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1.
Opinion statement
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| – | There is no controlled study for the best treatment or management of cervicocerebral artery dissection (CAD). |
| – | Rationale initial empiric treatment in acute CAD to prevent secondary embolism is partial thromboplastin time (PTT)-guided anticoagulation by intravenous heparin followed by anticoagulation with warfarin. |
| – | Carotid surgery for treatment of CAD is not recommended anymore with the possible exception of persisting severe stenosis of the proximal internal carotid artery (ICA). |
| – | There could be use of carotid angioplasty by balloon dilatation and stenting in selected cases of severe cerebral hemodynamic impairment by bilateral CAD. |
| – | Duration of secondary prophylaxis by anticoagulation is best guided by Doppler sonography follow-up, and should be continued until normalization of blood flow or until at least 1 year after the vessel is occluded. |
| – | There is no evidence that pseudoaneurysms increase the risk for embolic complication, and there is no evidence for surgery or continuation of anticoagulation in patients with pseudoaneurysms. |
| – | Caution should be recommended for exercises that involve excessive head movements (eg, bungee jumping, trampoline jumping, and chiropractic maneuvers). |
| – | The patient should be informed that recurrent rate is low in nonfamilial cases. |
| – | Doppler sonography is a low-cost and high-sensitivity method for patients at risk. |
2.
Gelanis DF 《Current treatment options in neurology》2001,3(2):133-138
Opinion statement
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| – | •Respiratory complications account for the majority of deaths occurring in patients suffering from amyotrophic lateral sclerosis (ALS). Patients normally succumb to their illness within an average of 3 to 5 years from the time of diagnosis from complications such as hypoventilation, hypoxemia, hypercarbia, aspiration, and other pneumonia and pulmonary emboli [1]. Although invariably disabling, ALS need not be fatal if respiratory involvement is detected early, which will allow sufficient time to discuss and implement treatment options. The recently published American Academy of Neurology guidelines for the management of ALS recommends the following: |
| – | •Serial measures of pulmonary function to guide management and determine prognosis. |
| – | •Noninvasive ventilatory support—an effective initial therapy for symptomatic chronic hypoventilation and prolonged survival. |
| – | •Invasive ventilatory support when long-term survival is the goal and noninvasive support is no longer sufficient. |
| – | •Physicians respect the right of the patient to choose, refuse, or withdraw ventilatory support. |
| – | •Liberal use of opiates and anxiolytics to relieve dyspnea and anxiety when ventilatory support is refused or withdrawn. |
3.
Rees L 《Pediatric nephrology (Berlin, Germany)》2009,24(3):475-484
The purpose of this article is to review:
相似文献
| 1. | Factors influencing long-term outcome data after transplantation |
| 2. | Patient survival overall, the effect of recipient age and donor type, causes of death, comparison of mortality after transplantation with that on dialysis, and effect of pre-emptive transplantation and race |
| 3. | Transplant survival overall, and the effect of recipient and donor age, donor type, pre-emptive transplantation, recurrent diseases, human leukocyte antigen (HLA) matching, immunosuppression, concordance, hypertension, bladder dynamics and type of donor nephrectomy |
| 4. | Final height and obesity |
| 5. | Psycho-social outcome |
4.
An antireflux procedure is critical to the long-term outcome of esophageal myotomy for achalasia 总被引：4，自引：0，他引：4
Jeffrey H. Peters M.D. 《Journal of gastrointestinal surgery》2001,5(1):17-20
Conclusions Based on these findings, the following conclusions may be drawn:
相似文献
| 1. | Abdominal myotomy combined with fundoplication provides excellent symptomatic out-come both short and long term in patients with achalasia. |
| 2. | Gastroesophageal reflux disease and its sequelae are significant long-term problems in postmyotomy patients with achalasia. |
| 3. | The preponderance of evidence suggests that pH-proved reflux is minimized by the addition of a partial fundoplication. |
| 4. | Approximately one third of patients treated with dilatation or myotomy without fundoplication will have pH-proved reflux. |
| 5. | Laparoscopic myotomy plus fundoplication results in less reflux (< 10%) than myotomy without an antireflux procedure (30% +). |
| 6. | Symptoms are not a reliable guide for detecting reflux. |
| 7. | Postoperative pH studies are necessary to detect patients with pathologic gastroesophageal reflux. 8.Reflux is uncommon in patients who have not undergone dilatation or surgery. |
5.
Opinion statement
相似文献
| – | The clinical syndrome of nerve agent toxicity varies widely, ranging from the classic cholinergic syndrome to flaccid paralysis and status epilepticus. |
| – | All nerve agents are capable of producing marked neuropathology. Seizure control is strongly associated with protection against acute lethality and brain pathology. |
| – | The mainstays of therapy of nerve agent poisoned patients are atropine, pralidoxime, and benzodiazepines. |
| – | Fosphenytoin provides little therapeutic anticonvulsant effectiveness for nerve agent-induced status epilepticus. |
| – | Tachycardia is not a contraindication to treatment with atropine in nerve agent toxicity. |
| – | Atropine should be administered to alleviate respiratory distress, symptomatic bradycardia, and as an adjunct to benzodiazepines and pralidoxime to alleviate seizure activity. |
| – | In significant nerve agent toxicity, a continuous pralidoxime infusion may be considered. |
6.
Diamond ML 《Current treatment options in neurology》2002,4(5):351-356
Opinion statement
相似文献
| – | Headache is the chief complaint in the emergency room in between 0.36% and 2.5% of patients. |
| – | It is essential that the headache diagnosis be established to rule-out a potentially morbid disorder, as well as facilitate selection of appropriate interventions. |
| – | Referral with follow-up care is essential to patients with frequent headaches in order to prevent repeat emergency room visits and possible narcotic dependency. |
| – | Two stages define emergency room treatment of any form of headache—initial stabilization and treatment (which may be started in the emergency room). |
| – | Despite the introduction of migraine-specific therapy in 1993, only a minority of migraine headache patients are prescribed this treatment. |
7.
Berger JR 《Current treatment options in neurology》2000,2(4):361-368
Opinion statement
相似文献
| – | Before embarking on experimental therapies for progressive multifocal leukoencephalopathy (PML), the diagnosis needs to be unequivocally established. |
| – | Improving the underlying immunodeficiency state is the best initial approach to the management of PML. Immunosuppressive therapies should be discontinued when feasible. In the patient with AIDS, highly active antiretroviral therapy should be administered; this appears to prolong survival. |
| – | At present, no therapy has been demonstrated to be effective in a well-designed prospective trial. Cytosine arabinoside, which has demonstrated efficacy in vitro against JC virus, has not been effective when administered intravenously or intrathecally to patients with AIDS and PML. The failure of regimens employing cytosine arabinoside in PML may have been the consequence of inadequate penetration of the drug to sites of infection in the brain. Other drugs with established in vitro activity against JC virus, such as topoisomerase and camptothecin, are poorly tolerated. The use of cidofovir in patients with AIDS and PML remains anecdotal, although it is currently under investigation. |
| – | Interferon alfa may improve survival in patients with AIDS and PML and may have general applicability to PML regardless of the cause of the underlying immunodeficient state. |
| – | Approximately 7% to 9% of patients with PML demonstrate prolonged survival (>12 months) and associated improvement in clinical and radiographic abnormalities in the absence of specific therapy. In patients with AIDS-related PML, prolonged survival correlates with PML as the presenting manifestation of AIDS, higher CD4 T-lymphocyte counts, and contrast enhancement of PML lesions on radiographic imaging. A brisk inflammatory response may also be associated with improved survival. |
| – | The increased understanding of the pathophysiology of JC virus provides hope for the development of curative strategies. The growing number of persons affected with PML has allowed the organization of carefully designed therapeutic trials to address this issue. |
8.
Baloh RW 《Current treatment options in neurology》2000,2(1):81-89
Opinion statement
相似文献
| – | When possible, treatment should be directed at the underlying cause of vertigo. |
| – | The particle repositioning maneuver is a simple curative bedside treatment for benign paroxysmal positional vertigo. |
| – | Symptomatic therapy using antivertiginous drugs can be used with specific treatments or when no specific treatment is available. |
| – | Surgery has a limited role in the treatment of vertigo and should be considered only when the diagnosis and pathophysiology are clear. |
| – | Vestibular rehabilitation helps the patient compensate for a fixed vestibular deficit. |
9.
Opinion statement
相似文献
| – | Use of valid diagnostic criteria is extremely important in the recognition of Alzheimer’s disease (AD). |
| – | Patients with mild to moderate Alzheimer’s disease should be started on a cholinesterase inhibitor and possibly anti-inflammatory agents, antioxidants (vitamin E or selegiline), and estrogen replacement therapy (for postmenopausal women). Close follow-up of functioning is needed to be able to provide symptomatic relief and possibly slow down the progression of the disease [1]. |
| – | Comorbid medical conditions as well as superimposed psychiatric disturbances should be aggressively treated. |
| – | Pharmacologic interventions and environmental engineering (including support for family members) should be used throughout the course of the disease. |
| – | Genetic testing is not recommended in asymptomatic family members [2],[3] considering the enormous potential for job and insurance discrimination. |
10.
Foldvary N 《Current treatment options in neurology》2002,4(2):129-135
Opinion statement
相似文献
| – | Seizures and antiepileptic drugs (AEDs) affect sleep macroarchitecture and may produce excessive daytime sleepiness (EDS) in patients with epilepsy. |
| – | Sleep is a potent activator of seizures and epileptiform discharges. In some patients, seizures occur exclusively or predominately in sleep. Benign focal epilepsy of childhood with centrotemporal spikes (BECTS), supplementary sensorimotor area epilepsy (SSMA) and Lennox Gastaut syndrome are a few of the more common epilepsy syndromes characterized by nocturnal seizures. |
| – | Excessive daytime sleepiness is a common complaint of patients with epilepsy. Causes of EDS include seizures, AEDs, poor sleep hygiene, and coexisting sleep disorders. |
| – | Pharmacologic therapy is aimed at identifying the single most effective drug for a given seizure type or epilepsy syndrome. Polytherapy is associated with a higher likelihood of adverse effects—most notably, EDS. |
| – | Poor sleep hygiene leads to sleep fragmentation that can exacerbate seizures and EDS. |
| – | Primary sleep disorders should be suspected in patients with EDS, particularly those treated with monotherapy at low serum drug concentrations and well controlled seizures. Treatment of sleep disorders may lead to better seizure control. |
11.
Opinion statement
相似文献
| – | Many disorders can mimic complex partial seizure (CPS), and clinicians must be careful to make an accurate diagnosis. Complex partial seizures must be distinguished from generalized-onset seizures (such as absence seizures), which require a different treatment regimen. |
| – | Treatment of CPS should begin with monotherapy with a standard antiepileptic drug (AED), such as phenytoin or carbamazepine. |
| – | Increasing evidence indicates that the newer AEDs, such as lamotrigine, topiramate, and possibly gabapentin, are effective as monotherapy. These AEDs may prove to be as effective as the standard AEDs but with fewer adverse effects. |
| – | All the newer AEDs have significant efficacy when used as add-on treatments, and they may have fewer adverse effects than standard AEDs used in combination. |
| – | Surgery for epilepsy should be considered in any patient in whom adequate Current Science Inc. trials of AEDs have failed. |
| – | The vagus nerve stimulator, a new nonpharmacologic treatment, is a reasonable option in patients in whom AED treatment has failed. |
| – | Randomized clinical trials comparing older and newer AEDs in the treatment of CPS are needed. |
12.
Opinion statement
相似文献
| – | The clinician must maintain a high level of suspicion for central nervous system infections even if not all of the classic signs are present, because prompt treatment may make a difference in patient outcome. |
| – | If bacterial meningitis is suspected, a CT scan of the head should be obtained prior to lumbar puncture if there is papilledema, a focal neurologic exam, or if the patient is comatose. |
| – | In bacterial meningitis, empiric antibiotics should be chosen based on a patient’s risk factors and should be started immediately. |
| – | Depending on the resistance patterns of the institution, Streptococcus pneumoniae may be resistant to penicillins and cephalosporins. |
| – | Corticosteroids are of uncertain benefit in bacterial meningitis and may decrease the penetration of antibiotics into the central nervous system. |
| – | The dosage for acyclovir treatment in herpes simplex encephalitis is 10 to 15mg/kg every 8 hours. |
| – | Subdural empyema is a neurosurgical emergency. |
| – | Brain abscesses should be surgically drained if they exceed 2.5 centimeters. |
13.
Opinion statement
相似文献
| – | •Depression in epilepsy patients is not only extremely common, but is often poorly recognized and inadequately treated. |
| – | •Depression can have significant consequences including increased medical utilization, poor quality of life, social disability, and mortality. |
| – | •Etiology of depression is multifaceted with prominent psychosocial determinants. Salient medical issues include iatrogenic causes, especially side effects of antiepileptic drugs (AEDs). In addition, seizures with increased frequency and with ‘forced normalization’ can be associated with mood disturbance. |
| – | •After a thorough search for correctable causes, treatment should not be delayed, and should include both psychotherapy and pharmacologic therapies. |
| – | •Antidepressants remain the mainstay of pharmacologic intervention with the selective serotonin reuptake inhibitors (SSRIs) considered first-line treatment. Venlafaxine, nefazadone, and tricyclic antidepressants (TCAs) can also be used, but with some important caveats. |
| – | •Decreasing the seizure threshold is a common side effect of all antidepressants, but the risk can be minimized and should not prevent vigorous treatment of the depressive state. |
| – | Other side effects present with varying frequency from the common (eg, sexual dysfunction as seen with SSRIs) to uncommon withdrawal reactions and rare complications of serotonin syndrome. |
| – | •Depression must also be considered a recurring disease, and when a successful regimen is ascertained, adequate continuation of treatment is a necessity. |
| – | •Care must be taken to treat the patient until complete resolution is achieved. Many patients with a major depressive disorder (MDD) will improve with inadequate treatment, but remain encumbered by a smoldering, low-level dysthymia that, in itself, can severely restrict the patient’s quality of life. |
14.
Sung GY 《Current treatment options in neurology》2002,4(4):319-322
Opinion statement
相似文献
| – | Correct and timely diagnosis of cerebral venous thrombosis (CVT) is imperative in determining the appropriate treatment plan. Clinical suspicion is crucial, followed by radiographic confirmation using CT, MRI, or conventional angiography. |
| – | Emergency and critical care of the patient is important, including control of airway and circulation. |
| – | Initially, the treatment of choice is anticoagulation with heparin. |
| – | Consideration should be given to intrathrombus delivery of thrombolytic agents. |
| – | Eventually, newer techniques such as laser, ultrasound, and suction may be considered. |
15.
Poceta JS 《Current treatment options in neurology》2002,4(2):121-128
Opinion statement
相似文献
| – | The relationship between sleep and headache has great individual variation. |
| – | Headaches that arise primarily out of sleep have a broader differential diagnosis than random headaches, and a specific cause should be identified, if possible. |
| – | Sleep apnea can trigger or cause sleep-related headaches. |
| – | Hypnic headache is one of a few specific, uncommon, idiopathic sleep-related headache syndromes. |
| – | Treatment of sleep-related headache includes treating the underlying cause, such as sleep apnea, and prescribing medications usually used for headache as well as medications for sleep disorders. |
16.
Lucas S 《Current treatment options in neurology》2002,4(5):343-350
Opinion statement
相似文献
| – | Stratify care by choosing the optimal medication for a migraine. Severe pain, significant disability, and associated features such as nausea or vomiting necessitate early treatment with specific, high efficacy therapy. |
| – | Migraine patients may have a spectrum of headache presentations ranging from tension-type headaches to migraine headaches with or without aura. Mild headache types may respond to simple analgesics, though there is evidence that migraineurs will respond to migraine-specific medications such as the triptans for a range of headache phenotypes. |
| – | Physicians should provide patients with medication to treat nausea and vomiting. They may be infrequent accompaniments, but medication such as a neuroleptic may avoid a trip to the emergency room. |
| – | Provide rescue medication for an occasional failure of usual treatment to avoid further disability or emergency room visits. |
| – | Avoid medication overuse by matching treatment to patient needs. A cycle of repetitive and escalating medication use can lead to transformation of migraine into chronic daily headache with analgesic-dependent rebound. |
17.
Young WB 《Current treatment options in neurology》2001,3(2):181-188
Opinion statement
相似文献
| – | •Medication overuse headache is common and affects 2% of the United States population. |
| – | •Simple analgesics, caffeine-containing analgesics, butalbital-containing analgesics, opioids, ergotamine, and triptans may cause medication overuse headache. The recidivism rate is higher after detoxification from butalbital and opioids than after detoxification from other substances. |
| – | •Treatment venues have included the patient’s home, an infusion center, or a hospital setting. No consensus exists to determine the setting that is most appropriate. |
| – | •Patients with analgesic overuse headache have a different psychologic substrate than psychiatric substance abusers. Most should not be treated in psychiatric detoxification facilities, although, psychiatric assessment and support may be beneficial. |
18.
Irizarry L 《Current treatment options in neurology》2001,3(5):413-426
Opinion statement
相似文献
| – | Cryptococcal meningitis, often seen in immunocompromised hosts, is also a disease of the immune-competent individual. |
| – | The diagnosis of cryptococcal meningitis requires a lumbar puncture with measurement of the opening pressure, standard laboratory assessment including cell count, protein and glucose, fungal culture, and cryptococcal polysaccharide antigen. Serum cryptococcal antigen is of great diagnostic value in individuals infected with HIV. |
| – | Hospital admission for initial therapy with amphotericin B desoxycholate is required. |
| – | Adjuvant oral therapy with flucytosine for the first 2 weeks of therapy is strongly recommended. If flucytosine is not well tolerated, it may be discontinued with close monitoring and follow-up of cerebrospinal fluid (CSF) response to therapy. |
| – | Good hydration and appropriate premedication concomitant to the use of amphotericin B are useful interventions preventing side effects. Occasionally, amphotericin B needs to be discontinued due to intolerance or side effects. |
| – | After CSF sterilization is completed, therapy can be switched to oral fluconazole. |
| – | Fluconazole is well absorbed orally. There is rarely a need to give intravenous fluconazole. |
19.
Opinion statement
相似文献
| – | Sleep disorders commonly complicate the course following traumatic brain injury (TBI). |
| – | Insomnia, excessive daytime somnolence and alteration of the sleep-wake schedule are common disturbances that affect the course of recovery and prognosis in TBI survivors. |
| – | Few studies, however, have looked at the diagnosis and management of these disturbances in TBI. Early treatment of sleep disorders must be considered an integral part of the rehabilitation process. Recognition and management of comorbid medical or surgical diseases, assessment and treatment of associated psychiatric disorders, and awareness of other psychosocial stressors are mandatory steps in the management of sleep disturbances following TBI. In addition to pharmacologic therapy, nonpharmacologic approaches such as diet, environmental modification, and behavioral interventions are essential components in the management of sleep disturbances in TBI. |
| – | Based on the evidence that sleep disturbances impact rehabilitation in TBI patients we support the need for ongoing studies in this area. |
20.
Aksamit AJ 《Current treatment options in neurology》2005,7(2):145-150
Opinion statement
相似文献
| – | Herpes simplex encephalitis (HSE) is a neurologically devastating illness associated with substantial morbidity and mortality in adults and older children. |
| – | The correct recognition of HSE, and distinguishing it from other forms of encephalitis, brain abscess or mimicking disorders early in the course of evaluation facilitates treatment decisions when neurologic complications occur. |
| – | The combination of clinical characteristics, magnetic resonance imaging of the head, and polymerase chain reaction (PCR) analysis of cerebrospinal fluid for herpes simplex type 1 DNA is a sensitive and specific way of diagnosing HSE for proper treatment. |
| – | Early treatment is essential. HSE is treated with acyclovir 10 mg/kg every 8 hours intravenously for 21 days, unless the illness is mild, or if nephrotoxicity occurs. |
| – | Whether prolonged therapy with oral antiviral treatment after standard intravenous acyclovir offers any advantage from the standpoint of neurologic morbidity or mortality is unproven. |
| – | PCR-negative typical cases and PCR-positive atypical cases of HSE can occur and require treatment with acyclovir. |