Neurology
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Optimal treatment of epilepsy in adults requires a tailored approach that weighs the efficacy of individual drugs in the specific diagnosis against the patient's risks for adverse events. Partial seizures, which are the most common seizure type in adults, can be effectively controlled by virtually all the standard and newer antiepileptic drugs (AEDs). For the generalized epilepsies, valproate remains the drug of choice. ⋯ Monotherapy should be the goal when AED treatment is instituted for the adult with epilepsy. Dosage modification on the basis of seizure control and toxicity should be implemented, as well as single-drug trials with alternative AEDs, before resorting to polytherapy. With the introduction of several promising newer AEDs, safe and effective seizure control may become a reality for an increasing number of adults with epilepsy.
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Review
The functional role of tumor suppressor genes in gliomas: clues for future therapeutic strategies.
The ability to transfer exogenous genes to cancer cells has yielded a wealth of information about the neoplastic processes that occur at molecular and cellular levels. Current research focuses on defining the biochemical factors that govern the interplay between cell growth and cell death in gliomas. The identification of tumor suppressor genes has greatly enhanced our understanding of the molecular mechanism of brain tumors. ⋯ Moreover, recent advances linking tumor suppressor genes, apoptosis, and cell-cycle control pathways in brain tumors are reviewed. The ability to detect mutations in tumor suppressor genes plays an important role in cancer diagnosis and prognosis. Perhaps of greatest significance has been the realization that tumor suppressor genes may provide novel targets for development of specific anticancer therapies for brain tumors.
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Review
Calcium antagonists in patients with aneurysmal subarachnoid hemorrhage: a systematic review.
It has been reported that nimodipine reduces the frequency of secondary ischemia and improves outcome after aneurysmal SAH, but definitive evidence concerning all available calcium antagonists is lacking. ⋯ Calcium antagonists reduce the proportion of ischemic neurologic deficits and nimodipine improves overall outcome within 3 months of aneurysmal SAH; evidence for a reduction of poor outcome from all causes by nicardipine and AT877 is inconclusive. The intermediate factors by which nimodipine exerts its beneficial effect remain uncertain.
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Review Case Reports
Rhabdomyolysis and hypoxia associated with prolonged propofol infusion in children.
Propofol, a new anesthetic, is now used more commonly to sedate patients in the intensive care unit. Propofol's rapid elimination has popularized its use to induce and maintain hypnosis in patients with refractory status epilepticus. ⋯ We report a child and an adolescent who developed severe metabolic acidosis, progressive hypoxia, and rhabdomyolysis during maintenance infusion of propofol for the treatment of refractory status epilepticus. We suggest that propofol should not be used for prolonged sedation in children until its safety can be ensured.
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Review Case Reports
Cardiac cephalgia: a treatable form of exertional headache.
We report two patients with exertional headaches beginning with vigorous exercise and relieved by rest. Neurologic evaluation and neuroimaging were normal in both. ⋯ Based on these patients, and a review of prior similar reports, we conclude that myocardial ischemia is a rare and treatable cause of exertional headache. Accurate diagnosis is critical to controlling headaches and preventing myocardial infarction.