techniques, including combination therapy such as bridging therapy and the use of stent-like devices, is expected to increase technical success and improve overall efficacy and time to recanalization with minimal procedure-related morbidity in the treatment of acute ischemic stroke.
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Expert Rev Neurother · Aug 2011
Synopsis of the 10th International Neurotrauma Symposium: from bench to bedside in neurotrauma translational research.
The 10th International Neurotrauma Symposium was held in Shanghai, China, on 27-30 April 2011. This meeting marked the 20th anniversary of International Neurotrauma Symposia. ⋯ The Shanghai meeting brought together 1000 delegates from over 70 countries. Key areas discussed included current guidelines of neurotrauma management, the latest advances in neuroimaging, the latest concepts in cell death mechanisms after neurotrauma, the role of decompressive techniques for cranial and spinal neurotrauma, advances in biomarkers for CNS injury, and the future of clinical management and research in neurotrauma.
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Expert Rev Neurother · May 2011
ReviewThe use of ketamine in complex regional pain syndrome: possible mechanisms.
Complex regional pain syndrome is a neuropathic pain syndrome that is characterized by: severe pain beyond the area of injury; autonomic dysregulation; neurogenic edema; movement disorder; and atrophy and dystrophy. Ketamine is an open-channel NMDA blocker that only acts on those receptors whose Mg(2+) block has been lifted. ⋯ Different protocols are utilized depending on the severity of illness. There have been no serious ketamine-induced complications from these protocols, owing to careful psychological screening and the liberal use of midazolam and lorazepam to counter any psychomimetic effects and clonidine to block possible 'Olney's' lesions.