Neurology
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Phenytoin (PHT) is widely used to treat epilepsy in elderly patients, but information on its pharmacokinetics in this population is limited. ⋯ Healthy elderly adults appear to have the same phenytoin (PHT) pharmacokinetics as younger adults. Reduced PHT dosage requirements may be due to age-related changes in patients' sensitivity to the therapeutic and toxic effects of the drug. The prolonged elimination half-life suggests that most patients can take PHT once daily and the time to reach steady-state may extend to 2-3 weeks.
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Clinical practice guidelines (CPGs) shape clinical care worldwide but are prone to potential error and bias due to conflicts of interest (COI). ⋯ Conflicts of interest are common for authors of American Academy of Neurology clinical practice guidelines across many domains of personal and professional interests. More research is needed to improve the methods to identify and quantify the types of conflicts and their potential biasing effects on selecting guideline topics, grading research evidence, and formulating practice recommendations.
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Review Meta Analysis
Motor cortex stimulation for chronic pain: systematic review and meta-analysis of the literature.
To conduct a systematic review and meta-analysis to quantify the efficacy of invasive and noninvasive brain stimulation for the treatment of chronic pain. ⋯ This meta-analysis shows that two different techniques of brain stimulation of motor cortex--invasive and noninvasive--can exert a significant effect on pain in patients with chronic pain. We discuss potential reasons that invasive brain stimulation showed a larger effect in this meta-analysis. Our findings encourage continuation of research in this area and highlight the need for well-designed clinical trials to define the role of brain stimulation in pain management.
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Randomized Controlled Trial Multicenter Study
Controlled trial of high-concentration capsaicin patch for treatment of painful HIV neuropathy.
HIV-associated distal sensory polyneuropathy (HIV-DSP) is a painful condition with limited effective treatment. Capsaicin desensitizes cutaneous nociceptors resulting in reduced pain. We report a placebo-controlled study of a high-concentration capsaicin dermal patch (NGX-4010) for the treatment of painful HIV-DSP. ⋯ A single NGX-4010 application was safe and provided at least 12 weeks of pain reduction in patients with HIV-associated distal sensory polyneuropathy. These results suggest that NGX-4010 could provide a promising new treatment for painful HIV neuropathy.
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Half of the adults in the United States use complementary and alternative medicine with mind-body therapy being the most commonly used form. Neurology patients often turn to their physicians for insight into the effectiveness of the therapies and resources to integrate them into their care. The objective of this article is to give a clinical overview of mind-body interventions and their applications in neurology. ⋯ There are several conditions where the evidence for mind-body therapies is quite strong such as migraine headache. Mind-body therapies for other neurology applications have limited evidence due mostly to small clinical trials and inadequate control groups.