Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Mar 2017
Awake versus asleep deep brain stimulation for Parkinson's disease: a critical comparison and meta-analysis.
No definitive comparative studies of the efficacy of 'awake' deep brain stimulation (DBS) for Parkinson's disease (PD) under local or general anaesthesia exist, and there remains significant debate within the field regarding differences in outcomes between these two techniques. ⋯ Our meta-analysis demonstrates that while DBS under general anaesthesia may lead to lower complication rates overall, awake DBS may lead to less treatment-induced side effects. Nevertheless, there were no significant differences in clinical motor outcomes between the two techniques. Thus, DBS under general anaesthesia can be considered at experienced centres in patients who are not candidates for traditional awake DBS or prefer the asleep alternative.
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J. Neurol. Neurosurg. Psychiatr. · Mar 2017
Review Meta AnalysisMeta-analysis of timing of endovascular aneurysm treatment in subarachnoid haemorrhage: inconsistent results of early treatment within 1 day.
To systematically review and meta-analyse the data on impact of timing of endovascular treatment in aneurysmal subarachnoid haemorrhage (SAH) to determine if earlier treatment is associated with improved clinical outcomes and reduced case fatality. ⋯ In only 1 of the analyses was there a statistically significant result, which favoured treatment <1 day. The inconsistent results and heterogeneity within most analyses highlight the lack of evidence for best timing of endovascular treatment in SAH patients.
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J. Neurol. Neurosurg. Psychiatr. · Mar 2017
ReviewZika virus infection and Guillain-Barré syndrome: a review focused on clinical and electrophysiological subtypes.
In 2016, we have seen a rapid emergence of Zika virus-associated Guillain-Barré syndrome (GBS) since its first description in a French-Polynesian patient in 2014. Current evidence estimates the incidence of GBS at 24 cases per 100 000 persons infected by Zika virus. ⋯ In this review, we evaluate the existing literature on GBS in association with Zika and other flavivirus to better define its clinical subtypes and electrophysiological characteristics, demonstrating a demyelinating subtype of GBS in most cases. We also recommend measures that will help reduce the gaps in knowledge that currently exist.
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J. Neurol. Neurosurg. Psychiatr. · Mar 2017
Randomized Controlled TrialCognitive outcome after ventral capsule/ventral striatum stimulation for treatment-resistant major depression.
We report the neuropsychological outcome of 25 patients with treatment-resistant major depressive disorder (TRD) who participated in an Institutional Review Board (IRB)-approved randomised double-blind trial comparing active to sham deep brain stimulation (DBS) in the anterior limb of the ventral capsule/ventral striatum (VC/VS). ⋯ These data suggest that VC/VS DBS in patients with TRD does not significantly affect neuropsychological function. Age at surgery, regardless of stimulation status, may be related to cognitive outcome at the individual patient level.
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J. Neurol. Neurosurg. Psychiatr. · Mar 2017
Randomized Controlled TrialPhase II randomised controlled trial of a 6-month self-managed community exercise programme for people with Parkinson's disease.
Evidence for longer term exercise delivery for people with Parkinson's disease (PwP) is deficient. ⋯ PwP exercised safely and the possible long-term benefits observed support a substantive evaluation of this community programme.