Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Apr 2016
ReviewSudden unexpected death in epilepsy: basic mechanisms and clinical implications for prevention.
Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in patients with intractable epilepsy. The substantial lifetime risk of SUDEP and the lack of a clear pathophysiological connection between epilepsy itself and sudden death have fuelled increased attention to this phenomenon. ⋯ We integrate these data to suggest the most probable mechanisms underlying SUDEP. Understanding the modifiable risk factors and pathophysiology allows us to discuss potential preventative strategies.
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J. Neurol. Neurosurg. Psychiatr. · Apr 2016
Review Meta AnalysisTranscranial direct current stimulation facilitates motor learning post-stroke: a systematic review and meta-analysis.
Transcranial direct current stimulation (tDCS) is an attractive protocol for stroke motor recovery. The current systematic review and meta-analysis investigated the effects of tDCS on motor learning post-stroke. ⋯ A random effects model meta-analysis showed a significant overall effect size=0.59 (p<0.0001; low heterogeneity, T(2)=0.04; I(2)=22.75%; and high classic fail-safe N=240). 4 moderator variable analyses revealed beneficial effects of tDCS on long-term motor learning: (1) stimulation protocols: anodal on the ipsilesional hemisphere, cathodal on the contralesional hemisphere, or bilateral; (2) recovery stage: subacute or chronic stroke; (3) stimulation timing: tDCS before or during motor practise; and (4) task-specific training or conventional rehabilitation protocols. This robust meta-analysis identified novel long-term motor learning effects with tDCS and motor practise post-stroke.
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J. Neurol. Neurosurg. Psychiatr. · Apr 2016
Review Meta AnalysisAssociation of the APOE-ε4 allele with outcome of traumatic brain injury in children and youth: a meta-analysis and meta-regression.
To disentangle the temporal relationship between the APOE-ε4 allele and outcomes of paediatric traumatic brain injury (TBI). ⋯ This meta-analysis provides cumulative evidence that the APOE-ε4 allele is important to the prognosis of paediatric TBI, but may have a different effect compared with adult TBI; moreover, this effect may be time dependent.
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J. Neurol. Neurosurg. Psychiatr. · Apr 2016
Review Meta AnalysisSun exposure is an environmental factor for the development of blepharospasm.
Adult-onset isolated focal dystonia may present with various phenotypes including blepharospasm and cervical dystonia. Although inherited in an autosomal dominant manner with a markedly reduced penetrance, environmental factors are considered important in disease penetrance and expression. We observed a marked variation by latitude in the reports of the frequency of patients with blepharospasm relative to those with cervical dystonia; we hypothesised that sun exposure is an environmental risk factor for the development of blepharospasm in genetically susceptible individuals. ⋯ The increase in the blepharospasm: cervical dystonia case ratio with decreasing latitude and increasing insolation suggests that sunlight exposure is an environmental risk factor for the development of blepharospasm (rather than cervical dystonia) in individuals genetically susceptible to adult-onset dystonia.
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J. Neurol. Neurosurg. Psychiatr. · Apr 2016
A second chance-reoperation in patients with failed surgery for intractable epilepsy: long-term outcome, neuropsychology and complications.
Resective surgery is a safe and effective treatment of drug-resistant epilepsy. If surgery has failed reoperation after careful re-evaluation may be a reasonable option. This study was to summarise the risks and benefits of reoperation in patients with epilepsy. ⋯ Reoperation after failed resective epilepsy surgery led to approximately 70% long-time seizure freedom and reasonable neuropsychological outcome. There is an increased risk of permanent postoperative neurological deficits, which should be taken into consideration when counselling for reoperation.