No neurotoxicity from long-term (>5 years) intrathecal infusion of midazolam in humans.
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Biomedical subjects
Publications and source records attributed to Sergio Canavero.
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Trigeminal neuralgia is a chronic pain syndrome of still unestablished origin. Its diagnosis depends on clinical grounds. Drug therapy initially helps a great majority of patients. The choice of drugs is quite large, but truly effective compounds with a tolerable side effect profile remain few. Carbamazepine (or oxcarbazepine) and lamotrigine appear to be the most effective, followed by baclofen. Several patients require further nonpharmacological treatment for which no evidence-based recommendation is possible. In the future, neuromodulation may be brought to bear, as in other chronic pain syndromes.
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Transcranial magnetic stimulation recently has emerged as a therapeutic tool in neurology and psychiatry, with contradictory results. Central pain, a major chronic pain syndrome affecting millions of people worldwide, has been the focus of a few studies. Although transcranial magnetic stimulation has no role in the chronic management of such pain, it has potential as a screening procedure for the much more effective extradural cortical stimulation, a minimally invasive neurosurgical procedure that has emerged as the technique of choice in treating these patients.
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BACKGROUND: Neuroprotection in the setting of severe head injury (SHI) remains an unsettled problem. We tested a combination of high-dose magnesium and low-dose lidocaine, infused over 3 days, in a pilot study to assess safety. This combination appears indicated to protect both gray and white matter from secondary injury following SHI. METHODS: We studied 32 consecutive patients admitted to the emergency department of our hospital, a large tertiary referral center. RESULTS: No toxicity was observed. Mortality was lower than published statistics. CONCLUSIONS: These results open the stage to a controlled randomized study.
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Extradural motor cortex stimulation was introduced in 1989 for control of central pain. In recent years this has been found useful in several patients with movement disorders. This paper attempts to bring together all the relevant literature, discuss mechanisms and lay out guidelines for future research and clinical applications.
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Motor cortex stimulation is a minimally invasive surgical procedure used for pain control. The authors report their results treating two patients with typical Parkinson disease. Unilateral motor cortex stimulation proved to be beneficial bilaterally. Motor cortex stimulation may represent a cost-effective alternative to deep brain stimulation.
A case of simultaneous trigeminal and vagoglossopharyngeal neuralgia is described. No microvascular compression was seen at the trigeminal complex while the origin of vagoglossopharyngeal pain could have been due either to Chiari malformation or microvascular compression of the IX-X nerve complex. Decompressive surgery was ineffective. The patient could completely block his facial painful fits by strongly pinching the anterior axillary fold. This case militates against peripheral theories of facial neuralgias, including microvascular compression and ganglion ignition focus theories, and supports a central origin thereof.
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Central pain remains a therapeutic challenge. We report beneficial effects of lamotrigine, a novel antiepileptic drug, on four patients suffering from long-standing central pain. Analgesia may be due to interference with glutamatergic transmission.
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