Neurology
-
Medical therapy is the mainstay for epilepsy, with most patients well controlled on a single antiepileptic drug (AED). In this non-refractory group, many patients have medication side effects and occasional seizures. Approximately 30% of patients with partial epilepsy and 25% of patients with generalized epilepsy are not well controlled on medications. ⋯ A meta-analysis of the second-generation AEDs used as adjunctive therapies shows that 12% to 29% of patients had a 50% or greater reduction in seizure frequency. Surgery and the vagus nerve stimulator provide important therapeutic options in patients whose seizures are not controlled by AEDs. Special considerations about epilepsy care must be made in pediatric populations, those with developmental delays, women, and the elderly.
-
Preclinical studies have increased our understanding of the pathophysiology of neuropathic pain at the anatomic, cellular, and molecular levels. These lines of investigation have enabled more logical uses of older therapies for neuropathic pain and have contributed to our understanding of the potential mechanisms underlying the efficacy of newer remedies. ⋯ This review focuses on the central and peripheral nervous system changes believed to be important in the initiation and perpetuation of neuropathic pain. Currently used medications, as well as medications that are on the horizon, are highlighted.