Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Jun 2014
Randomized Controlled Trial Multicenter StudyRivastigmine in apathetic but dementia and depression-free patients with Parkinson's disease: a double-blind, placebo-controlled, randomised clinical trial.
Even with optimal dopaminergic treatments, many patients with Parkinson's disease (PD) are frequently incapacitated by apathy prior to the development of dementia. We sought to establish whether rivastigmine's ability to inhibit acetyl- and butyrylcholinesterases could relieve the symptoms of apathy in dementia-free, non-depressed patients with advanced PD. ⋯ Clinicaltrials.gov reference: NCT00767091.
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J. Neurol. Neurosurg. Psychiatr. · Jun 2014
Review Meta AnalysisLong-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis.
There is uncertainty about the long-term prognosis after spontaneous intracerebral haemorrhage (ICH). Therefore, we systematically reviewed the literature for studies reporting long-term survival and ICH recurrence, and their predictors. ⋯ Less than a half of patients with ICH survive 1 year and less than a third survive 5 years. Risks of recurrent ICH and ischaemic stroke after ICH appear similar after ICH, provoking uncertainties about the use of antithrombotic drugs.
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J. Neurol. Neurosurg. Psychiatr. · Jun 2014
ReviewAn algorithmic approach to structural imaging in dementia.
Accurate and timely diagnosis of dementia is important to guide management and provide appropriate information and support to patients and families. Currently, with the exception of individuals with genetic mutations, postmortem examination of brain tissue remains the only definitive means of establishing diagnosis in most cases, however, structural neuroimaging, in combination with clinical assessment, has value in improving diagnostic accuracy during life. ⋯ While neuroradiological expertise is invaluable in accurate scan interpretation, there is much that a non-radiologist can gain from a focused and structured approach to scan analysis. In this article we describe the characteristic MRI findings of the various dementias and provide a structured algorithm with the aim of providing clinicians with a practical guide to assessing scans.
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J. Neurol. Neurosurg. Psychiatr. · Jun 2014
ReviewSubcutaneous immunoglobulin therapy for inflammatory neuropathy: current evidence base and future prospects.
Intravenous immunoglobulin therapy is of proven effect in chronic inflammatory neuropathies, including chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN). In more recent years, there have been a number of anecdotal case reports and small series, followed by a few trials of variable design, of subcutaneous immunoglobulin therapy in these neuropathies. To date, limited evidence suggests that the subcutaneous route may be a more clinically effective, better-tolerated, at least cost-equivalent and a more patient-friendly option than the still more used intravenous alternative. ⋯ The current use in clinical practice, day-to-day benefits, including quality of life measures and health economics as published thus far, are evaluated. The limitations of this form of treatment in CIDP and MMN are also analysed in the light of current literature and taking into account the remaining unknowns. Future prospects and research with this mode of immunoglobulin therapy administration are discussed.