Expert review of neurotherapeutics
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Expert Rev Neurother · May 2004
ReviewDo minimally invasive procedures have a place in the treatment of chronic low back pain?
Chronic low back pain is the leading cause of disability in the industrialized world. Medical and surgical treatments remain costly despite limited efficacy. The field of 'interventional pain' has grown enormously and evidence-based practice guidelines are systematically developed. ⋯ Interventional pain literature suggests that there is moderate evidence (small randomized, nonrandomized, single group or matched-case controlled studies) for medial branch neurotomy and limited evidence (nonexperimental one or more center studies) for intradiscal treatments in mechanical low back pain. There is moderate evidence for the use of transforaminal epidural steroid injections, lumbar percutaneous adhesiolysis and spinal endoscopy for painful lumbar radiculopathy, and spinal cord stimulation and intrathecal pumps mostly after spinal surgery. In reality, there is no gold standard for the treatment of chronic low back pain, but these results appear promising.
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Expert Rev Neurother · May 2004
ReviewEtiology of primary headaches: the importance of genes and environment.
Results from twin studies show that genes play an important role for susceptibility to migraine. The propensity for migraine to run in some families but not in others arises predominantly from alleles shared by family members and not the shared family environment, and that environmental influences on migraine are unique to the affected family member. The main genetic and environmental architecture for the other two major primary headaches, tension-type and cluster, remains to be elucidated. This review focuses on recent advances in twin studies of primary headaches and the future prospects are outlined.
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Expert Rev Neurother · May 2004
ReviewOxidative injury in epilepsy: potential for antioxidant therapy?
Biological ill effects of oxidative injury from excess free radical production are implicated in many human conditions. Epilepsy is a chronic, dynamic neurological disorder associated with ongoing neuronal damage, particularly when uncontrolled. ⋯ However, there is sparse direct clinical data on the use of antioxidants in human epilepsy. This review examines the evidence for the role of oxidative injury in epilepsy, the rationale for use of antioxidant therapy in epilepsy and appraises the current clinical performance of the studies of antioxidant therapies.
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Pain is a common complaint in children after surgery. Four out of five children require analgesia even after minor surgery, and after more extensive surgery, significant postoperative pain may last for weeks. Severe pain during, and after surgery may aggravate long-lasting negative effects to the body and mind. ⋯ Recent trials indicate that children may undergo major surgery with minimal untoward effects when effective proactive pain management is provided. This review will focus on new clinical strategies on pain management in children. Since most pediatric surgery is performed as a day-case or short-stay basic recommendations for parental guidance and pain management after discharge are also presented.