European neurology
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A continuous intraoperative EEG monitoring was performed in 369 consecutive carotid artery revascularizations (CARs) (321 patients) to minimize the intraoperative neurological morbidity. There were 227 carotid endarterectomies and patch graft angioplasty (198 patients), 79 carotid eversion endarterectomies (70 patients) and 58 internal carotid artery reimplantations into the common carotid artery (48 patients). Indications for CARs were TIAs (141, 43.9%), amaurosis fugax (60, 18.6%) and fixed or partial nonprogressing stroke (14, 4.3%). ⋯ In 2 of these cases, the intraoperative EEG monitoring was absolutely normal and the IS was not used: the carotid occlusion was due to technical errors. The most striking finding of this series is the absence of false-negative results in continuous EEG monitoring. EEG monitoring appears an available and useful method for the detection of cerebral ischemia secondary to carotid cross-clamping and contributes to put at zero the intraoperative complications of the surgical procedure.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of immediate-release and controlled release carbidopa/levodopa in Parkinson's disease. A multicenter 5-year study. The CR First Study Group.
Motor response fluctuations and dyskinesias compromise long-term levodopa therapy in Parkinson's disease. Variations in plasma levodopa levels contribute to adverse reactions associated with chronic therapy. Therefore, sustained-release levodopa preparations may be associated with less motor fluctuations and a better outcome. We conducted a large, 5-year, multicenter study to address this hypothesis. ⋯ During a 5-year treatment period, control of parkinsonian symptoms was maintained by both immediate-release and sustained-release carbidopa/levodopa. Both treatment regimens were associated with a low incidence of motor fluctuations and dyskinesias. There was a statistically significant difference (p < 0.05) in activities of daily living as measured by the UPDRS in favor of Sinemet CR.
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We report a case with bilateral paramedian thalamic infarcts. The patient showed a dramatic personality change characterized by childish behavior and euphoria; which remained unchanged for 2 years after the onset. 'Vorbeireden' characterized by approximate answers was also observed. Anterograde amnesia had quite improved after 2 years, while retrograde amnesia for 1 year prior to the stroke onset and vertical gaze palsy remained unchanged. ⋯ A position emission tomography study showed that cerebral metabolic rate for glucose was markedly decreased in both thalami and in the cerebellum, and only slightly decreased in the parietal and occipital cortical regions. Cerebral metabolic rates of glucose in the frontal and temporal cortices were within normal range. The paramedian thalamic lesions per se may be responsible for the patient's personality change, 'Vorbeireden', and amnesia.
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Randomized Controlled Trial Multicenter Study Clinical Trial Controlled Clinical Trial
Studies to assess if pizotifen prophylaxis improves migraine beyond the benefit offered by acute sumatriptan therapy alone.
Two multi-centre studies-one double-blind, placebo-controlled (study 1) and one open (study 2)-were set up to assess if pizotifen prophylaxis improved migraine beyond the benefit offered by acute sumatriptan therapy alone. Eighty-eight patients completed the blinded study and 63 patients completed the open study. Both studies were of crossover design with patients undertaking a 4 week run-in period prior to a 12-week treatment period. ⋯ In these studies, where the average number of migraine attacks was around 4 per month, the benefits conferred by pizotifen were at the expense of the adverse events associated with the drug, particularly weight gain. Therefore the clinical benefit of treatment with pizotifen for patients who have less than 4 attacks per month should be carefully reviewed as acute treatment with sumatriptan may be the most appropriate treatment. Pizotifen may be better reserved for those patients who have 4 of more attacks per month.