Current opinion in neurology
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Curr. Opin. Neurol. · Dec 2007
ReviewRecovery and treatment of aphasia after stroke: functional imaging studies.
In this review of papers published between May 2006 and May 2007, we discuss functional neuroimaging studies of recovery and treatment of patients with aphasia after stroke. ⋯ Recent studies of aphasia recovery allow a deeper appreciation of the changing neuronal activation patterns associated with time after stroke. The distinction between neuronal reorganization that does and does not sustain recovery in the chronic phase after stroke, either spontaneous or in response to treatment, remains controversial and further studies are necessary. Clinical diagnosis and treatment of aphasia requires many more longitudinal studies with larger patient numbers and more detailed behavioural and lesion characterization of stroke patients.
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Patients in a vegetative or minimally conscious state continue to pose problems in terms of diagnosis, prognosis and treatment. Despite recent waves of international media attention following Terri Schiavo's death and the 'miracle recovery' of Terry Wallis, research efforts aimed at increasing our knowledge about brain function in these conditions remain scarce and must address a series of difficulties, including financial and ethical barriers. Here we review current possibilities and limitations of clinical and para-clinical assessment of chronic disorders of consciousness. ⋯ Consciousness is a subjective experience whose study has remained within the purview of philosophy for millennia. That has finally changed, and empirical evidence from functional neuroimaging offers a genuine glimpse at a solution to the infamous mind-body conundrum. New technological and scientific advances offer the neurological community unique ways to improve our understanding and management of vegetative and minimally conscious patients.
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With the aging of the population, treatment of painful neuropathies is becoming more and more important for neurological practice. This short review highlights recent findings and current problems. ⋯ A large variety of drugs are being tried in the treatment of painful neuropathy. Neurologists now have a wide choice. Recent publications can help in choosing the best treatment course.
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Developments in imaging following traumatic brain injury are outlined. Numerous techniques have evolved over the past several years giving us more information about the injury and prognosis for recovery. Some of these techniques are in clinical use while others are used primarily in research but have the potential to become clinically useful. ⋯ CT and MRI are now the imaging techniques for acute and subacute brain injury, respectively. Diffusion tensor imaging is being developed to provide more information on structural damage in brain injury. There are several research techniques available for brain injury, particularly relating to cerebral blood flow and metabolism.
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Here we discuss recent advances regarding the molecular genetic basis of dominantly inherited ataxias. ⋯ The dominant ataxias, also known as spinocerebellar ataxias, continue to grow in number. Here we review the major categories of spinocerebellar ataxias: expanded polyglutamine ataxias; noncoding repeat ataxias; and ataxias caused by conventional mutations. After discussing features shared by these disorders, we present recent evidence supporting a toxic protein mechanism for the polyglutamine spinocerebellar ataxias and the recognition that both protein misfolding and perturbations in nuclear events represent key events in pathogenesis. Less is known about pathogenic mechanisms in spinocerebellar ataxias due to noncoding repeats, though a toxic RNA effect remains possible. Newly discovered, conventional mutations in spinocerebellar ataxias suggest a wide range of biological pathways can be disrupted to cause progressive ataxia. Finally, we discuss how new mechanistic insights can drive the push toward preventive treatment.