Brain and nerve = Shinkei kenkyū no shinpo
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Review
[Treatment strategy for central nervous system involvement in intravascular large B-cell lymphoma].
Intravascular large B-cell lymphoma (IVLBCL) is a distinct disease entity of non-Hodgkin lymphoma which is characterized in the current WHO classification by the selective growth of tumour cells in the lumina of small vessels of various organs. This rare disease entity has a high incidence of central nervous system (CNS) involvement at diagnosis. Although several retrospective analyses indicate that the treatment of this lymphoma has improved in the post-rituximab era, risk of CNS recurrence at 3 years still reaches ~25%. ⋯ Considering that almost all IVLBCL patients have similar risk factors, CNS prophylaxis could also be effective, and thereby give rise to better clinical outcomes, in the treatment of IVLBCL, especially for patients without CNS involvement at initial diagnosis. Intensity regimens for CNS and systemic chemotherapy could be useful for patients with CNS involvement at initial diagnosis. This review describes the current understanding of clinical outcome and CNS involvement in IVLBCL, and discusses the optimal treatment strategy and future perspectives for CNS involvement of this rare lymphoma.
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We report a case of malignant catatonia initially diagnosed as neuroleptic malignant syndrome (NMS) that responded successfully to diazepam administration. A 29-year-old man with mental retardation was admitted to our hospital because of high fever, muscle pain, and consciousness disturbance. Fifteen days before admission, he had developed muscle pain and weakness in his legs. ⋯ The clinical presentation of malignant catatonia is similar to that of NMS. Indeed, some authors have described NMS as a variant of malignant catatonia. If treatment is refractory in cases of NMS, malignant catatonia may be suspected, and changing treatment to diazepam administration may be useful.
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Surgery is a better treatment option than prolonged medical therapy for patients with temporal lobe epilepsy. Randomized trials on surgery for epilepsy are feasible and appear to yield precise estimates of the effects of surgical treatment. This study includes 56 patients who underwent anterior temporal lobectomy with a mean follow-up of 11.3 years. ⋯ No significant relationships were found between objective indices of change and subjective ratings for postoperative memory function. A new surgical method based on multiple subpial transections for the hippocampus was developed in 2006. It remains unclear whether mesial resection involving a larger area leads to better seizure outcomes.
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Warfarin is underused because it has many disadvantages for clinical use despite it has been used more than a half century as an only oral anticoagulant. Dabigatran is a direct thrombin inhibitor, which is not metabolized by cytochrome P450, and thus does not require blood coagulation monitoring or vitamin K intake limitation, or produce drug interaction. ⋯ Dabigatran is expected to be approved as a more effective and safer oral anticoagulant than warfarin for stroke prevention in patients with atrial fibrillation. Randomized controlled trials of many factor Xa inhibitors in comparison with warfarin are also ongoing in patients with atrial fibrillation.
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Despite the advances in pharmacologic treatments for epilepsy, approximately one-third of patients with epilepsy continue to have seizures, and alternative treatment approaches are necessary in such cases. For many patients, resective surgery can be an alternative for achieving seizure freedom; however, its success depend on identifying seizure foci before surgery. Many patients with medically intractable epilepsy are not suitable candidates for surgery. ⋯ The responsive neurostimulator, which can be called a brain pacemaker, is another stimulation device for the treatment of epilepsy. A clinical trial involving the Neuropace system is in progress in the USA. Preliminary results indicating the efficacy of the Neuropace study were presented at the annual American Epilepsy Society meeting in 2010; the final results of this study are awaited.