Brain : a journal of neurology
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Randomized Controlled Trial Clinical Trial
Intravenous immunoglobulin therapy in multifocal motor neuropathy: a double-blind, placebo-controlled study.
We conducted a double-blind, placebo-controlled, study of 19 patients fulfilling eligibility criteria for multifocal motor neuropathy with persistent conduction block. They were enrolled and divided into two groups: those who had never been treated previously with intravenous immunoglobulins (IVIg) (Group 1: 10 patients) and those who presented recurrent symptoms after previously successful treatment with IVIg (Group 2: nine patients). They were randomized prospectively to receive either IVIg or placebo at a dose of 500 mg/kg/day for 5 consecutive days, once a month for 3 months. ⋯ IgM anti-GM1 titres did not change significantly in patients treated with IVIg compared with those who received placebo, between baseline, month 4 and month 7. However, of five patients who had significantly high anti-GM1 titres (>3200) at baseline, four responded to IVIg. This trial confirms that IVIg is a promising therapeutic option for multifocal motor neuropathy.
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The subthalamic nucleus (STN) currently is considered to play a key role in the pathophysiological origin of the parkinsonian state and is therefore the main target for surgical treatment of Parkinson's disease. The authors review the incidence of hemichorea/ballism (HCB) as a complication of thalamotomy, pallidotomy or campotomy procedures before the introduction of levodopa therapy, including the few reported cases accompanied by a neuropathological study. The literature shows that only a small number of parkinsonian patients with HCB had a lesion of the STN. ⋯ Lesioning of the STN reduces excitation of the GPm, and theoretically this should induce dyskinesias. However, an STN lesion also, simultaneously, further reduces the hypoactivity in the globus pallidus lateralis (GPl) that is a feature of Parkinson's disease, and hence may compensate for GPm hypoactivity, thus self-stabilizing basal ganglia output activity and reducing the risk of HCB. We conclude that lesioning of the STN in Parkinson's disease is a feasible approach in some circumstances.
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Clinical Trial Controlled Clinical Trial
Extrahippocampal temporal lobe atrophy in temporal lobe epilepsy and mesial temporal sclerosis.
Visual inspection and volumetric analysis of MRIs allow mesial temporal sclerosis (MTS) to be reliably identified in patients with temporal lobe epilepsy. The presence of unilateral MTS ipsilateral to the side of habitual seizure onset is an indicator for the prognosis of good outcome after temporal lobe resection. There is evidence to suggest that widespread temporal lobe pathology, leading to atrophy, may be associated with MTS and such abnormal tissue may play an important role in epileptogenesis. ⋯ There was no correlation between the degree of atrophy in the extrahippocampal structures and the duration of epilepsy, a history of febrile convulsions or of generalized seizures. These findings suggest that there may be widespread pathological abnormalities in the temporal lobe associated with MTS. The importance of extrahippocampal atrophy to surgical outcome and whether it occurs in temporal lobe epilepsy not associated with MTS remain to be investigated.