Current opinion in neurology
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Ablative surgery and deep brain stimulation for Parkinson's disease can be performed in the thalamus, the pallidum and the subthalamic nucleus. The efficacy and safety of unilateral pallidotomy is well established. Deep brain stimulation has a lower morbidity and is preferred for bilateral surgery. The subthalamic nucleus presently seems to be the most promising target in advanced stage Parkinson's disease.
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Conventional magnetic resonance imaging (MRI) techniques acquire signal mainly from differences in relaxation properties and density of free water protons. Thus, the sensitivity in depicting lesions is high but pathological specificity is poor. Efforts are being made to increase the diagnostic power of MRI; better correlation with the clinical presentation and the use of better MRI criteria have increased the specificity of the conventional T2 sequences. ⋯ The basic aspects of the pathological lesions in multiple sclerosis such as oedema, membrane disruption, demyelination, gliosis, cellular infiltration and axonal loss, can be studied more precisely by the new magnetic resonance techniques, which should better describe the actual clinical impact of the destructive process. In the past year the importance of axonal loss has simultaneously been confirmed by magnetic resonance spectroscopy and pathological findings. However, magnetization transfer imaging, magnetic resonance diffusion imaging and functional MRI are under intensive investigation for a better analysis of these different factors that impact on the reversibility of the patients disability.
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Curr. Opin. Neurol. · Jun 1998
ReviewBrain excitability in migraine: evidence from transcranial magnetic stimulation studies.
Central neuronal hyperexcitability is proposed to be the putative basis for the physiologic disturbances in migraine. Because there are no structural disturbances in migraine, only physiologic studies can provide insight into the underlying mechanisms. Recently, transcranial magnetic stimulation has been developed as a valuable research tool and can be used to study brain function noninvasively. This article is a review of the studies done in migraine using transcranial magnetic stimulation.
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Management of pain after spinal cord injury remains a difficult clinical problem. In particular, neuropathic spinal cord injury pain, like other forms of deafferentation pain in which there is loss or modification of normal afferent sensory inputs, is notoriously resistant to currently available modes of treatment. Although there have been some advances in our understanding of spinal cord injury pain, the mechanisms of neuropathic spinal cord injury pain remain largely unknown and treatment is often ineffective. This review presents findings from recent publications that deal with the mechanisms and management of spinal cord injury pain.
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Curr. Opin. Neurol. · Oct 1995
ReviewDiscordance between phenotype and genotype in malignant hyperthermia.
Eight mutations in the ryanodine receptor gene on human chromosome 19q13.1 have been linked to malignant hyperthermia. Although 50% of malignant hyperthermia families are not linked to the ryanodine receptor gene, only single malignant hyperthermia families have been linked to alternative loci on chromosome 7q21-22 and on chromosome 3q13.1. Problems in malignant hyperthermia linkage studies may arise from the inadequacy of the caffeine halothane contractures test for phenotypic diagnosis of malignant hyperthermia.