Lancet neurology
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Neural stimulation is a promising new technology for the treatment of medically-intractable seizures. Vagus-nerve stimulation (VNS) is licensed in several countries as an adjunctive therapy. VNS is as effective as antiepileptic drug therapy, and serious complications are rare. ⋯ Electrode implantation in the brain for indications other than seizures has been associated with a 5% risk for intracranial haemorrhage and 5% for infection. A controlled study of anterior thalamic stimulation in patients with intractable partial and secondarily generalised seizures has been started. Future investigations are likely to study extrathalamic sites of stimulation, and effects of stimulation contingent upon detection of or prediction of EEG patterns of epileptiform activity.
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Multiple sclerosis (MS) is probably aetiologically heterogeneous. Systematic genetic epidemiological and molecular genetic studies have provided important insights. Both genetic and non-genetic (environment, stochastic) factors may be involved in susceptibility as well as outcome, but we have yet to understand their relative roles. ⋯ There are, however, many genes that seem to be associated with MS. These include, but are in no way limited to, HLA classes I and II, T-cell receptor beta, CTLA4, ICAM1, and SH2D2A. The future of MS genetics, as for most common complex disorders, will be dependent on the resources available, ranging from biological samples and comprehensive databases of clinical and epidemiological information to the development of new technologies and statistical methods.
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An artist-in-residence programme at the Capital Health Memory Clinic in Halifax, Canada, was established 6 years ago. The artists contribute to the clinic's academic mission by helping to describe how Alzheimer's disease treated by cholinesterase inhibitors is providing a better understanding of human cholinergic neurotransmission. The artists also contribute to the clinical programme by helping to establish a therapeutic ambience, and by allowing clinicians to see themselves through their patients' eyes. The artist programme has inspired a design initiative for the improvement of the physical environment for older patients, and has created a unique art collection that is becoming a resource for scholarship.