Current opinion in neurology
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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.
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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.
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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.
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Documentation of disease impact, both on the individual and on society, is vital to ensure that healthcare resources are distributed according to the relative importance of the different disorders. For headache, international initiatives now promote the cause of headache sufferers by documenting the prevalence, burden, and cost. The present review aims to give an update on studies on these aspects of headache that have appeared since 2004. ⋯ Robust and increasing evidence suggests that headache should be taken seriously as a public health problem, not only in the rich countries. More studies on the impact of non-migrainous headaches, largely of the tension type, are urgently needed for a full evaluation of the consequences of headache disorders.
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Only two functionally validated susceptibility genes, CACNA1H and GABRD, have so far been identified in the common epilepsies using a candidate gene approach. The difficulty with the alternative statistical approach, where none of the suggested candidates has been functionally validated, may partly be due to the posited genetic architecture of the common epilepsies, such as the idiopathic generalized epilepsies. A subset of both rare and common variants from a much larger pool of susceptibility genes may contribute to disease risk. We review methods and designs for the genetic dissection of common epilepsies. ⋯ We conclude by emphasizing the importance of deeper endophenotyping using electroclinical, imaging, and molecular approaches to dissect the common epilepsies.