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zaterdag 2 december 2017

The Lancet: [Series] Diagnosis, pathophysiology, and management of cluster headache

[Series] Diagnosis, pathophysiology, and management of cluster headache
Cluster headache is a trigeminal autonomic cephalalgia characterised by extremely painful, strictly unilateral, short-lasting headache attacks accompanied by ipsilateral autonomic symptoms or the sense of restlessness and agitation, or both. The severity of the disorder has major effects on the patient's quality of life and, in some cases, might lead to suicidal ideation. Cluster headache is now thought to involve a synchronised abnormal activity in the hypothalamus, the trigeminovascular system, and the autonomic nervous system.
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[In Context] Telestroke: India's solution to a public health-care crisis
Stroke is a leading cause of morbidity and mortality in India. Yet much of the country is composed of rural, low-income and middle-income communities that lack access to essential neurological care. Telemedicine is helping to tackle this important problem. Jacquelyn Corley investigates.
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[Comment] The evolving landscape of epilepsy neuropathology
The neuropathological findings from brain tissue specimens taken from 9523 adults and children with treatment-resistant focal epilepsy who had resective surgery were recently published in the New England Journal of Medicine.1 These specimens were taken from a collaborative brain tissue registry involving 27 European centres, which is possibly the largest database of surgically resected neuropathology in epilepsy compiled to date. The most common pathologies were hippocampal sclerosis (36%), developmental tumours (gangliogliomas and dysembryonic neuroepithelial tumours, 16%), focal cortical dysplasias (14%), cavernous angioma (4·5%), and glial scars (4·8%); in around 8% of the specimens no pathology was found.
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[Articles] Focused ultrasound subthalamotomy in patients with asymmetric Parkinson's disease: a pilot study
MRI-guided focused ultrasound unilateral subthalamotomy was well tolerated and seemed to improve motor features of Parkinson's disease in patients with noticeably asymmetric parkinsonism. Large randomised controlled trials are necessary to corroborate these preliminary findings and to assess the potential of such an approach to treat Parkinson's disease.
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[Comment] Subthalamotomy for Parkinson's disease: back to the future?
MRI-guided focused ultrasound is a novel method for creating thermic ablations in the thalamus or basal ganglia without opening the skull. The method uses focused sonic energy and real-time MRI thermography of brain temperature to control lesion size and location precisely. This is a principle advantage over gamma-knife radiosurgery, which is another incision-free lesioning technique but induces radionecrosis that is difficult to control and develops within months of the procedure. In July, 2016, the US Food and Drug Administration approved MRI-guided focused ultrasound for unilateral thalamotomy for treatment of medically refractory and disabling essential tremor.
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