Rev Neurol France
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In recent years, advances in our understanding of the biology of low-grade gliomas (LGG) and high-grade gliomas (HGG) have driven new paradigms in molecular markers, diagnostic imaging, operative techniques and technologies, and adjuvant therapies. Taken together, these developments are collectively pushing the envelope towards improved quality of life and survival. Here, we review the recent literature to synthesize a comprehensive review of the value of extent of resection for LGGs and HGGs in the modern neurosurgical era.
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OMICS is the term used to designate new biological sciences investigating a large group of molecules in biological samples. For instance, genomics and transcriptomics study changes in genome and transcription expression respectively. Numerous others OMICS are emerging (e.g. epigen-, prote-, metabol-, lipid-, glucid-OMICS). Support from bioinformatics and biostatistics, together with new molecular biology technologies for screening these large molecular groups (i.e. high-throughput biological arrays), has led to the development of these scientific fields. They help to draw relevant molecular identity cards of tumors. ⋯ OMICS have a growing impact in neuro-oncology improving basic research in brain tumors and clinical management of patients through the discovery of biomarkers.
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Some data in the current medical literature suggests a link between medication overuse headache (MOH) and addictive behaviors. We present here a review of the clinical and biological data highlighting the role of addictive behaviors in MOH. ⋯ A pluridisciplinary approach is the only way to reduce the relapse rate which remains too high in MOH.
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Stroke can produce irreversible brain damage of massive proportion leading to severe disability and poor quality of life. Resuscitation and mechanical ventilation of these patients remain controversial because of the high mortality and severe disability involved. ⋯ Decisions for life-sustaining therapies in severe stroke are always difficult and often based on subjective and uncertain criteria. We have to improve prognosis estimation and our understanding of patient preferences to promote patient-centered care. An ethical approach may guide these complex decisions.
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Organ procurement practices are tending towards the use of older or more borderline donors. In the current context of steadily decreasing availability of traumatic donors, stroke victims make up the majority of donors. In France, where organ procurement activity has stabilized following a period of growth, the possibility of organ donation after a cerebral stroke is variable and uncertain. ⋯ This approach allows both support for end-of-life patients, and fulfillment of their wishes with regards to organ donation. It enables case-by-case decision-making, after relatives have agreed on transfer to the intensive care unit for organ removal. Thus, each hospital should institute a fully cooperative care procedure where all therapeutic possibilities are evaluated in order to enable the most appropriate therapeutic approach, and, if applicable, organ procurement.