摘要:

BACKGROUND–Intraoperative neuromonitoring (IONM) has been a valuable part of surgical procedures for over 25 years. Insight into the nervous system during surgery provides critical information to the surgeon allowing reversal or avoidance of neural insults.REVIEW SUMMARY–Electrophysiological tests including electroencephalography, electromyography, and multiple types of evoked potentials (somatosensory, auditory, and motor) are monitored during surgeries that involve risk to the nervous system. Deterioration of signals suggests a surgical insult and is associated with an increased risk of postoperative deficit. Intraoperative identification of this risk allows corrective action. In addition, IONM teams make use of their armamentarium of tests to evaluate anatomy or function of the nervous system in response to specific questions posed by the surgical team.CONCLUSIONS–Intraoperative recordings are now a routine part of many surgical procedures. Their correct application leads to improved surgical outcome.

ISSN:1074-7931    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BACKGROUND–The objective for this article is to highlight several challenges faced by patients and providers in the utilization of disease-modifying agent (DMA) therapy in multiple sclerosis (MS) and to offer practical management strategies that can effectively mitigate or even prevent limiting adverse reactions and enhance treatment compliance.REVIEW SUMMARY–Our discussion will be limited to the use of interferon &bgr;1a (Avonex, Rebif), interferon &bgr;1b (Betaseron), and glatiramer acetate (Copoxane) as these are the primary agents used in the United States for primary disease-modifying therapy in relapsing forms of MS. Some of the recommendations contained herein are derived from evidence-based studies, while others are contingent upon our collective clinical experiences. At the University of Texas Southwestern Medical Center at Dallas and Texas Neurology in Dallas we actively follow approximately 5000 MS patients. The majority of our patients with relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS) are treated with one of the currently available DMAs. Our experience with these patients, and the challenges they face in continuing long-term treatment, constitutes the basis of our proposed treatment strategies. As part of this effort we formulated an assessment and intervention instrument that can be used in the clinic and by telephone to enhance compliance and minimize adverse events.CONCLUSION–A comprehensive treatment approach to the utilization of disease-modifying therapy in MS can serve to optimize the management of our patients and effectively meet the challenges that arise during the course of treatment.

ISSN:1074-7931    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BACKGROUND–Most peripheral neuropathies involve large as well as small-fiber dysfunction. A small subset of neuropathies present with restricted or predominant small-fiber involvement.REVIEW SUMMARY–In this review, we discuss the differential diagnosis, clinical presentation, evaluation, and treatment of small-fiber neuropathies. Although these neuropathies are rare, their differential diagnosis is broad, and includes many disorders, including metabolic, toxic, inflammatory, infectious, and genetic etiologies. As small fibers subserve pain and autonomic functions, these neuropathies usually present with pain and temperature loss, painful dysesthesias, autonomic dysfunction, or a combination. These neuropathies are especially challenging as nerve conductions and EMG, which help guide the evaluation of most peripheral neuropathies, may have normal findings in patients with small-fiber neuropathies. Other specialized studies, including tests of autonomic function, intraepidermal nerve fiber analysis, and quantitative sensory testing, are often required to confirm the presence of a small-fiber neuropathy. In some cases, the underlying etiology can be directly treated. In most, management is limited to symptomatic treatment of sensory and autonomic dysfunction.CONCLUSION–Small-fiber neuropathies are a heterogeneous group of disorders. They vary in etiologies and require special attention, as many disorders are rare and the differential diagnosis is broad. Evaluation is often extensive and may need pathologic specimen. Many patients respond to symptomatic therapy, but some are difficult to treat.

ISSN:1074-7931    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BACKGROUND–Disorders of gait and mobility are common neurologic abnormalities of aging and can have disastrous consequences. Etiology is multifactorial, and normal age-related changes are difficult to distinguish from those resulting from the disease.REVIEW SUMMARY–Gait evaluation with special techniques provides scientific understanding of physiologic mechanisms, but experienced clinicians can make diagnoses based on general medical and neurologic history and physical examination. Details to observe include posture, length of stride, width of base, speed and fluidity of motion, arm swing, bilateral symmetry of motor activity, and neurologic signs. Gait disorders are classified into lowest-level, middle-level, and highest-level disorders. In lowest-level gait disorders, only one major afferent system (visual, proprioceptive, or vestibular) is affected and the disturbance is usually self-limited or compensated. Middle-level disorders include myelopathy from cervical spondylosis; spastic hemiparetic gait from unilateral impairment of the corticospinal tract; gaits associated with movement disorders; and dystonic, choreic, hemiballistic, and cerebellar ataxic gaits. Highest-level gait disorders include cautious gait, subcortical dysequilibrium, frontal dysequilibrium, isolated gait ignition failure, frontal gait, primary progressive freezing gait, and psychogenic gait disorders.CONCLUSIONS–A treatable cause can often be found. Physical therapy with gait evaluation and training is recommended. Medication must be kept to a minimum.

ISSN:1074-7931    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BACKGROUND–Frontotemporal dementia (FTD) is a syndrome encompassing the clinical expression of frontal or temporal lobe degeneration. The many clinical phenotypes of FTD include primary progressive aphasias and a more common frontotemporal degeneration with less marked language alteration but significant behavioral changes.SUMMARY–This paper describes the clinical progression of neuropsychiatric symptoms among 62 predominantly behavioral presentations and 30 language presentations of FTD. Disinhibition and depression became common for both subject groups over the course of illness. Significantly more cases presenting with behavioral changes had apathy and disinhibition.CONCLUSIONS–Language presentations of FTD had longer latency to onset of distinct neuropsychiatric changes but eventually converge with the phenotype initially affected with behavioral change. Clinicians should anticipate such neuropsychiatric changes, prepare families for the course of illness in patients with either clinical presentation, and treat symptomatically with psychotropic medications to help families cope with behaviorally disturbed patients.

ISSN:1074-7931    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2002

数据来源: OVID