Neurology
-
Randomized Controlled Trial Comparative Study
Blepharospasm and the modulation of cortical excitability in primary and secondary motor areas.
Traditionally, benign essential blepharospasm (BEB) is considered a disorder caused by basal ganglia dysfunction. Electrophysiologic and brain imaging studies suggest pathologic changes in excitability in the primary motor cortex (MC), anterior cingulate (AC), and secondary motor areas, such as premotor (PMC) and supplementary motor cortices (SMA). ⋯ Electrophysiologic and clinical improvements by functional inhibition of the medial frontal areas using low-frequency repetitive transcranial magnetic stimulation suggests that hypersensitivity of the anterior cingulate is directly or indirectly involved in the pathophysiology of benign essential blepharospasm. Inhibition of these areas using low-frequency repetitive transcranial magnetic stimulation could provide a therapeutic tool and is worthy of a larger study.
-
Randomized Controlled Trial Comparative Study Controlled Clinical Trial
A reassessment of the plateauing relationship between T2 lesion load and disability in MS.
A recent cross-sectional study has shown a plateauing relationship between T2 lesion volume (T2LV) and disability in patients with multiple sclerosis (MS). In this analysis, which also included longitudinal observations, we investigated whether such a relationship is a consequence of the decreased frequency of "inflammatory" events occurring in more disabled patients, rather than reflecting their disability status. ⋯ We showed that the plateauing relationship between T2 lesion volume and disability in multiple sclerosis is not always present and is likely due to the reduced frequency of "inflammatory" events in the most common form of secondary progressive multiple sclerosis.
-
Randomized Controlled Trial
Randomized, controlled trial of telcagepant for the acute treatment of migraine.
The neuropeptide calcitonin gene-related peptide (CGRP) plays a key role in migraine pathophysiology. In this large phase 3 clinical trial, we sought to confirm the efficacy of telcagepant, the first orally bioavailable CGRP receptor antagonist. ⋯ This study confirmed previous findings that telcagepant 300 mg was effective at relieving pain and other migraine symptoms at 2 hours and providing sustained pain freedom up to 24 hours. In this study, telcagepant 150 mg was also effective. Telcagepant was generally well tolerated.
-
Randomized Controlled Trial Comparative Study
Migraine frequency and risk of cardiovascular disease in women.
Migraine has been associated with risk of cardiovascular disease (CVD). Data on the association between migraine frequency and CVD are sparse. ⋯ In our data, the association between migraine and cardiovascular disease varies by migraine frequency. Significant associations were only found among women with migraine with aura. Ischemic stroke was the only outcome associated with a high-attack frequency while a low-attack frequency was associated with any vascular event. Low number of outcome events should caution the interpretation.
-
Randomized Controlled Trial
Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS): A single-center RCT.
Constraint-induced movement therapy (CIMT) is among the most developed training approaches for motor restoration of the upper extremity (UE). ⋯ Constraint-induced movement therapy (CIMT) was equally as effective but not superior to an equal dose of traditional therapy during inpatient stroke rehabilitation. Higher intensity CIMT resulted in less motor improvement at 90 days, indicating an inverse dose-response relationship. Motor intervention trials should control for dose, and higher doses of motor training cannot be assumed to be more beneficial, particularly early after stroke.