Belcastro V.,Neurology Unit |
D'Egidio C.,University of Chieti Pescara |
Striano P.,University of Genoa |
Verrotti A.,University of Perugia
Epilepsy Research | Year: 2013
Treatment of epileptic patients with valproic acid (VPA) may be associated with substantial weight changes that may increase morbidity and impair adherence to the treatment regimen. VPA-induced weight gain seems to be associated with many metabolic disturbances; the most frequent are hyperinsulinemia and insulin resistance, hyperleptinemia and leptin resistance. Patients who gain weight during VPA therapy can develop dyslipidemia and metabolic syndrome that are associated with long-term vascular complications such as hypertension and atherosclerosis. Moreover, an elevation in the levels of uric acid and homocysteine, together with oxidative stress, may contribute to atherosclerotic risk in patients under long-term therapy with VPA.The aim of this review is to discuss the metabolic and endocrine effects of VPA chronic treatment in patients with epilepsy. © 2013 Elsevier B.V.
Salawu F.K.,Neurology Unit
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria | Year: 2010
BACKGROUND: Non-motor symptoms (NMS) of Parkinson's disease (PD) are a key determinant of health, quality of life (QoL) and societal cost of PD. They are often less appreciated than motor symptoms but are important sources of disability for many PD patients. METHODS: Literature search was performed using the reference databases Medline, Science Citation Index and EMBASE. The keywords used were 'non-motor symptoms', Parkinson's disease, olfaction and constipation. Papers discovered by this search were reviewed, as were references cited therein. RESULTS: Contrary to common perception, many NMS of PD occur early in PD and some may even predate the diagnosis of PD that is based on motor signs. These include olfactory deficit, sleep problems such as rapid eye movement behaviour disorder, constipation and the more recently described male erectile dysfunction. CONCLUSION: There is compelling evidence that non-motor symptoms of PD play a dominant role in the QoL and disability of PD patients and the QoL of their 'informal' carers. Effective clinical management of PD therefore demands that these symptoms be identified and to the extent possible treated.
Chinvarun Y.,Neurology Unit
Neurology Asia | Year: 2013
PET and SPECT are valuable clinical tools in the management of patients with medically resistant, partial epilepsy who are under evaluation for surgical treatment. The value of PET for localization of seizure activity has been firmly established for patients with temporal lobe epilepsy and extratemporal lobe epilepsy. It is a very useful test partly because it is non-invasive. The localizing value of ictal SPECT is based on cerebral metabolic and perfusion coupling. Ictal hyperperfusion is used to localize the epileptogenic zone noninvasively, and is particularly useful in MRI- negative partial epilepsy and focal cortical dysplasia. Use of subtraction ictal SPECT coregistered with MRI (SISCOM) improves localization area of hyperperfusion. However, ictal SPECT should be interpreted in the context of full presurgical evaluation.
Morelli N.,Neurology Unit
Cephalalgia : an international journal of headache | Year: 2013
The functional neuroimaging of headache patients has revolutionized our understanding of the pathophysiology of primary headaches, providing unique insights into these syndromes. Indeed, functional neuroimaging studies have shown the activation of specific brain structures, the brainstem in migraine and posterior hypothalamus in cluster headache (CH), as well as in other trigeminal autonomic cephalalgias. We describe the functional neuroimaging findings in a patient suffering from CH headache, investigated with functional magnetic resonance imaging (fMRI) during typical pain attacks. Two typical, consecutive CH attacks were investigated by two fMRI imaging sessions on the same day. Both fMRI scans were performed at rest, during the CH attacks and the pain-free state induced by subcutaneous administration of sumatriptan. Significant activation of the bilateral red nucleus, ventral pons and trigeminal root entry zone ipsilaterally to the pain side was detected during the pain state, in addition to the hypothalamic region ipsilaterally to the pain side. Being that such structures are mainly involved in motor function and reactive behaviour, their activation, in our hypothesis, may be linked to pain avoidance and may well represent a defence reaction in cluster headache, which is characterised by a "fight-or-flight" type behavioural pattern during pain attacks.
Bostrom I.,Linkoping University |
Stawiarz L.,Karolinska Institutet |
Landtblom A.-M.,Linkoping University |
Landtblom A.-M.,Neurology Unit
Multiple Sclerosis Journal | Year: 2013
Background: Sex ratio in multiple sclerosis has been reported from several geographical areas. The disease is more common in women. In Europe the female-to-male ratio varies from 1.1 to 3.4. A recent study from Canada has reported a significant increase, with time, in female-to-male ratio in multiple sclerosis over the last 100 years. Objective: The aim of this study was to analyse any change in sex ratio in multiple sclerosis in the Swedish population. Methods: Data from the Swedish MS Register and data from the Swedish National Statistics Office were used to estimate sex ratio by year of birth and year of onset. Results: In the analysis of sex ratio by year of birth there were 8834 patients (6271 women and 2563 men) born between 1931 and 1985. The mean women-to-men ratio was 2.62. No clear trend was noted for the women-to-men ratio by year of birth (Spearmans rho = 0.345, ρ = 0.298, η = 11). The number of patients analysed by year of onset was 9098 during the time period 1946 until 2005. The mean women-to-men ratio was 2.57. No significant change in womento- men ratio (Spearmans rho = -0.007, ρ = 0.983, η = 12) with time was observed. Conclusion: There is no evidence for an increasing women-to-men ratio with time amongst Swedish multiple sclerosis patients. © The Author(s) 2012.