Current opinion in neurology
-
Curr. Opin. Neurol. · Apr 2007
ReviewThe use of SPECT and PET in routine clinical practice in epilepsy.
The aim of this article is to give a subjective review of the usefulness of single photon emission computed tomography (SPECT) and positron emission tomography (PET) imaging in clinical practice in epilepsy for 2007. ⋯ Optimized interictal FDG-PET and ictal perfusion SPECT as part of a multimodality imaging platform will be important tools to better understand the neurobiology of epilepsy and to better define the epileptogenic, ictal onset, functional deficit and surround inhibition zones in refractory partial epilepsy.
-
Curr. Opin. Neurol. · Apr 2007
ReviewNew potential leads in the biology and treatment of attention deficit-hyperactivity disorder.
This review highlights recent neuroimaging and genetic studies of attention deficit-hyperactivity disorder that may inform biologically targeted interventions and treatments. ⋯ Identification of which cognitive and neural processes are altered in attention deficit-hyperactivity disorder and acknowledgement of different casuses of the condition will lead to more individualized, biologically targeted interventions and treatments. This new direction in research and treatment has occurred as the result of a shift from diagnosis as a phenotype, to refined phenotypes of core cognitive deficits that can be more easily tied to the underlying biology.
-
Curr. Opin. Neurol. · Feb 2007
ReviewStroke and the statistics of the aspirin/clopidogrel secondary prevention trials.
Four randomized trials have investigated the combination of clopidogrel plus aspirin for secondary prevention of vascular outcomes in 54,949 patients. Here we argue that attempts to translate the results of these trials into clinical practice have proven frustrating because of the following statistical considerations: differences in study populations and study design make comparisons difficult (comparisons of 'apples and oranges'), incomplete factorial designs prevent proper contrasts (examining 'bits and pieces' of a larger picture), results concern widely different vascular diseases ('puzzling subgroups'), and negative results are easily misinterpreted. ⋯ Even after four large randomized trials we still do not know the optimal treatment for secondary prevention of stroke. We suggest that subsequent trials should focus on a particular vascular disease and test hypotheses that relate to a specific mechanism.
-
The health and socioeconomic impacts of dementia with Lewy bodies and dementia associated with Parkinson's disease have become increasingly recognized. Whilst the nosological status of dementia with Lewy bodies has been better classified as 'Lewy body dementias', both conditions are now believed to represent a disease spectrum, characterized pathologically by synuclein protein and clinically by a variable admixture of cognitive, neuropsychiatric and extrapyramidal features. ⋯ The pathology underlying dementia with Lewy bodies and Parkinson's disease is heterogeneous, and is neither stereotyped in its topography nor its composition. Cholinesterase inhibitor drugs improve cognition and neuropsychiatric symptoms but the clinical response is unpredictable. Major future challenges are to better understand the pathophysiological basis underpinning the diseases, what determines clinical phenotypic expression and how disease-modifying therapies may best be developed and deployed.
-
Curr. Opin. Neurol. · Dec 2006
ReviewDisorders of speech and language: aphasia, apraxia and dysarthria.
We review recent important papers pertaining to acquired aphasia, apraxia of speech and dysarthria with special attention to clinically significant work published in the last 12 months. ⋯ Recent studies of aphasia provide clues regarding language recovery poststroke, but further studies of the role of the ipsi and contralateral inferior frontal gyrus are necessary, and should be longitudinal. There are relatively few recent studies on the treatment of acquired disorders of speech and language, other than poststroke aphasia.