Neurología : publicación oficial de la Sociedad Española de Neurología
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The professional activity of the Spanish neurologists require an analysis because their current situation and future perspectives need some transformations. ⋯ Ambulatory neurological assistance and neurological training (undergraduate and postgraduate and of the family physician) are the main professional aspects that require substantial improvement for the progress of the speciality.
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The prognosis for patients with malignant brain tumors has always been poor and until recently chemotherapy had not shown to be very effective. Temozolomide is a novel second-generation alkylating agent that has shown efficacy for the treatment of high-grade gliomas. ⋯ The benefit of temozolomide is greatest in patients with tumors that have a methylated 06-methyl-guanine DNA methyl transferase gene promoter that results in decreased repair of temozolomide-induced DNA damage. This chapter will briefly review the diagnosis and treatment of patients with malignant brain tumors and then will focus on the role of temozolomide in glioma therapy.
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All pharmacological treatment is surrounded by a psychosocial context that contributes in part to the outcome of the therapy. The placebo effect is the improvement observed after a simulated treatment in which the subject, without his or her knowledge, is exposed only to the psychosocial context surrounding the treatment, without receiving the pure "pharmacodynamic" effect of the medication. The aim of this paper is to examine which brain regions and neurochemical mechanisms are responsible for the analgesia resulting from the placebo. ⋯ In placebo analgesia at least two anatomically differentiated cerebral systems work together. The guiding mechanism, which appears to be located prefrontally, is activated first. This system would influence other cortical regions (cingulate and insula), attenuating the processing of nociceptive information at these higher levels.
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Both single photon emission computed tomography (SPECT) and positron emission tomography (PET) are helpful in the practice of neurology. Ictal SPECT is useful to determine the origin of focal seizures in the pre-surgical evaluation. ⋯ Given its higher resolution and some other factors, PET is more useful in the evaluation of brain tumors, dementia and the parkinsonian syndromes. It is also useful in the presurgical evaluation of epilepsy.
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Multiple sclerosis is the most important disabling neurological disease in young adulthood in our environment. However, its etiology remains unknown. It has been proposed that multiple sclerosis is caused by an interaction of genetic and environmental factors. In particular, Epstein-Barr virus infection could play a fundamental role in the pathophysiology of multiple sclerosis. ⋯ Based on the published evidence, Epstein-Barr virus infection can be considered to have a causal role in the etiology of multiple sclerosis. Further research should be conducted to elucidate the mechanisms underlying this association and to assess its potential for multiple sclerosis prevention and treatment.