Current neurology and neuroscience reports
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Curr Neurol Neurosci Rep · May 2005
Randomized Controlled Trial Comparative Study Clinical TrialConcomitant chemoradiotherapy followed by adjuvant temozolomide improves survival in glioblastoma multiforme.
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Trigeminal neuralgia is considered to be one of the most severe forms of pain in the human experience. In this discussion, classical neurology, current advances in medical science, and the relief of human suffering converge in a single nerve. ⋯ Further developments in neurosurgical and radiosurgical techniques have provided effective treatments with increasingly wider margins of safety. Significant advances in cortical stimulation technology are also making headway into pain relief and delineating the central mechanisms of chronic neuropathic pain.
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Neuromuscular disorders are caused by the primary involvement of the motor unit. In these patients, sleep-disordered breathing (SDB) due to respiratory muscle weakness is often encountered during sleep. ⋯ Overnight polysomnography is the best investigation for SDB and nocturnal desaturations. In the management of these patients, noninvasive intermittent positive pressure ventilation results in improvement of SDB and breathing.
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For many neurologists, seizures in critically ill patients represent a difficult problem. Etiology can be elusive because of the complexity of the environment, and treatment decisions can be compromised by the paucity of evidence-based guidelines. Emerging data support a higher than previously thought incidence of nonconvulsive epileptic activity in this patient population, which is another important consideration. ⋯ Although there is no reason to believe that late seizures after severe head trauma cannot be prevented with prophylactic treatment, such an approach may be useful during the first week after the injury. Physicians, however, have to individualize the treatment to the critical patient after stroke or trauma based on the presence of additional factors that increase the risk for seizures, including structural cortical injuries and medications used in critical illness with epileptogenic potential. A general therapeutic scheme for seizures in the intensive care unit and the role newer antiepileptic drugs can play are also presented in this review.
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Traumatic brain injury often affects people in their most productive years, inflicting a significant burden on families and society. The advances in modern critical care have improved survival of patients; thus more patients live after traumatic brain injury, which raises an important issue about their neurologic outcome. ⋯ In this review, we try to bring information from different sources to show new approaches to achieve that goal. Some of the techniques employed are investigational and some are waiting to find broader application in intensive care units across the country.