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Port Glasgow, United Kingdom

Hauser R.A.,University of South Florida | Grosset D.G.,Institute of Neurological science
Journal of Neuroimaging | Year: 2012

Objective: To review [ 123I]FP-CIT (Ioflupane I 123, DaTscan) SPECT imaging and its role in clinical practice. BACKGROUND: [ 123I]FP-CIT is a radiopharmaceutical that binds reversibly to striatal presynaptic dopamine transporters. Methods: We review the two principal multicenter clinical trials of [ 123I]FP-CIT SPECT imaging and provide additional, previously unreported information. Study 1 was a trial of [ 123I]FP-CIT SPECT in patients with early suspected parkinsonism that compared baseline scans to the consensus clinical diagnosis established 3 years later. Study 2 was a trial of [ 123I]FP-CIT SPECT in patients with established diagnoses of parkinsonian syndrome (PS) or essential tremor (ET). Results: In Study 1, positive percent agreement (abnormal baseline scan and clinical diagnosis of PS at 36 months [n= 71]) was 78-79%. Negative percent agreement (normal baseline scan and a clinical diagnosis of non-PS at 36 months [n= 28]) was 97%. In study 2, positive percent agreement (abnormal scan and a clinical diagnosis of PS [n= 158]) was 92-97%. Negative percent agreement (normal scan and a clinical diagnosis of ET [n= 27]) was 74-96%. Conclusion: [ 123I]FP-CIT SPECT brain imaging is used to assist in the evaluation of adult patients with suspected PS and may help differentiate ET from PS as an adjunct to other diagnostic evaluations. © 2011 by the American Society of Neuroimaging. Source


Murthy J.M.K.,Institute of Neurological science
Neurology India | Year: 2010

Dengue infection is endemic in more than 100 countries, mostly in the developing world. Recent observations indicate that the clinical profile of dengue is changing, and that neurological manifestations are being reported more frequently. The exact incidence of various neurological complications is uncertain. The pathogenesis of neurological manifestations is multiple and includes: neurotrophic effect of the dengue virus, related to the systemic effects of dengue infection, and immune mediated. In countries endemic to dengue, it will be prudent to investigate for dengue infection in patients with fever and acute neurological manifestations. There is need for understanding of the pathogenesis of various neurological manifestations. Source


Beran R.G.,Griffith University | Spira P.J.,Institute of Neurological science
Cephalalgia | Year: 2011

Introduction: Chronic daily headache (CDH) represents a temporal profile of headache (15+ days/month; 4+ hours/day; >6 months). We report the first comprehensive and largest levetiracetam (LEV) trial in CDH. Methods: A 27-week, multi-centre, randomised, placebo-controlled, cross-over, phase III B study assessed efficacy of a target of 3 g/day LEV of 6 placebo tablets/day in CDH. Primary efficacy was headache-free rate (HFR) while secondary parameters were loss of diagnostic criteria; severity; duration; disability; associated features; pain; and quality of life. Results: Ninety-six patients were recruited (baseline HFR 10.4 ± 14.6%; median 0%). At onset of history 73 (74.1%) had migraine +/- aura and 35 (36.5%) had tension-type headache (TTH). Over the six months preceding recruitment 54 (56.3%) had migraine and 42 (43.8%) had TTH. Headache history was 22.6 ± 15.0 years (median 20.0). Eighty-eight received placebo and 89 received LEV with >80 receiving stable dose in either arm. LEV achieved 3.9% increased HFR over placebo, showing a trend but not significance. There was 9.9% increase in loss of CDH diagnostic criteria re: headache days/month for LEV over placebo (p =.0325), reduced disability (p =.0487) and reduced pain severity for LEV (p =.0162). The Short-Form Quality of Life assessment instrument (SF-36) showed impaired mental health on LEV (p =.001). Discussion: These findings conflict with reports of LEV efficacy, mandating placebo control in headache trials. Primary efficacy equated to one extra headache-free day/month with reduced disability and pain intensity. Mental health was reduced on LEV. The 10% loss of diagnostic criteria, decreased intensity and disability suggest a subpopulation with CDH where LEV remains a therapeutic option. © International Headache Society 2010. Source


Murthy J.M.K.,Institute of Neurological science
Neurology India | Year: 2010

Tuberculous meningitis (TBM) is a serious meningitic infection commonly found to occur in the developing countries endemic to tuberculosis. Based on the clinical features alone, the diagnosis of TBM can neither be made nor excluded with certainty. Unfortunately there is still no single diagnostic method that is both sufficiently rapid and sensitive. Most factors found to correlate with poor outcome can be directly traced to the stage of the disease at the time of diagnosis. The only way to reduce the mortality and morbidity is by early diagnosis and timely recognition of complications and institution of the appropriate treatment strategies. Source


Grosset D.,Institute of Neurological science
Journal of the Neurological Sciences | Year: 2010

The response to dopamine replacement therapy in patients with degenerative parkinsonism is variable. Reasons for a poor therapy response include the type of parkinsonism, comorbidities, and differential effects on clinical features. An additional explanation, which has received much less attention, is sub-optimal therapy compliance. Single and multicentre studies of therapy compliance report significant under- and overuse of dopamine replacement therapy resulting in poor symptomatic control, or features of the dopamine dysregulation syndrome or other signs of dopaminergic excess (dyskinesia, confusion, visual hallucinations). In this article, the evidence for sub-optical adherence in Parkinson's disease (PD) is reviewed, and factors associated with sub-optimal compliance were examined, with two case vignettes to illustrate clinical consequences of deviation from the prescribed therapy regimen. © 2009. Source

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