Abstract:
:Postherpetic pain persisting 1 month or longer occurs in only a small percentage of all patients with herpes zoster. In most patients, PHN tends to diminish with time. The incidence is, however, directly related to age. Any therapeutic claim for prophylaxis or treatment of PHN has to be evaluated with these observations in mind. There is some information about the pathologic features and a concept of the pathogenesis can be suggested. There is evidence for an imbalance in fiber input (reduced large, inhibitory fibers, and intact or increased small, excitatory fibers) to an abnormal dorsal horn that may contain hypersensitive neurons. Prevention of PHN remains difficult. There is evidence that systemic steroids exert a preventive effect when employed in the treatment of herpes zoster in the immunocompetent patient. A reasonable regimen is 60 mg of prednisone tapered over 10 to 14 days. One double-blind, controlled study supports the use of amantadine in this situation; this drug is an option in patients for whom steroids are contraindicated, such as those with peptic ulcer, diabetes mellitus or compromised immune function. The dosage of amantadine used in this study was 100 mg twice daily for a month. Although a number of other therapies have been suggested, these remedies remain in need of further, more scientific study. For established PHN, there is firm support for the reduction of pain from severe to mild in two thirds of patients administered low doses of amitriptyline followed by gradual, small increments. In the age group over 65 years, one may use as small a dose as 10 mg with an increase of 10 mg every 5 to 7 days. In those younger than 65, a dose of 25 mg to start is reasonable, with increments of 25 mg. Although unproved, the addition of a phenothiazine, such as fluphenazine, may provide further pain relief. Preliminary studies also indicate that topical capsaicin may be a useful new treatment. Although widely used, there is no good evidence for the use of anticonvulsants alone in this disorder. Studies of local anesthetic sprays with vibration and continuous TENS are uncontrolled, but these modalities may be of some merit. One uncontrolled study reported benefit from epidural steroids. DREZ lesions are a possibility in failed medical cases, but other surgical procedures appear to be of little or no use. Although the measures described here will benefit a number of patients, PHN remains an intractable problem in some cases.(ABSTRACT TRUNCATED AT 400 WORDS)
journal_name
Neurol Clinjournal_title
Neurologic clinicsauthors
Watson CPsubject
Has Abstractpub_date
1989-05-01 00:00:00pages
231-48issue
2eissn
0733-8619issn
1557-9875journal_volume
7pub_type
杂志文章,评审abstract::Dementia, defined as progressive cognitive decline, is a feature of a wide variety of genetic disorders. For example, a search of "dementia" in the Online Mendelian Inheritance in Man (www.ncbi.nlm.nih.gov/Omim) reveals 162 entries. Therefore this article cannot be encyclopedic and will be necessarily restricted to mo...
journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8619(01)00020-2
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abstract::The evaluation and treatment of spinal cord injury continues to evolve, enhanced by new imaging modalities. Their application in reference to the cervical, thoracic, and lumbar spine is discussed. Treatment options, both conservative and surgical, are outlined. ...
journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:
更新日期:1991-08-01 00:00:00
abstract::In this series of clinical vignettes, the authors have attempted to provide a "feel" for the varied causes of syncope. The neurologist should be able to diagnose most causes of syncope using a simple algorithmic approach. Initial evaluation includes detailed clinical history, physical examination, and 12-lead ECG. Fol...
journal_title:Neurologic clinics
pub_type: 杂志文章
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更新日期:2006-05-01 00:00:00
abstract::A large body of medical and ethical opinion holds that it is justifiable to terminate medical treatment for permanently unconscious persons. But opponents of particular decisions to withhold or withdraw treatment may argue that the decisions violate laws against homicide, pose a threat to the lives of other less sever...
journal_title:Neurologic clinics
pub_type: 杂志文章
doi:
更新日期:1989-11-01 00:00:00
abstract::Approximately 2 per cent of organ transplant recipients develop primary CNS lymphomas. There is no pathognomonic clinical or radiographic presentation of the tumor, although multicentric involvement of deep white matter is common. Evidence has linked PCNSL to immunosuppression and to infection with the EBV. The most r...
journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:
更新日期:1988-05-01 00:00:00
abstract::This review explores the principle features of the immunopathology of multiple sclerosis (MS), particularly relapsing-remitting MS. It highlights the emerging concepts in the pathogenesis of MS in the context of known features of pathology, including the characterization of cytokine networks promoting inflammatory dam...
journal_title:Neurologic clinics
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doi:10.1016/j.ncl.2010.12.009
更新日期:2011-05-01 00:00:00
abstract::Current law in the United States authorizes physicians to diagnose brain death by applying generally accepted neurologic criteria for determining loss of function of the entire brain. This article offers a medical-legal perspective on problems that may arise with respect to the determination of brain death. These incl...
journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8619(05)70132-8
更新日期:1999-05-01 00:00:00
abstract::Primary brain tumors consist of neoplasms with varied molecular defects, morphologic phenotypes, and clinical outcomes. The genetic and signaling abnormalities involved in tumor initiation and progression of the most prevalent adult primary brain tumors, including gliomas, meningiomas, and medulloblastomas, are descri...
journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ncl.2007.07.014
更新日期:2007-11-01 00:00:00
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journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8619(05)70255-3
更新日期:1996-05-01 00:00:00
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journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8619(05)70084-0
更新日期:1998-08-01 00:00:00
abstract::There should be a collaborative evaluation of a child with apparent learning disabilities. This article describes what the neurologist can expect from the other disciplines and how the services can be coordinated, using either the multidisciplinary services of a clinic or comprehensive assessment by a private practiti...
journal_title:Neurologic clinics
pub_type: 杂志文章
doi:
更新日期:1984-02-01 00:00:00
abstract::In a recent trial limited to arteriovenous malformations discovered not to have bled, medical management was superior to medical management plus intervention. The trial was halted after 226 randomizations and a mean follow-up of 3.3 years owing to a disparity favoring the medical arm. Eligible patients were selected a...
journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ncl.2014.12.006
更新日期:2015-05-01 00:00:00
abstract::This article concentrates primarily on infections of viral origin, although numerous microorganisms can infect the fetal and newborn brain (see Tables 1 and 2). Intrauterine infections occur most often for HIV, CMV and rubella, whereas HSV is preferentially transmitted intrapartum. In the last decade, changes in the e...
journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:
更新日期:1994-08-01 00:00:00
abstract::Pseudotumor cerebri is a perplexing syndrome of increased intra-cranial pressure without a space-occupying lesion. The terminology for the disorder has changed over the years and the diagnostic criteria revised to reflect advances in diagnostic technology and insights into the disease process. The classification and n...
journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/S0733-8619(03)00096-3
更新日期:2004-02-01 00:00:00
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journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ncl.2018.07.005
更新日期:2018-11-01 00:00:00
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journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ncl.2014.09.010
更新日期:2015-02-01 00:00:00
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journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ncl.2008.03.005
更新日期:2008-08-01 00:00:00
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journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ncl.2019.03.003
更新日期:2019-08-01 00:00:00
abstract::Childhood sleep-wake disorders are common and associated with significant impairment of quality of life. The recent discovery of hypocretin deficiency as the pathophysiologic basis for narcolepsy-cataplexy is likely to spur the development of hypocretin analogs for definitive treatment [82,83]. The link between disrup...
journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8619(03)00034-3
更新日期:2003-11-01 00:00:00
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journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8619(05)70280-2
更新日期:1996-11-01 00:00:00
abstract::Oxidative phosphorylation (OXPHOS) accounts for approximately 95% of the adenosine triphosphate (ATP) produced by the cell. The central nervous system, peripheral nervous system, cardiac muscle, skeletal muscle, and smooth muscle are highly susceptible to dysfunction of this complex enzyme system. Although most OXPHOS...
journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8619(05)70180-8
更新日期:2000-02-01 00:00:00
abstract::Parkinson disease (PD) is well recognized by its motor features of bradykinesia, tremor, rigidity, and gait and balance difficulties. However, PD is also characterized by a myriad of nonmotor symptoms, which may occur even before motor symptoms, early in the course of disease, and throughout the advancing disease. The...
journal_title:Neurologic clinics
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doi:10.1016/j.ncl.2019.12.003
更新日期:2020-05-01 00:00:00
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journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8619(05)70246-2
更新日期:1996-02-01 00:00:00
abstract::Different types of conduction defects, avenues available for functional recovery after demyelination, therapeutic and diagnostic measures, and electrophysiologic testing are covered. ...
journal_title:Neurologic clinics
pub_type: 杂志文章
doi:
更新日期:1983-08-01 00:00:00
abstract::Pediatric central nervous system (CNS) tumors are the most common solid tumors in children and comprise 15% to 20% of all malignancies in children. Presentation, symptoms, and signs depend on tumor location and age of the patient at the time of diagnosis. This article summarizes the common childhood CNS tumors, presen...
journal_title:Neurologic clinics
pub_type: 杂志文章,评审
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更新日期:2018-08-01 00:00:00
abstract::Intensive care unit-acquired weakness (ICUAW) is a substantial contributor to long-term disability in survivors of critical illness. Critical illness polyneuropathy, critical illness myopathy, and muscle atrophy from disuse contribute in various proportions to ICUAW. ICUAW is a clinical diagnosis supported by electrop...
journal_title:Neurologic clinics
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doi:10.1016/j.ncl.2017.06.008
更新日期:2017-11-01 00:00:00
abstract::Smartphones make mobile computing at point of care practical. Smartphones can think, sync, and link. Built-in and user-installed applications facilitate communications between neurologists and their medical colleagues and patients and augment data acquisition and processing in the core medical information domains of p...
journal_title:Neurologic clinics
pub_type: 杂志文章
doi:10.1016/j.ncl.2009.11.001
更新日期:2010-05-01 00:00:00
abstract::Stroke involving the brainstem and cerebellum frequently presents acute vestibular syndrome. Although vascular vertigo is known to usually accompany other neurologic symptoms and signs, isolated vertigo from small infarcts involving the cerebellum or brainstem has been increasingly recognized. Bedside neuro-otologic e...
journal_title:Neurologic clinics
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更新日期:2015-08-01 00:00:00
abstract::Postamputation phenomena, including painful and nonpainful phantom sensations occur following loss of limbs and other body parts. Peripheral and central nervous system mechanisms play a role in persistent phantom pain. Understanding the pathophysiology of this syndrome has improved in recent years. Comprehensive evalu...
journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8619(05)70105-5
更新日期:1998-11-01 00:00:00
abstract::Given the magnitude of the problem of motor fluctuations in patients who have Parkinson's disease treated with levodopa, a significant effort has been expended by physicians, researchers, and pharmaceutical manufacturers over the years to find effective treatments. This article briefly reviews the medical options for ...
journal_title:Neurologic clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ncl.2008.05.006
更新日期:2008-08-01 00:00:00