Seminars in neurology
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Primary headache disorders encompass a heterogeneous group of neurologic disorders that cause recurrent or persistent head pain without any clear underlying cause. The epidemiology of the most common primary headache disorders, tension-type headache and migraine, the most common trigeminal autonomic cephalalgia, cluster headache, as well as chronic daily headache are addressed in this review. The incidence, prevalence, burden, and comorbidities of these disorders are discussed, and the risk factors for progression from episodic to chronic daily headache are also reviewed.
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Sleep disturbances are common in neurodegenerative diseases. Disturbed sleep can result in fatigue, irritability, morning headaches, impaired motor and cognitive skills, depression, and daytime somnolence. The major sleep complaints include insomnia, hypersomnia, parasomnia, excessive nocturnal motor activity, circadian sleep-wake rhythm disturbance, and respiratory dysrhythmia. ⋯ Overnight polysomnography (PSG), Multiple Sleep Latency Test, Maintenance of Wakefulness Test, and actigraphy are some important diagnostic laboratory tests in the evaluation of sleep disturbances. Management of sleep disturbances is complex and is based primarily on the nature of the sleep disturbance. The clinical profiles, pathogenetic mechanisms, PSG findings, and management issues are discussed here with reference to some common neurodegenerative diseases.
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Sleep disorders in patients with neuromuscular disease are common, but underrecognized by health care providers, and sometimes by patients themselves. Their symptoms may be confused with those of the underlying disease. Their recognition is an important part of the management of patients with neuromuscular disorders, improving quality of life, and sometimes increasing survival. ⋯ Involvement of the central or peripheral nervous system, or both, may disrupt sleep, with the relative contribution of each depending on the specific disorder. The pertinent anatomy, physiology, and clinical features of sleep disorders in neuromuscular diseases and a basic approach to their assessment is discussed. Specific neuromuscular disorders in which sleep is commonly affected are reviewed and the principles of management of sleep disorders summarized.
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Seminars in neurology · Jul 2009
Review Historical ArticlePsychiatric neurosurgery 2009: review and perspective.
In the treatment of psychiatric disorders, modern lesion procedures and nonablative deep brain stimulation (DBS) offer a degree of hope for patients who remain severely ill and impaired despite pharmacological and behavioral treatments. The available data support the therapeutic promise of these procedures, primarily for those suffering with obsessive-compulsive disorder (OCD) or major depressive disorder (MDD). ⋯ The data also show that psychiatric neurosurgical procedures can be implemented most successfully by dedicated interdisciplinary teams in the context of a multimodal treatment plan. Treatment using these procedures is further complicated by issues involving the criteria for patient selection, the long-term management of patients receiving psychiatric neurosurgery, and the different patterns of potential clinical benefits and burdens presented by DBS and contemporary lesion procedures.
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In this article, isolated palsies of cranial nerves III, IV, and VI are addressed. After discussion of the pertinent clinical anatomy of cranial nerves III, IV, and VI, the isolated involvement of each of these oculomotor nerves is defined. Based on a review of the literature, methods of evaluation and follow-up of patients presenting with diplopia from lesions of these cranial nerves are presented.