Expert review of neurotherapeutics
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Mortality in people with epilepsy is two- to three-times that of the general population. This can be attributed to epilepsy itself (epilepsy-related death) or to the underlying cause of the epilepsy. Sudden unexpected death in epilepsy (SUDEP) is the commonest cause of epilepsy-related death. ⋯ Poor incident case reporting, inaccurate death certification and fewer post-mortem examinations have limited the value of epidemiological data on SUDEP. Here, we review the characteristics of SUDEP, its likely risk factors, mechanisms and differential diagnosis, and consider possible strategies for prevention. We also explore the discussion of SUDEP with patients and the management of relatives of SUDEP patients.
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Neurostimulation therapy involves the use of peripheral or central nerve electrical stimulation approaches for the treatment of medically intractable headache. Currently, for peripheral stimulation the main approach is that of occipital nerve stimulation, while for central stimulation deep-brain approaches with the target of the region of the posterior hypothalamic gray matter have been explored. Target conditions include migraine and the trigeminal autonomic cephalalgias: cluster headache, paroxysmal hemicrania and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/cranial autonomic features (SUNCT/SUNA), as well as hemicrania continua. The initial results are encouraging and given the very significant disability of medically intractable primary headaches, this is a very promising area for patients and physicians alike.
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Expert Rev Neurother · Nov 2007
ReviewPostherpetic neuralgia: epidemiology, pathophysiology and management.
Postherpetic neuralgia (PHN) is a neuropathic pain syndrome and is the most common complication of herpes zoster (HZ; shingles). PHN occurs mainly in HZ patients 60 years of age and older, in particular in those suffering from more severe acute pain and rash. Administration of antiviral drugs reduces the duration of pain associated with HZ. ⋯ Mechanism-based therapy is a desirable goal but so far proves elusive. The incidence of HZ, and therefore that of PHN, is likely to increase as a result of greater longevity and increasing numbers of patients receiving treatment that compromises cell-mediated immunity. A zoster vaccine for administration to adults reduces the incidence of HZ and PHN, as well as the burden of illness associated with these conditions.
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Expert Rev Neurother · Nov 2007
ReviewVoltage-gated sodium channel blockers for the treatment of neuropathic pain.
Pain serves a crucial physiological function, warning the body of impending or actual tissue damage, preventing further damage and aiding the healing process. Neuropathic pain, resulting from nervous system injury or dysfunction, can be a serious medical problem and especially difficult to treat. Although sodium channel blockers are clinically useful for treating pain, they often provide only partial relief and adverse effects associated with nonspecific actions can limit their use. Research on the roles of sodium channels in neuronal excitability and pain shows that specific sodium channel isoforms are crucial determinants of nociception and neuropathic pain, indicating that it should be possible to develop sodium channel blockers with lower toxicity and enhanced efficacy for treating neuropathic pain.
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The relationship of the neck to headache has been recognized by physicians for over a century. However, whether the neck is the cause of a separate diagnostic entity, cervicogenic headache or simply a part of other headache complexes is the source of controversy. In recent years, there has been an increasing awareness of neck symptoms associated with headache. ⋯ Review of the literature shows many older uncontrolled studies and later literature reports describe only small numbers of patients. Cervicogenic headache or headache related to the neck afflicts many persons and research with adequate patient inclusion is needed. This paper describes cervicogenic headache and treatment options.