Journal of neurology
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Journal of neurology · May 2013
Time trends in incidence of Parkinson's disease diagnosis in UK primary care.
To examine time trends and the influence of socio-demographic and geographic factors on incidence of Parkinson's disease (PD) diagnosis in a large UK population-based cohort from The Health Improvement Network (THIN), a UK primary care database. All patients aged over 50 years and contributing data to THIN between January 1999 and December 2009 were extracted and the incidence rates of PD diagnoses were determined by age, gender, time period, social deprivation score and urban/rural status. The overall incidence of PD diagnosis for people over 50 years was 84 per 100,000 person years (95 % CI 82-85). ⋯ With the broader definition, the adjusted incidence rates remained significantly higher in men compared to women and in urban areas compared with rural areas but not in socially deprived areas. The PD diagnosis rates in the primary care setting were, as expected, higher in men, and slightly higher in urban areas, but not different between socio-economic groups. There was a decline in PD diagnosis in the primary care setting, which may largely represent changes in diagnosis and/or coding rather than a true decline in incidence.
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Journal of neurology · May 2013
Interdisciplinary treatment of unruptured intracranial aneurysms: impact of intraprocedural rupture and ischemia in 563 aneurysms.
This study was conducted to determine the risk factors and the clinical impact of intraprocedural aneurysm rupture (IAR) and periprocedural ischemia in the treatment of symptomatic and asymptomatic unruptured intracranial aneurysms (UIAs). A single-center retrospective data analysis of 563 UIAs treated between 2000 and 2010 was conducted. Treatment assignment was made on the basis of individual aneurysmal criteria in an interdisciplinary neurovascular conference with attending neurosurgeons, neuroradiologists and neurologists. ⋯ Treatment of UIAs can be conducted with an equivalent low rate of permanent morbidity for clipping and coiling-treatment of symptomatic aneurysms elevates the procedural risk. IAR was less frequent during coiling, but was associated with relevant mortality. IAR and periprocedural ischemia represent significant treatment-associated risks, which should be taken into account in interdisciplinary treatment planning and patient counseling.
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Journal of neurology · May 2013
Cognitive outcome of survivors of space-occupying hemispheric infarction.
In patients with space-occupying hemispheric infarction, surgical decompression within 48 h after stroke onset increases the chance of a good functional outcome, but also the chance of survival with severe disability. Until now, cognitive outcome in these patients has not been reported in a consecutive series. Participants of the hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial (HAMLET; ISRCTN94237756) underwent detailed neuropsychological examination at a median of 14.5 months after stroke onset. 'Global cognitive impairment' was defined as a score on the Cambridge cognitive examination (CAMCOG) ≤ 83. ⋯ The majority of survivors of space-occupying hemispheric infarction suffered from long-term global cognitive impairment. Isolated focal neuropsychological deficits were found in only a quarter. Impaired cognitive outcome was associated with worse functional outcome.
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Journal of neurology · May 2013
Gastrointestinal manifestations in Parkinson's disease: prevalence and occurrence before motor symptoms.
To assess the prevalence of gastrointestinal symptoms (GIS) in Parkinson's disease (PD) compared to control subjects and their timing of appearance in relationship to the onset of motor symptoms. There is a rostrocaudal gradient of alpha-synuclein (α-SYN) neuropathology in the enteric nervous system at early stages of PD with higher burden in the upper than the lower gut. However, only constipation has been recognized as a premotor gastrointestinal manifestation of PD. 129 PD patients and 120 controls underwent a structured questionnaire to assess the presence of GIS and, in PD patients, the time of their appearance respect to the onset of motor manifestations. ⋯ Constipation and defecatory dysfunction preceded motor manifestations. Whereas gastroparesis symptoms preceded motor manifestations, their prevalence was not significantly different from controls. Despite evidence of a higher α-SYN burden in the upper gut, only constipation and defecatory dysfunction were prominent premotor GIS of PD.
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Journal of neurology · Apr 2013
Randomized Controlled Trial Multicenter StudyA double-blind, randomized, placebo-controlled, parallel-group study of THC/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis.
Central neuropathic pain (CNP) occurs in many multiple sclerosis (MS) patients. The provision of adequate pain relief to these patients can very difficult. Here we report the first phase III placebo-controlled study of the efficacy of the endocannabinoid system modulator delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray (USAN name, nabiximols; Sativex, GW Pharmaceuticals, Salisbury, Wiltshire, UK), to alleviate CNP. ⋯ While there were a large proportion of responders to THC/CBD spray treatment during the phase A double-blind period, the primary endpoint was not met due to a similarly large number of placebo responders. In contrast, there was a marked effect in phase B of the study, with an increased time to treatment failure in the THC/CBD spray group compared to placebo. These findings suggest that further studies are required to explore the full potential of THC/CBD spray in these patients.