Neurology
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Randomized Controlled Trial Multicenter Study Clinical Trial
Repeated dosing of botulinum toxin type A for upper limb spasticity following stroke.
The authors evaluated the long-term efficacy and safety of botulinum toxin type A (BTX-A) in poststroke spasticity patients who completed a 12-week placebo-controlled study and received multiple open-label treatments with 200 to 240 U BTX-A for 42 weeks. Significant and sustained improvements were observed for Disability Assessment and Ashworth scores. Adverse events were generally mild. This extension of a double-blind study demonstrates that repeated treatments of BTX-A significantly improve function and tone in spasticity.
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The incidence of new-onset epilepsy is higher among the elderly, the most rapidly growing segment of the population, than in any other age group. New-onset seizures in elderly patients are typically cryptogenic or symptomatic partial seizures that require long-term treatment. Because seizures in the elderly are often readily controlled, considerations of tolerability and safety, including pharmacokinetics and the potential for drug interactions, may be as important as efficacy in the selection of an antiepileptic drug (AED). ⋯ Among the newer AEDs, gabapentin and levetiracetam have good safety and cognitive effect profiles and do not interact with other drugs, and lamotrigine offers many of the same benefits. Oxcarbazepine has better tolerability than carbamazepine, and topiramate and zonisamide, although they have more cognitive side effects than the other new AEDs, can be considered for some elderly patients. Forthcoming data from the Veterans Affairs Cooperative Trial 428, as well as recent guidelines from the American Academy of Neurology and the American Epilepsy Society, are likely to provide support for the use of selected second-generation AEDs as first-line agents for the treatment of epilepsy in elderly patients.
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To examine the association between diabetes in midlife (1963-1968) and dementia more than three decades later (1999-2001). ⋯ Evidence for diabetes as a risk factor for dementia was found, similar to other epidemiologic studies. In contrast to the earlier studies, however, the authors linked diabetes in midlife to dementia more than three decades later in the very old survivors of a large male cohort.
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Thirty patients with a typical orthostatic headache were treated by early lumbar epidural blood patch (EBP) without previously performing lumbar puncture or identifying a CSF leak and with or without typical MRI changes. A complete cure was obtained in 77% of patients after one (57%) or two (20%) EBPs. Spontaneous intracranial hypotension with typical orthostatic headache can be diagnosed without lumbar puncture and can be cured by early EBP in a majority of patients.