Journal of neurology, neurosurgery, and psychiatry
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Migraine with aura (MA) arises from a combination of genetic and environmental factors. The sibling risk, age at onset, and aura type were compared in 54 MA probands categorised by family history of MA. Three family types were ascertained each having an MA proband and: (1) an MA parent and MA offspring (three generation; n=15), (2) either an MA parent or an MA offspring (two generation; n=20), and (3) neither an MA parent nor an MA offspring (one generation; n=19). ⋯ The MA probands from three generation families were significantly younger than probands from the one generation families (F=5.14, p=0.030). MA probands from three generation families were more likely to report more than one type of aura than MA probands from two generation families (chi(2)=4.44, p=0.035). The significant difference in genetic loading and the earlier age at onset in the three generation families add further evidence for a genetic basis for MA and the difference in sibling risks demonstrates that the MA population is heterogeneous.
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J. Neurol. Neurosurg. Psychiatr. · Aug 2003
Features involved in the diagnostic delay of cluster headache.
Cluster headache (CH) is a comparatively rare, very severe primary headache. Although circumscript and recognisable criteria are available, the diagnosis is often missed or delayed. Besides, while adequate and evidence based treatment is available in diagnosed cases, CH seems to be poorly managed. The authors performed a nationwide survey among CH patients, and looked for factors involved in the diagnostic delay. ⋯ CH remains unrecognised or misdiagnosed in many cases for many years. Photophobia or phonophobia and nausea were in part responsible for this delay, and should be recognised as part of the clinical spectrum of CH. Many patients were first seen by a dentist or ENT specialist for their CH episodes, so more attention should be paid to educate first line physicians to recognise CH, to improve the diagnostic process and so to expose patients to earlier and better treatment of CH.
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J. Neurol. Neurosurg. Psychiatr. · Aug 2003
Hemisensory syndrome is associated with a low diagnostic yield and a nearly uniform benign prognosis.
To describe the diagnostic yield and prognosis for patients with hemisensory syndrome. ⋯ Diagnostic yield in hemisensory syndrome is low, and prognosis is almost always uniformly benign. The author advocates careful assessment of medical history and consideration for neuroimaging in this group of patients.
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J. Neurol. Neurosurg. Psychiatr. · Aug 2003
Predictors of successful self control during brain-computer communication.
Direct brain-computer communication uses self regulation of brain potentials to select letters, words, or symbols from a computer menu to re-establish communication in severely paralysed patients. However, not all healthy subjects, or all paralysed patients acquire the skill to self regulate their brain potentials, and predictors of successful learning have not been found yet. Predictors are particularly important, because only successful self regulation will in the end lead to efficient brain-computer communication. This study investigates the question whether initial performance in the self regulation of slow cortical potentials of the brain (SCPs) may be positively correlated to later performance and could thus be used as a predictor. ⋯ Initial performance in the self regulation of SCP is positively correlated with later performance in severely paralysed patients, and thus represents a useful predictor for efficient brain-computer communication.
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J. Neurol. Neurosurg. Psychiatr. · Aug 2003
Identification of target areas for deep brain stimulation in human basal ganglia substructures based on median nerve sensory evoked potential criteria.
In the interventional treatment of movement disorders, the thalamic ventral intermediate nucleus (VIM) and the subthalamic nucleus (STN) are the most relevant electrode targets for deep brain stimulation (DBS). This study tested the value of somatosensory evoked potentials (SEP) for the functional identification of VIM and STN. ⋯ Based on SEP criteria, the VIM target but not the STN region can be identified by typical SEP configuration changes, when penetrating the target zone. The approach is independent of the patient's cooperation and vigilance and therefore feasible in general anaesthesia. It provides an easy, reliable, and robust tool for the final assessment of electrode positions at the last instance during electrode implantation when eventual electrode revisions can easily be performed.