Revue médicale de Liège
-
Migraine is a frequent neurological syndrome with a heterogenous clinical presentation. Its pathophysiology remains poorly understood but a genetic aetiology has been suspected for a long time, as well as a significant influence of the environment. Familial hemiplegic migraine belongs to monogenic migraines, which are very rare entities with an autosomal dominant transmission. ⋯ The environmental contribution (endogenous or exogenous) is much more pronounced in the common forms of migraine, with the identification of numerous predisposing or triggering factors, among which only some can be avoided. Finally, a recent behavioural hypothesis coming from adaptative darwinian theories has proposed a genetic-environment integrative model for common migraine. The latter would result of hereditary physiological adaptative defence mechanisms which would be progressively impaired by repeated brain homeostasis imbalances due to the environment.
-
Revue médicale de Liège · May 2012
Review[Vitamin D tweets light to genes in multiple sclerosis].
The relationship between sunlight exposure and the incidence of multiple sclerosis and the understanding of immunomodulatory effects of vitamin D triggered, in recent years, a broad range of investigations. Immunological studies performed in vitro and in vivo have demonstrated how tolerogenic vitamin D can be. Epidemiological studies confirmed an increased incidence of multiple sclerosis in vitamin D deficient subjects and signs of increased disease activity in such MS patients. Although small-scale observational studies have suggested a beneficial impact of vitamin D supplementation on the incidence and severity of multiple sclerosis, large scale clinical trials remain warranted to confirm these preliminary results.
-
Up to 50% of cancer patients will receive radiation therapy as a part of their treatment. Radiation may be delivered with curative or palliative intent, according to the extent of disease, the patient's performance status and his wishes. ⋯ The total dose, the dose per fraction and the technique of irradiation used vary with the treatment aim. Indications of radiotherapy in the end of life are reviewed in this paper
-
Revue médicale de Liège · Feb 2012
Review[Neurostimulation: which place in the treatment of refractory headaches?].
The management of refractory headaches (migraine or cluster headache) is often challenging in clinical practice. Most of the time, these patients are "desperate" and have already tried all existing medications. Many progresses have recently been made in the therapeutic approach of these diseases, especially with the advent of neurostimulation techniques. ⋯ The most effective and best studied methods are occipital nerve stimulation (ONS) and hypothalamic deep brain stimulation (DBS), the latter being however at higher surgical risk. Hence, there is a new hope for patients with refractory headaches. Various clinical trials are still underway.