Clinical and experimental neurology
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Daily salivary anticonvulsant monitoring in epileptic patients with frequent seizures appears a promising, practicable and inexpensive approach which may assist in the management of drug therapy. It offers the possibility of predicting the optimal drug concentration likely to minimise seizure activity in a given patient, and sometimes allows the inference that different anticonvulsant drugs should be tried forthwith. The use of the method is described in one patient who collected daily saliva specimens and recorded any seizure activity over periods of several weeks. ⋯ Saliva was again collected daily over another 3 months. Analysis of the data on this occasion suggested that carbamazepine, in the presence of methylphenobarbitone, may have played little role in seizure prevention, and also predicted the salivary level of phenobarbitone likely to minimise seizures. Unfortunately the patient again could not tolerate the drug doses necessary to attain this phenobarbitone concentration.
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Hyperalgesia and allodynia, lasting for months or even years, occurs in the form of post-herpetic neuralgia in approximately 70% of adults previously infected with the varicella herpes zoster virus. The present study aimed at testing the analgesic desensitising actions and reversibility of repeated application of topical capsaicin on disordered polymodal nociceptors and peptidergic sensory fibres mediating warm and pain sensation. Cutaneous nociceptor desensitisation was measured using the Glasgow automated thermal threshold test (Medelec TTT). ⋯ There was a poor correlation between pain relief and elevation of warm detection in response to capsaicin treatment. Generally, it was found that those patients with less initial desensitisation to warm detection as a consequence of post-herpetic neuralgia experienced better pain relief after capsaicin was applied. The method used permits determination of the minimum effective desensitising dose of capsaicin, enables patient compliance and progress to be monitored and should allow the prediction of patients likely to achieve the best response to treatment.
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A community-based register of cases of acute cerebrovascular disease in a representative segment of the city of Perth, Western Australia, has been developed. Stroke attack rates, pathological diagnoses and site of care of the cases, as revealed by the register, are analysed.
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Chronic rheumatic pain syndromes such as the fibrositis syndrome, 'whiplash' syndrome, low back pain syndrome and regional pain syndrome are common clinical disorders of unknown cause. The presence of tender points in predictable anatomical locations is essential to their diagnosis. Exaggerated dermatographia or flare response to mechanical stimulation is also a commonly observed physical finding. ⋯ Patients with chronic rheumatic pain syndromes had a lower threshold for capsaicin-induced flare responses compared with controls. They also had larger flares at capsaicin concentrations of 0.02 and 0.033 mg/mL (p less than 0.05) applied as 20 microL aliquots over 30 minutes. It is concluded that neurogenic flare responses are increased in patients with chronic rheumatic pain syndromes.
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One hundred and twenty-nine patients notified to the Perth Community Stroke Study in whom the final diagnosis was cerebrovascular disease were matched with controls of the same sex and 5-year age group drawn from the records of the usual general practitioner of each index case. The control subjects were interviewed and examined briefly at home, following the same protocol as that used for assessment of cases. ⋯ Being married (0.6) and history of migraine (0.4) were significant protective factors. There was no association between a history of hypertension and cerebrovascular disease in this series.