Expert review of neurotherapeutics
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Hemicrania continua (HC) is a primary headache disorder that is characterized by a continuous unilateral headache of moderate severity, exacerbations of severe pain, and complete responsiveness to indomethacin. Misdiagnosis of HC is probably common in general neurology settings and other clinical specialties. This paper is an attempt to bridge the gap between the correct and misdiagnosis of this disorder. ⋯ HC can be of continuous or remitting form. Variants such as HC with aura have been described and secondary cases may occur. Indomethacin is the best treatment, although HC could respond to other NSAIDs, such as the selective COX-2 inhibitors.
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Expert Rev Neurother · Sep 2009
ReviewAdverse effects of medications commonly used in the treatment of migraine.
The classes of medications for migraine treatment are numerous and include ergots, triptans, NSAIDs, antidepressants, anti-epilepsy drugs, antihypertensives and natural supplements. Physicians need to be aware not only of medication efficacy but also of tolerability and safety. ⋯ However, these same coexistent conditions can be worsened by migraine medication or be contraindicated and multiple medications prescribed for several conditions can result in drug-drug interactions. This article reviews adverse events associated with migraine and medications, and their implications in clinical treatment.
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Expert Rev Neurother · Aug 2009
ReviewPredicting and preventing stroke after transient ischemic attack.
The prognosis of transient ischemic attacks (TIAs) is not as favorable as previously thought. Given a risk of stroke of approximately 10% in the first week following a TIA, urgent evaluation and initiation of treatment are required. Recently developed scores to predict the early risk of subsequent stroke in individual patients may guide treatment decisions in the acute phase. ⋯ The significance of this finding and its implications for treatment are not yet clear. There is substantial evidence from a number of clinical trials that adequate secondary prevention therapies can reduce the risk of stroke after TIA. In addition to the conventional vascular risk factors, interest has grown in less strong but more prevalent lifestyle factors, but trials evaluating the effect of modifying these factors are as yet lacking.
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Expert Rev Neurother · Aug 2009
ReviewMild cognitive impairment in stroke patients with ischemic cerebral small-vessel disease: a forerunner of vascular dementia?
Ischemic cerebral small-vessel disease accounts for a third of acute cerebral ischemic events and contributes to the development of cognitive decline and dementia. Cerebral small-vessel disease can be visualized on MRI studies as lacunar infarcts, white matter lesions and cerebral microbleeds. In general, the short-term prognosis of ischemic cerebral small-vessel disease compared with other stroke subtypes is more favorable, with almost negligible early mortality, absence of neuropsychological impairment and excellent neurological recovery. ⋯ Moreover, patients with small-vessel disease have an increase in the mid- and long-term risk of death, stroke recurrence and dementia. Neuropsychological abnormalities in small-vessel disease occurred more frequently than previously recognized. Ischemic cerebral small-vessel disease should be regarded as a potentially severe condition prodrome of subcortical vascular dementia rather than a relatively benign disorder.
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Expert Rev Neurother · Aug 2009
ReviewNovel preventive and therapuetic strategy for post-stroke pneumonia.
Pneumonia is a significant complication of ischemic stroke that increases mortality. Post-stroke pneumonia is defined as newly developed pneumonia following stroke onset. Clinically and chronologically, post-stroke pneumonia is divided into two types of aspiration pneumonia. ⋯ The preventive and therapeutic strategies have been developed thoroughly and appropriate antibiotic use, and both pharmacological and nonpharmacological approaches for the treatment of post-stroke pneumonia have been studied rigorously. Increases in substance P levels, oral care, and swallowing rehabilitation are necessary to improve swallowing function in post-stroke patients, resulting in a reduction in the incidence of post-stroke pneumonia in a chronic stage. The stroke must be a cause of aspiration pneumonia.