Expert review of neurotherapeutics
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Expert Rev Neurother · Jun 2009
ReviewElectrophysiologic and immunopathologic correlates in Guillain-Barré syndrome subtypes.
Guillain-Barré syndrome (GBS) includes demyelinating and axonal subtypes with different immunopathologic mechanisms. In acute inflammatory demyelinating polyradiculoneuropathy, segmental demyelination and conduction block are the pathological and electrophysiological correlates of muscle weakness. Slowed conductions and increased temporal dispersion of motor responses are more characteristic of the remyelinative phase and do not affect muscle power. ⋯ Severity of axonal damage induced by antiganglioside antibodies may vary from reversible functional impairment of nodal axolemma to complete axonal damage with subsequent Wallerian degeneration. In early GBS, current electrophysiologic criteria are unable to distinguish with certainty different subtypes. Serial electrophysiologic studies are mandatory for identification of GBS subtypes and to elucidate the pathophysiologic mechanisms of muscle weakness among demyelination, axonal degeneration and physiologic conduction block.
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Expert Rev Neurother · May 2009
ReviewTransition from acute to chronic postsurgical pain: risk factors and protective factors.
Most patients who undergo surgery recover uneventfully and resume their normal daily activities within weeks. Nevertheless, chronic postsurgical pain develops in an alarming proportion of patients. The prevailing approach of focusing on established chronic pain implicitly assumes that information generated during the acute injury phase is not important to the subsequent development of chronic pain. ⋯ Evidence is then reviewed for a preventive multimodal analgesic approach to surgery. While there is some evidence that chronic postsurgical pain can be minimized or prevented by an analgesic approach involving aggressive perioperative multimodal treatment, other studies fail to show this benefit. The transition of acute postoperative pain to chronic postsurgical pain is a complex and poorly understood developmental process, involving biological, psychological and social-environmental factors.
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Expert Rev Neurother · May 2009
ReviewSugammadex: a selective relaxant binding agent for reversal of neuromuscular block.
Neostigmine, the currently used agent for reversal of neuromuscular block, has several drawbacks, such as a slow onset of peak effect, inability to reverse deep block and the occurrence of widespread muscarinic effects. Sugammadex is a new class of reversal agent that acts by encapsulating the molecules of the relaxants rocuronium and vecuronium, for which it is a specific antagonist. ⋯ Sugammadex can also reverse an intense (profound) high-dose rocuronium block, but the dose required in this situation is 16.0 mg/kg. The agent has been found to be safe so far, with few side effects.
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Expert Rev Neurother · May 2009
ReviewBrain-evoked potentials as a tool for diagnosing neuropathic pain.
Neuropathic pain is a complex subject, not completely understood yet, and it is quite common in clinical practice, even outside of a neurological context. Neuropathic pain, often being a chronic process, alters and profoundly affects the quality of life. Therefore, the management of neuropathic pain involves a multidimensional approach, as physicians have to take care not only of the objective aspects of the problem, but also of the subjective experiences of pain. ⋯ Several studies report the use of brain-evoked potentials for studying patients suffering from neuropathic pain. In particular, laser- and contact heat-evoked potentials have proved useful for the diagnosis of clinical conditions characterized by neuropathic pain. However, although these tools are reliable and safe instruments to assess function of the nociceptive system, their use is still largely confined to research purposes.
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Pain is one of the most troublesome sequelae of stroke, occurring in 19-74% of patients. A portion of this post-stroke pain is caused by the brain lesion itself; this is called 'central post-stroke pain' (CPSP). Although the prevalence of CPSP among stroke patients is low (1-8%), the persistent, often treatment-refractory, painful sensations can be a major problem, decreasing the affected patient's quality of life. ⋯ Antiepileptics, such as lamotrigine, can be used as an adjunctive therapy, while GABAergic drugs, such as gabapentin or pregabalin, have recently emerged as a potentially useful therapy. Nonpharmacological treatments, such as motor cortex stimulation or deep brain stimulation, also appear to be useful in a certain group of patients. Additional studies are urgently needed to improve our understanding of the pathophysiology of CPSP and support the development of better treatment modalities.