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Precision medicine neurology

S Döpfmer, M C Münchmeyer, T Natschke, W Herrmann, F Holzinger, R Burian, A Berghöfer, C Heintze
BACKGROUND: The aim of this study was to compare the approach of general practitioners (GP) and outpatient specialists for psychiatry, neurology or psychosomatic medicine to patients with somatically unexplained complaints. METHODS: Qualitative interviews were conducted with general practitioners in Berlin and with outpatient specialists. Interviews were analyzed by qualitative content analysis. RESULTS: Both GPs and specialists rarely used structured diagnostic instruments...
October 5, 2016: Der Nervenarzt
Marina Hodolic, Raffi Topakian, Robert Pichler
BACKGROUND: Epilepsy is a neurological disorder characterized by epileptic seizures as a result of excessive neuronal activity in the brain. Approximately 65 million people worldwide suffer from epilepsy; 20-40% of them are refractory to medication therapy. Early detection of disease is crucial in the management of patients with epilepsy. Correct localization of the ictal onset zone is associated with a better surgical outcome. The modern non-invasive techniques used for structural-functional localization of the seizure focus includes electroencephalography (EEG) monitoring, magnetic resonance imaging (MRI), single photon emission tomography/computed tomography (SPECT/CT) and positron emission tomography/computed tomography (PET/CT)...
September 1, 2016: Radiology and Oncology
Craig Nolan, Lisa M DeAngelis
PURPOSE OF REVIEW: The purpose of this review is to provide a practical clinical approach to confusion in the patient with cancer. Confusion in the cancer population has a broader differential diagnosis than in the general medical population. The clinician must consider the usual differential diagnoses as well as causes unique to the cancer patient including direct complications from the cancer and indirect complications related to cancer treatment. RECENT FINDINGS: In the recent age of precision medicine, the oncologist now utilizes the genomic profile of both the patient and the tumor to provide advanced biologic therapies including targeted anticancer drugs, antiangiogenic agents, and immunotherapy...
September 26, 2016: Current Opinion in Neurology
Wendy Cheng, Tony K L Kiang, Penny Bring, Mary H H Ensom
BACKGROUND: The Winter-Tozer equation for estimating free phenytoin concentration is biased and imprecise. Alternative predictive equations are available, but most remain unvalidated. OBJECTIVES: To assess the bias and precision of the Winter-Tozer equation and selected derivative equations in predicting free phenytoin concentration and to derive new equations with better predictive performance. METHODS: A retrospective chart review (for patients with samples drawn for free phenytoin concentration between September 2008 and September 2013) was conducted for 3 subpopulations (critical care, general medicine, neurology) in one hospital...
July 2016: Canadian Journal of Hospital Pharmacy
Rahil Ghanavati, Foroogh Namjoyan, Hosein Rezaee Zadeh
BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory disease of central nervous system (CNS) and is the most common cause of neurologic disability in young adults (20-40 years old). About 2.5 million patients all over the world are suffering from MS. Common symptoms of the disease include sensory disorders, optic neuritis, and limb weakness. Following disease progression, other symptoms like fatigue, bladder disorders, and cognitive impairment also occur. Traditional Persian medicine (TPM) is an ancient medical system from 6000 years ago in Persia, where Iran was its most important state...
May 2016: Iranian Journal of Medical Sciences
H Eugene Hoyme, Wendy O Kalberg, Amy J Elliott, Jason Blankenship, David Buckley, Anna-Susan Marais, Melanie A Manning, Luther K Robinson, Margaret P Adam, Omar Abdul-Rahman, Tamison Jewett, Claire D Coles, Christina Chambers, Kenneth L Jones, Colleen M Adnams, Prachi E Shah, Edward P Riley, Michael E Charness, Kenneth R Warren, Philip A May
The adverse effects of prenatal alcohol exposure constitute a continuum of disabilities (fetal alcohol spectrum disorders [FASD]). In 1996, the Institute of Medicine established diagnostic categories delineating the spectrum but not specifying clinical criteria by which diagnoses could be assigned. In 2005, the authors published practical guidelines operationalizing the Institute of Medicine categories, allowing for standardization of FASD diagnoses in clinical settings. The purpose of the current report is to present updated diagnostic guidelines based on a thorough review of the literature and the authors' combined expertise based on the evaluation of >10 000 children for potential FASD in clinical settings and in epidemiologic studies in conjunction with National Institute on Alcohol Abuse and Alcoholism-funded studies, the Collaborative Initiative on Fetal Alcohol Spectrum Disorders, and the Collaboration on FASD Prevalence...
August 2016: Pediatrics
Ettore Beghi, Giancarlo Logroscino
BACKGROUND: The traditional design of the randomized clinical trial (RCT) is challenged by the peculiarities of the genotype and phenotype of neurological disorders. SUMMARY: RCTs are intended to verify the net effect of an investigational treatment on the outcome of a disease. This implies the inclusion of strictly homogeneous sample of patients that represent only in part the full disease spectrum. For this reason, pragmatic trials on representative samples of the general population are welcome...
2016: Frontiers of Neurology and Neuroscience
Jacob A Miller, Elizabeth Emily Bennett, Roy Xiao, Rupesh Kotecha, Samuel T Chao, Michael A Vogelbaum, Gene H Barnett, Lilyana Angelov, Erin Murphy, Jennifer Yu, Manmeet Ahluwalia, John H Suh, Alireza M Mohammadi
INTRODUCTION: Over the past decade, there has been tremendous interest in biological risk stratification and precision medicine. The chief dose-limiting toxicity of stereotactic radiosurgery (SRS) is radiation necrosis (RN), which occurs following approximately 5% to 10% of treatments. This complication may worsen neurological deficits, increase the frequency and cost of imaging, and necessitate prolonged treatment with steroids or antiangiogenic agents. We hypothesized that tumor biology is associated with RN, and that biological risk stratification may be used to guide dose escalation and dose reduction...
August 2016: Neurosurgery
Simona Pellacani, Federico Sicca, Cherubino Di Lorenzo, Gaetano S Grieco, Giulia Valvo, Cristina Cereda, Anna Rubegni, Filippo M Santorelli
Channelopathies are a heterogeneous group of neurological disorders resulting from dysfunction of ion channels located in cell membranes and organelles. The clinical scenario is broad and symptoms such as generalized epilepsy (with or without fever), migraine (with or without aura), episodic ataxia and periodic muscle paralysis are some of the best known consequences of gain- or loss-of-function mutations in ion channels. We review the main clinical effects of ion channel mutations associated with a significant impact on migraine headache...
2016: Frontiers in Cellular Neuroscience
Shih-Pin Chen, Cenk Ayata
PURPOSE OF REVIEW: Spreading depression (SD) is a wave of simultaneous and near-complete depolarization of virtually all cells in brain tissue associated with a transient "depression" of all spontaneous or evoked electrical activity in the brain. SD is widely accepted as the pathophysiological event underlying migraine aura and may play a role in headache pathogenesis in secondary headache disorders such as ischemic stroke, subarachnoid or intracerebral hemorrhage, traumatic brain injury, and epilepsy...
July 2016: Current Pain and Headache Reports
Lv-Ming Zhang, Zhao Dong, Sheng-Yuan Yu
Migraine is a common neurovascular disorder in the neurologic clinics whose mechanisms have been explored for several years. The aura has been considered to be attributed to cortical spreading depression (CSD) and dysfunction of the trigeminovascular system is the key factor that has been considered in the pathogenesis of migraine pain. Moreover, three genes (CACNA1A, ATP1A2, and SCN1A) have come from studies performed in individuals with familial hemiplegic migraine (FHM), a monogenic form of migraine with aura...
March 2016: Annals of Translational Medicine
Lin Tan, Teng Jiang, Lan Tan, Jin-Tai Yu
Technological development has paved the way for accelerated genomic discovery and is bringing precision medicine into view. The goal of precision medicine is to deliver optimally targeted and timed interventions tailored to an individual's molecular drivers of disease. Neurological diseases are promisingly suited models for precision medicine because of the rapidly expanding genetic knowledge base, phenotypic classification, the development of biomarkers and the potential modifying treatments. Moving forward, it is crucial that through these integrated research platforms to provide analysis both for accurate personal genome analysis and gene and drug discovery...
March 2016: Annals of Translational Medicine
Yihui Shi, Renfu Quan, Changming Li, Liang Zhang, Mengxuan Du, Jinwei Xu, Zongbao Yang, Disheng Yang
ETHNOPHARMACOLOGICAL RELEVANCE: Acupuncture is a key part of traditional Chinese medicine, shown to induce favorable neuroplasticity for injuries in the central and peripheral nervous systems. Recent studies report elongated needle therapy (ENT) with BL54 and ST28 may restore acute spinal cord injury (ASCI). However, the precise mechanism for this has not been elucidated. AIM OF THE STUDY: In our current study, we investigated the effects of ENT on inflammation and neuronal apoptosis induced by ASCI, and whether PI3K/Akt and MAPK/ERK signaling pathways are involved in the ENT restoration effect...
July 1, 2016: Journal of Ethnopharmacology
Corey T McMillan
No abstract text is available yet for this article.
June 2016: Nature Reviews. Neurology
Daniel Golan, Elsebeth Staun-Ram, Ariel Miller
PURPOSE OF REVIEW: In recent years we notice paradigm shifts in the understanding of multiple sclerosis (MS), leading to important transition in the patients' management. This review discusses some of the recent findings and developments underlying the conceptual changes being translated from 'treating the disease' to 'treating the patient' with MS (PwMS). RECENT FINDINGS: Applying advanced technologies combined with cross-disciplinary efforts in the fields of neuropathology, neuroimmunology, neurobiology, and neuroimaging, together with clinical neurology provided support for the notion that MS is not a single disease but rather a spectrum...
June 2016: Current Opinion in Neurology
Yu-Sheng Hsiao, Yan-Hao Liao, Huan-Lin Chen, Peilin Chen, Fang-Chung Chen
Current bioelectronic medicines for neurological therapies generally involve treatment with a bioelectronic system comprising a power supply unit and a bioelectrode device. Further integration of wireless and self-powered units is of practical importance for implantable bioelectronics. In this study, we developed biocompatible organic photovoltaics (OPVs) for serving as wireless electrical power supply units that can be operated under illumination with near-infrared (NIR) light, and organic bioelectronic interface (OBEI) electrode devices as neural stimulation electrodes...
April 13, 2016: ACS Applied Materials & Interfaces
F S Schreiber, I Becker, P Deckert, H Elsbernd, C Isensee
OBJECTIVES: There is minimal information on malnutrition in neurologic-psychiatric patients compared to internal and trauma-surgical patients. The aim of the present study was to explore if there is a correlation of these different disease groups with the nutritional assessment and biochemical markers. DESIGN: Cross - sectional study. SETTING AND PARTICIPANTS: The study was done in a department of geriatric medicine with subspecialisation in neurologic diseases and stroke unit...
April 2016: Journal of Nutrition, Health & Aging
Hosein Delavar Kasmaei, Zahra Ghorbanifar, Farid Zayeri, Bagher Minaei, Seyed Hamid Kamali, Hossein Rezaeizadeh, Gholamreza Amin, Ali Ghobadi, Zohreh Mirzaei
BACKGROUND: Migraine is one of the most common and debilitating neurological problems. Although numerous preventive drugs are used to treat migraine, their complications are unavoidable. Application of herbal medicine, especially well-known medicinal plants, to treatment of chronic diseases, like migraine, could be effective. Coriandrum sativum L. (C. sativum) fruit is one of the most commonly prescribed herbs in Persian medicine, which has been used to treat headache. OBJECTIVES: This study was designed to evaluate the effects of C...
January 2016: Iranian Red Crescent Medical Journal
Mike Sathekge, James M Warwick, Alex Doruyter, Mariza Vorster
Individualised patient treatment approaches demand precise determination of initial disease extent combined with early, accurate assessment of response to treatment, which is made possible by positron emission tomography/computed tomography (PET/CT). PET is a non-invasive tool that provides tomographic images and quantitative parameters of perfusion, cell viability, and proliferation and/or metabolic activity of tissues. Fusion of the functional information with the morphological detail provided by CT as PET/CT can provide clinicians with a sensitive and accurate one-step whole-body diagnostic and prognostic tool, which directs and changes patient management...
November 2015: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
P Gruber, T Böni
Today, lumbar disc disease is a very common disease, which will be often seen in both the family practice as well as in the consultations of orthopedics, neurology, rheumatology or neurosurgery. Furthermore, lumbar disc surgery is one of the most common spinal surgical procedures worldwide. But, for many centuries, physician had no clear understanding of the anatomical condition and the pathomechanism of this disease. Therefore, no rational treatment was available. The Hippocratic physicians knew the signs and symptoms of lumbar disc disease, which they then called "sciatica"...
December 2015: Der Unfallchirurg
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