ISSN:1074-7931    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BACKGROUNDSurgery has become a widely accepted torm of therapy tor medically refractory epilepsy. Epilepsy surgery usually involves resection of an epileptogenic region with the intention of curing the seizures or disconnection of the epileptogenic region from other cerebral areas with the intention of limiting seizure propagation and minimizing the clinical manitestations of the seizures.REVIEW SUMMARYThe selection of appropriate candidates for resective surgery requires recognition of seizure characteristics, demonstration of a unifocal or uniregional onset of habitual seizures, and determination of the critical functional activity of the tissue. With advanced techniques to define functional cerebral anatomy, the risks of resective surgery can be accurately predicted and neurological deficits avoided. The role of electroencephalography in identifying the epileptogenic area, magnetic resonance imaging in defining structural abnormalities, and single photon emission computed tomography and positron emission tomography in functional localization are reviewed. Based on magnetic resonance imaging findings, three broad groups of patients are defined: those with space-occupying lesions; those with medial temporal lobe epilepsy; and those with nonmedlial temporal, nonlesional epilepsy. The outcome of resective procedures is reviewed in terms of seizure control, neurological deticits, and quality of life. Nonresective surgical options, including corpus callosum section, stereotactic lesions, vagal nerve stimulation, and subpial transection, are also addressed.CONCLUSIONSContinuing research into the molecular and genetic basis of the epilepsies, made possible in part by analysis of tissue removed from patients undergoing resective procedures, may provide new conceptual surgical and medical applications.

ISSN:1074-7931    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BACKGROUNDAlzheimer's disease (AD) is a common fatal neurodegenerative disorder for which there is no effective treatment or cure. The biological basis of AD is poorly understood, although age and family history are two prominent risk factors.REVIEW SUMMARYEpidemiological and molecular evidence suggests that there are multiple etiologies for AD. Studies of the incidence and patterns of transmission in families demonstrate that relatives of affected individuals have an increased risk of developing AD compared with members of the general population. In the last few years, defects in the amyloid precursor protein gene and two novel genes dubbed presenilin 1 and 2, which cause familial (autosomal dominant) early-onset AD (<65 years) have been identified. These mutations account for approximately 80% of early-onset familial cases but less than 2% of all cases. In the vast majority of remaining cases, susceptibility is governed by a complex interaction of genes and environmental factors. Apolipoprotein E (APOE) is a cholesterol-binding protein that has three common isoforms encoded by alleles &epsis;2, &epsis;3, and &epsis;4. Association studies have revealed that APOE is an important susceptibility locus for sporadic and familial late-onset AD in most ethnic and racial groups. Risk of AD increases and age at onset decreases as a function of the dose of e4. APOE may interact with other genetic and environmental factors in modulating risk. The contribution of APOE genotype to risk of other dementias is controversial.CONCLUSIONPredictive and diagnostic testing for the rare causative mutations may be appropriate in some circumstances. However, the predictive value of APOE genotype on an individual basis is weak, and it is therefore not recommended as a predictive test. APOE may be an important adjunct for diagnosis in some situations. Many ethical, legal, and counseling concerns need to be addressed before genetic testing is offered outside carefully monitored research protocols.

ISSN:1074-7931    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BACKGROUNDThe attention deficit hyperactivity disorders (ADHD) have long been recognized in children. During the past several years, there is growing evidence that these disorders persist into adulthood. Many adult patients seek treatment for these problems from neurologists.REVIEW SUMMARYThis article reviews the historical evidence for ADHD, plus recent studies that support the contention that the disorder persists into adulthood. Critical articles are reviewed. The concept of coexistent conditions (disorders that are concurrent with ADHD in the same patient) is explained. A clinical approach is described, and effective treatment modalities are discussed.CONCLUSIONADHD is a complicated disorder that persists into adulthood. ADHD can be part of a spectrum of disorders that affect adults. The clinician can make the diagnosis during a standard office visit using an interview technique. Medical and behavioral therapies can produce gratifying results.

ISSN:1074-7931    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BACKGROUNDWe discuss current indications and results after stereotactic radiosurgery for the management of cerebral vascular malformations, brain tumors, and functional disorders. The development of gamma knife and modified linear accelerator technology has been associated with a significant increase in the number of gamma knife units worldwide. The clinical and experimental experience continues to be published in terms of indications for radiosurgery, medical physics testing, long-term clinical outcomes, and morbidity. Using the gamma knife, more than 50,000 patients have undergone radiosurgery worldwide. At the University of Pittsburgh, more than 2,000 patients have undergone radiosurgery during the first 9 years after installation. This review discusses indications and results from our experience.REVIEW SUMMARYAn increasing number of patients have been considered for stereotactic radiosurgery over the last 9 years. An ongoing scientific analysis of results facilitated refinements in techniques, and results continue to improve. Stereotactic radiosurgery can play an important role in the management of vascular malformations, brain tumors, and carefully selected chronic pain and movement disorders. Radiosurgery is truly a “no access” technique, but is not risk free. An appreciation of short- and long-term outcomes is necessary to obtain the best results for patients who choose this procedure as an addition or an alternative to other therapies.CONCLUSIONIn this review, we address the current status of radiosurgery for vascular malformations, acoustic neuromas, meningiomas, brain metastases, glial tumors, head and neck cancer, and trigeminal neuralgia. Indications for primary or adjuvant treatment, results and complications, and modifications of the technique are presented.

ISSN:1074-7931    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BACKGROUNDWe reviewed four prophylactic treatments for multiple sclerosis recently described in the literature: copolymer-1, interferon β-1b, cladribine, and oral methotrexate. Six problem areas are the subject of this commentary: 1) disease scales, 2) steroid use, 3) definition of exacerbation or relapse, 4) previous symptomatic/radiologic history, 5) magnetic resonance imaging, and 6) design variables: sample size, attrition rate, and power.REVIEW SUMMARYThe studies were chosen because of their importance in understanding therapeutic responses in multiple sclerosis patients. Aspects to be considered were disease scales, steroid use, previous history, definition of exacerbation, magnetic resonance imaging, and statistical data. The design of each trial was slightly different. Data from each study were analyzed independently and collectively. The aforementioned variables were compared, and shortcomings were elucidated. Discrepancies between entry criteria and outcome measures were identified. The frequency, preparation, and duration of steroid use was contrasted. Relevant magnetic resonance imaging parameters and outcome criteria were examined. Comparison of total sample size, attrition rate, power, a error rate, and predicted detection of difference were culled, and future design models were explored.CONCLUSIONSThis article reviews four current therapeutic trials involving multiple sclerosis patients. Differences and pitfalls of each study are compared. Statistical analysis among the trials is compared. The aim of this paper is to alert readers to the variability of current trials by direct comparison and to suggest design parameters for future trials.

ISSN:1074-7931    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:1997

数据来源: OVID