Ideggyogy Szemle
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Controlling pain has always been one of the biggest challenges of medical science. Despite pharmacological developments, still many patients suffer from long-lasting pain. During the last 40 years several surgical interventions have been used to modulate the activity of the central nervous system in order to control chronic, pharmacoresistant pain. ⋯ In the 90's new techniques of non-invasive brain stimulation have been introduced that enable the facilitation or inhibition of distinct cortical areas. These methods are based on the electrical stimulation of brain structures and to date they have been successfully used to modulate perceptual, cognitive and motor functions in healthy subjects and various diseases as well. In this review we describe such techniques of non-invasive brain stimulation, namely repeated transcranial magnetic stimulation and transcranial direct current stimulation and review the current literature about their efficacy in controlling acute and chronic pain.
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Based on our previous survey on the capacities of neurological services and on the predictable changes in the neurologist workforce in Hungary, we present a proposal for the organization of the structure of neurological services in the future. We discuss the diagnostic groups treated by neurologists, the neurological services and their progressive organization. Using the current capacities as baseline, we propose patient groups to be treated by neurologists in the future, and the levels of services. ⋯ In addition to the special outpatient units associated with university departments and regional/county hospitals, the general neurological outpatient services would be organized as private practices, similarly to the current system of general practitioners, where the individual practices contract independently with the health insurance fund. Their task would be a general neurological service offered 30 hours per week, and also basic, screening neurophysiological and neurosonological examinations, with proper equipment and trained assistance. A transformation in residency training and a change in financing is needed for this plan to fulfill.
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Prolonged EEG monitoring and video-EEG monitoring are basic methods on the level of epilepsy centers. These methods are able to make differences between epilepsy and non epileptic paroxysmal manifestations like psychogenic non epileptic seizures, parasomniac phenomena, narcolepsy. The application of the method, at least the video-EEG variant, needs team work, high level organisation, highly educated staff and high tech electrographic devices. Running the method even with these requirements is beneficial from the cost-benefit aspect as well.
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Review
[The role of neuronavigation in the assessment and surgical treatment of drug-resistant epilepsy].
For localizing the epileptogenic zone in cases of focal epilepsies detailed clinical investigations, imaging studies and electrophysiological methods are in use. In lesional epilepsies the intrapreoperative localization of the lesion and it's location to the eloquent cortex is essential for the neurosurgeon. ⋯ Neuronavigation brought changes in preoperative evaluation and in resective surgery in epilepsy as well. In this article we describe the basics of neuronavigation and enhance the advantages of the technique in epilepsy surgery during the presurgical evaluation with invasive electrodes, in resective surgery and DBS for epilepsy.
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The elevation of blood pressure above normal and premorbid values within the first 24 hours of symptom onset in patients with stroke is relatively common. This acute hypertensive response is usually managed by different group of physicians, including general practitioners, emergency physicians, neurologists, internists, intensivists. Management strategies of this phenomenon vary considerably. ⋯ However, in ischaemic stroke no treatment is recommended if systolic blood pressure <220 mmHg and/or diastolic blood pressure <120 mmHg in the acute stage. Clinical studies are rare which assess the effectiveness of different antihypertensive drugs in acute stroke. The first strong evidence came from the ACCESS (The Acute Candesartan Cilexetil Therapy in Stroke Survivors) trial which suggested that a 7-day course of candesartan after an acute ischaemic stroke significantly improves cardiovascular morbidity and mortality.