摘要:

BACKGROUND–By affecting young people during the most productive period of their lives, spinal cord injury (SCI) is a devastating problem for modern society. A decade ago, treating SCI seemed frustrating and hopeless because of the tremendous morbidity and mortality, life-shattering impact, and limited therapeutic options associated with the condition. Today, however, an understanding of the underlying pathophysiological mechanisms, the development of neuroprotective interventions, and progress toward regenerative interventions are increasing hope for functional restoration.REVIEW SUMMARY–This study addresses the present understanding of SCI, including the etiology, pathophysiology, treatment, and scientific advances. The discussion of treatment options includes a critical review of high-dose methylprednisolone and GM-1 ganglioside therapy. The concept that limited rebuilding can provide a disproportionate improvement in quality of life is emphasized throughout.CONCLUSIONS–New surgical procedures, pharmacologic treatments, and functional neuromuscular stimulation methods have evolved over the last decades that can improve functional outcomes after spinal cord injury, but limiting secondary injury remains the primary goal. Tissue replacement strategies, including the use of embryonic stem cells, become an important tool and can restore function in animal models. Controlled clinical trials are now required to confirm these observations. The ultimate goal is to harness the body’s own potential to replace lost central nervous system cells by activation of endogenous progenitor cell repair mechanisms.

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BACKGROUND–Tardive syndromes (TS) are a group of delayed-onset abnormal involuntary movement disorders induced by a dopamine receptor blocking agent. There are several phenomenologically distinct types of TS.REVIEW SUMMARY–The term tardive dyskinesia (TD) has been used to refer to the TS that presents with rapid, repetitive, stereotypic movements mostly involving the oral, buccal, and lingual areas. Tardive dystonia can be focal, segmental, or generalized. It commonly affects the face and neck followed by the arms and trunk. It usually results in retrocollis when it involves the neck and trunk arching backwards when it involves the trunk. Tardive akathisia is characterized by a feeling of inner restlessness and jitteriness with an inability to sit or stand still. Other tardive syndromes include tardive tics, myoclonus, tremor, and withdrawal-emergent syndrome. It remains unclear whether tardive parkinsonism truly exists. The only way to prevent TS is to avoid its etiologic agents. Chronic use of dopamine receptor blocking agents should be limited as much as possible to patients with chronic psychoses. In general, for mild TS, reducing the neuroleptic dose, switching to an atypical agent, or discontinuing antipsychotic treatment altogether in the hope of facilitating remission is recommended. For moderate to severe TS, tetrabenazine or reserpine may be the most effective agent. Neuroleptics should be resumed to treat TD in the absence of active psychosis only as a last resort for persistent, disabling, and treatment-resistant TD.CONCLUSIONS–The severity of the TS and the absolute need for antipsychotic therapy often dictate the treatment approach for this disorder.

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BACKGROUND–The neurologist is often asked to evaluate patients with a chief complaint of fatigue. Many neurologists do not believe in the pathologically based disease known as chronic fatigue syndrome (CFS), yet as a group, neurologists are well suited to guide the diagnostic work up of such patients to pinpoint treatable disorders in the realm of neurology, general medicine, and psychiatry.REVIEW SUMMARY–Every patient should be carefully evaluated for certain medical, psychiatric, and neurologic disease that can cause fatigue as the most prominent symptom. This is most pressing because new work in virology, immunology, and imaging holds promise but still does not provide any diagnostic test or a mechanism for the production of these symptoms. Only a few treatments meet with even modest success in CFS. The goal of this paper is to provide the clinical neurologist with a framework for the investigation and management of this challenging group of patients.CONCLUSION–Neurologists are typically also trained in psychiatry and general medicine, and this is a strong position to evaluate the patient with fatigue. Because no presently available test can make the diagnosis of CFS, the assessment is vital to seek out more treatable illnesses.

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BACKGROUND–To determine the relationship between chiropractic manipulative therapy (CMT) and internal carotid artery dissection (ICAD), a MEDLINE literature search was performed for the years 1966 through 2000 using the termsinternal carotid dissection.Literature that included information concerning causation of ICAD, as well as all case studies and series, was selected for review.REVIEW SUMMARY–In reviewing the cases of internal carotid dissection potentially related to CMT, there were many confounding factors, such as connective tissue aberrations, underlying arteriopathy, or coexistent infection, that obscured any obvious cause-and-effect relationship. To date there are only 13 reported cases of ICAD temporally related to CMT. Most ICADs seem to occur spontaneously and progress from local symptoms of headache and neck pain to cortical ischemic signs. Approximately one third of the reported cases were manipulated by practitioners other than chiropractic physicians, and because of the differential risk related to major differences in training and practice between practitioners who manipulate the spine, it would be inappropriate to compare adverse outcomes between practitioner groups.CONCLUSIONS–The medical literature does not support a clear causal relationship between CMT and ICAD. Reported cases are exceedingly scarce, and none support clear cause and effect.

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BACKGROUND-Mitochondriopathy has been rarely reported to imitate motor neuron disease.REVIEW SUMMARY-A 57-year-old, 157-cm-tall woman with clinical and electrophysiological features of motor neuron disease since 1993 is reported. She also had increased liver function parameters, hypothyroidism, and sinus tachycardia. Because her mother and sister had both died from assumed amyotrophic lateral sclerosis (ALS), familial ALS was diagnosed. On reevaluation, screening for superoxide-dismutase gene mutations was negative, but lactate stress testing was abnormal and muscle biopsy revealed patchy COX deficiency and abnormal mitochondria. Analysis of the muscle mtDNA revealed substitutions in the isoleucine tRNA, in the ATPase-6, and in the cytochrome-b gene, respectively. Based on these data, the diagnosis of ALS was changed to mitochondriopathy.CONCLUSIONS-Mitochondriopathy may mimic ALS, phenotypically and electrophysiologically. In patients with an ALS phenotype, slow progression, and multisystem involvement, mitochondriopathy should be considered a diagnostic possibility.

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2003

数据来源: OVID