Expert review of neurotherapeutics
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Expert Rev Neurother · Jul 2003
Fetal alcohol spectrum disorder and ADHD: diagnostic implications and therapeutic consequences.
The first association between prenatal alcohol exposure and a teratogenic effect in the developing fetus was made in 1968 by pediatrician Paul Lemoine in France. A few years later, Jones and Smith defined the fetal alcohol syndrome which combined dysmorphic facial, growth and CNS features. The classic fetal alcohol syndrome has been recently reviewed. ⋯ Therefore, the presence of full fetal alcohol syndrome does not necessarily mean that the patient has the most severe CNS impairments. Genetic research has suggested that genetic factors may have a role in a modulating a woman's susceptibility to having a baby with fetal alcohol spectrum disorder (specifically the full fetal alcohol syndrome subtype). Thus, genetic factors may increase the variability of the teratogenic effect of prenatal exposure to alcohol on the developing fetus.
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Delirium, a clinical syndrome characterized by the acute onset of confusion, indicates that there is a disruption in physiological equilibrium that may lead to death unless quick and appropriate action is taken. Despite its frequent appearance, delirium often goes unrecognized, undetected and untreated, leading to poorer outcomes including longer lengths of hospitalization, persistent deficits in cognitive function and the need for nursing home placement following acute treatment. Prevention and treatment strategies do not need to be complex or expensive, but require well co-ordinated interventions from multiple disciplines including nursing, psychiatry, neurology and primary care, as well as the co-operation and significant effort of family and friends who know the affected individual well.
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Guillain-Barré syndrome is characterized by acute progressive weakness, areflexia and maximal motor disability that occur within 4 weeks of onset. Its clinical and pathological spectra range extends from classical acute inflammatory demyelinating polyneuropathy to axonal variants with (acute motor sensory axonal neuropathy) or without (acute motor axonal neuropathy) sensory involvement. ⋯ Guillain-Barré syndrome now is recognized as a heterogeneous disorder with various clinical manifestations and recent neurophysiological and pathological findings have led to its reclassification. This review summarizes current concepts about the clinical spectrum of Guillain-Barré syndrome and its variants and about differential diagnosis.
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Anxiety disorders as a whole are the most common psychiatric disorders in children and adolescents, with a reported prevalence ranging from 6 to 18%. Childhood anxiety disorders predict adult disorders and the majority of adult anxiety disorders are antedated by childhood anxiety. Furthermore, social dysfunction may result from misdiagnosis of these early-onset disorders. ⋯ Different classes of medications have been used in pediatric anxiety disorders, including benzodiazepines, tricyclics and buspirone. Newer antidepressants (SSRIs and beyond) have fewer side effects, lower toxicity in overdose and a broader range of indications. This review will focus on the efficacy of these new drugs in the management of anxiety disorders in children and adolescents (obsessive-compulsive disorder, panic disorder, separation anxiety disorder/school refusal, generalized anxiety disorder, social phobia, post-traumatic stress disorder).
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Antiepileptic drugs were initially designed to treat epileptic seizures, but are increasingly used in the treatment of neuropathic pain. Efficacy of the newer antiepileptic drugs has been confirmed in placebo-controlled studies for trigeminal neuralgia, postherpetic neuralgia, painful polyneuropathy and central poststroke pain. ⋯ These mechanisms could account for their antiallodynic and antihyperalgesic effects demonstrated in animal models of neuropathic pain and also suggested for gabapentin and lamotrigine in humans. Additional studies are required to compare efficacy of newer versus standard antiepileptic drugs and to better define their place in comparison with other analgesics in the treatment of neuropathic pain.